Tuesday, 10 December 2013

Miscarriage - Symptoms, Causes and Risk Factors

Miscarriage is defined as the loss of an embryo before the 20th week of pregnancy as it is incapable of surviving independently. In medical terminology, miscarriage is a type of abortion, as it refers to the pregnancy ends with the death and removal or expulsion of the fetus, regardless of whether it is spontaneous or medically induced abortion. In US alone, over 15% of pregnancy ends in miscarriage.

1. Bleeding
Most common symptoms of miscarriage. 50% of bleeding during 20 weeks of pregnancy ends in miscarriage
2. Abdominal cramps and pain
Generally, it is the first sign of the incidence
3. Etc.

Causes and risk factors
1. Chorionic hematoma
It is the most common cause 0f vaginal bleeding presented in the live embryo in the first trimester, known as sonographic abnormality. It is the pooling of blood between the chorion, a membrane surrounding the embryo, and the uterine wall. The risk of miscarriage increase depending to the size of of hematoma.

2. Chromosomal abnormalities
Genetic defects such as Down Syndrome can increase the risk of miscarriage as a result of abnormal chromosomes forming of when fertilization occurs.

3. History of recurrent miscarriages
In a study of "The effect of recurrent miscarriage and infertility on the risk of pre-eclampsia." by Trogstad L, Magnus P, Moffett A, Stoltenberg C. researchers found that women with a history of recurrent miscarriages are at risk of developing preeclampsia.

4. Collagen vascular diseases
Increased risk of miscarriage for a woman with collagen vascular diseases such as antiphospholipid syndrome and systemic lupus erythematosus as a result of autoimmune disorders, that causes the immune system to attack its own tissue.

5. Diabetes
Risk of miscarriage for women with uncontrolled diabetes during pregnancy.

6. Hormonal factors
In a study presented at European Society for Human Reproduction and Embryology conference in Stockholm, researchers found that levels of progesterone and of the pregnancy hormone human chorionic gonadotrophin (hCG), are 2 of 6 hormonal factors which have greatest impact on miscarriage risk.

7. Reproductive tract infections
Sexually transmitted infections, Chlamydia, Cytomegalovirus (CMV), etc. are the greastest risk of reproductive tract infection and can lead to miscarriage.

8. Abnormal structural anatomy
Abnormal anatomy of the uterus, such as bicornuate uterus, septate uterus, and unicornuate uterus, Uterine fibroids, etc. can also increase the risk of miscarriages.

9. Prenatal Diagnosis
Medical procedure in used to test the chromosomal abnormalities and fetal infections such as amniotic fluid test or AFT, can increase the risk of miscarriage but rarely. Others such as chorionic villus sampling (CVS) use to test the chromosomal or genetic disorders in the fetus also increase the risk as well.

10. Tissue rejection
Antiphospholipid antibodies can interfere with the formation of the normal placenta involves the fusion of small cells called cytotrophoblasts into giant cells known as syncytiotrophoblasts, causing tissue rejection.

11. Smoking
In the article of "Effect of Maternal Cigarette Smoking on Pregnancy Complications and Sudden Infant Death Syndrome" by Joseph DeFranza and Robert Lew, published in the Journal of Family Practice on 4/1/95, the authors indicated that smoking causes 18,925 miscarriages a year.

14. Nonsteroidal anti-inflammatory drugs
In a study of Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study by De-Kun Li, epidemiologist (dkl@dor.kaiser.org), Liyan Liu, programmer analyst, Roxana Odouli, research associate, researchers found that 53 women (5%) reported prenatal NSAID use around conception or during pregnancy. After adjustment for potential confounders, prenatal NSAID use was associated with an 80% increased risk of miscarriage (adjusted hazard ratio 1.8 (95% confidence interval 1.0 to 3.2)). The association was stronger if the initial NSAID use was around the time of conception or if NSAID use lasted more than a week. Prenatal aspirin use was similarly associated with an increased risk of miscarriage. However, prenatal use of paracetamol, pharmacologically different from NSAIDs and aspirin, was not associated with increased risk of miscarriage regardless of timing and duration of use.

15. Caffeine
In a report of Caffeine doubles miscarriage risk, study finds by CTV.ca News Staff, Dated Tue. Jan. 22 2008 10:30 AM ET, indicated that women who drink even moderate amounts of caffeine during pregnancy -- whether from coffee, tea, caffeinated soft drinks or hot chocolate -- have almost double the risk of miscarriage compared to women who stay away from such drinks.

16. Alcohol
In article of New Link Between Alcohol and Miscarriage Found By Colette Bouchez HealthScoutNews Reporter, the author indicated that alcohol has toxic effects on the baby, especially at the earliest stages of development.....""Any toxin, anything that can affect [egg] quality, will increase the risk of miscarriage--and alcohol is one of those toxins," says Lockwood, the director of obstetrics and gynecology at Bellevue Medical Center in New York City.

17. Polycystic ovary syndrome
Increased risk of miscarriage by over 30% if a woman is diagnosis with PCO's. In a study of "Effects of metformin on early pregnancy loss in the polycystic ovary syndrome" by Jakubowicz DJ, Iuorno MJ, Jakubowicz S, Roberts KA, Nestler JE in 2002, researchers found that the drug metformin significantly lower the rate of miscarriage in women with PCOS in one-third of the miscarriage rates of the control groups.

18. High blood pressure during pregnancy
High blood pressure during pregnancy also known as Pre-eclampsia can cause endothelial dysfunction, leading to abnormal immune respond to the developing fetus.

19. Etc.

9. Etc.
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