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Recurrent Miscarriage, Habitual Miscarriages

 

Treatment of Recurrent Miscarriages

 

  Abnormal Uterine Morphology

As for uterine morphology, it is thought of that the deformation of the uterine cavity (the space inside the uterus where the fetus is growing)and when the blood flow becomes insufficient to the section of implantation will be the cause of miscarriage.  It is seen that the morphology of bicornuate uterus and septum uterus and the like is at about 3.2%, the first time pregnancy success rate is at 9.5%, and if compared to the 71.7% whom possess a normal uterus it tends to be low.  However, even without surgery there is a report (Sugiura-Ogasawara M, et al. Fertil Steril. 2010 Apr;93(6):1983-8.) that 78% of patients are giving birth, and it will be determined on an individual basis whether surgery and aggressive therapy will be useful or not.
Similarly, even if there are polyps and sub mucous myoma protruding from the lumen of the uterus and have attached, we will consider the merits and demerits of size and the position of them and make sure that the surgery will not be carried out in a simple way.

 

 

  Endocrine abnormalities

There are 6.8% of people with thyroid dysfunction, and 1% of people with diabetes.  There is still not clear as to the necessity of treatment, but these illnesses not only cause miscarriages, but also influence the progress of pregnancy thereafter and because they have an effect on health after birth we think that treatment through endocrinology is necessary.
Furthermore, currently the relation of the recurrent miscarriage in regards to the hormones such as the prolactin level and its relation to ovulation disorder and the progesterone level that are needed to know the luteal insufficiency have not been reported (Rai R and Regan L, Lancet. 2006 Aug 12;368(9535):601-11).

 

 

 

  Antiphospholipid Antibody Syndrome

In order to prevent a wasted pregnancy as an antithrombotic treatment, low dosage aspirin and heparin treatment will occur. Upon the confirmation of the pregnancy, internal usage of low dosage aspirin and injections of herapin will start. In regards to the aspirin, a children’s bufferin will be taken internally one time in two days. As for the heparin, 5,000 units will be given by hypodermic injection two times in one day. Aspirin will be until the 28th week of pregnancy, and we will continue with the heparin until the day before delivery. It is reported that the rate of living infant acquisition from this treatment is at about 70~80%.
Additionally, there is a report of a high 84.6% living infant acquisition by the single aspirin treatment for those who are contingent antiphospholipid antibody + not diagnosed with the antiphospholipid antibody syndrome.
In the case of if you are antiphopholipid antibody - , there is no need for drug administration. There is need to be warned of a bleeding tendency and loss in bone mass from the thrombopenia that is a side-effect of the aspirin and heparin.

 

 

  Coagulation System Abnormalities

It is known that among blood coagulation factors, that the 12th factor known as the “protein deficiency” may be involved with recurring miscarriages.  In this case, in order to prevent thrombosis, the aspirin treatment alone is effective.

 

 

  Habitual Miscarriages of Unknown Cause

In fact, more than half the numbers of cases of habitual miscarriages are due to unknown causes.  We can also say that it is caused from the coincidental continuation of chromosome abnormalities on the side of the fetus.  Therefore, in the case where the cause is unknown or is not found, then we cannot consider to easily go forward with treatment.