Miscarriage

Miscarriages are fairly common in the general population, particularly early miscarriage. However the incidence of miscarriage (both first and midtrimester) in DES daughters is slightly greater than that in other women.

Mid trimester miscarriage can occur because there is a weakening of the cervix and it often presents with little warning. Occasionally you will feel heaviness in the pelvic area or there might be an increase in vaginal discharge. These might be the only warning signs.

An obstetrician can detect early cervical incompetence by a series of ultrasound examinations that will measure the cervical length. Frequent visits (every two weeks) between the 14 and 28-week mark, will provide the opportunity for the cervix to be assessed digitally (by vaginal examination). This will also help in the early detection of cervical incompetence.

Signs & Symptoms of a threatened miscarriage

• Vaginal bleeding or spotting: Some bleeding may occur during the course of a normal pregnancy. However, any bleeding or spotting should be investigated by your doctor.
  
   
• Abdominal cramping: Pain will usually accompany the bleeding and will grow more severe as the miscarriage progresses.

Intervention

Unfortunately little can be done to prevent most miscarriages. Bed rest may be recommended in cases where there is bleeding in early pregnancy.

There are no drugs currently recommended for prevention of miscarriage. In some situations, a stitch can be placed in the cervix to prevent premature dilation, which may prevent a miscarriage. This procedure is usually done if the woman has had a previous miscarriage due to a weakness of the cervix. The procedure is not done routinely.  This is controversial, but most experts do not feel this guideline should be changed for DES exposed women.

When a Pregnancy Is Lost

When a woman has a miscarriage, bleeding and cramping will become more severe until finally the foetus and contents of the uterus are expelled. If you are not in hospital when this happens, call your doctor or maternity unit for instructions. Usually an ultrasound scan will be arranged to see if the pregnancy is viable or not.

As a rule it is wise to try and save any tissue you pass and bring it with you to hospital for possible examination. Bleeding will continue for several days after the miscarriage and diminish gradually.

If bleeding continues or if your doctor feels that not all the contents of the uterus have been expelled (i.e. an "incomplete" miscarriage), curettage will be necessary.

Emotional Impact

Miscarriage frequently comes at a time when you are just beginning to adjust to being pregnant.

If you have previously struggled with infertility, your loss and disappointment may be even more intense. It is quite valid for you to grieve this loss regardless of any future or previously conceived children. It is useful for some women or couples to seek professional support from a grief counsellor.

Premature Labour

DES daughters have a higher risk of mid-trimester miscarriage and premature labour. It is important that your doctor or midwife understands your increased risk so that you can prepare for any difficulties when they arise. You can both develop strategies to cope with any situation so that you feel assured that they will be on hand. You should also talk to your doctor or midwife about how they can be contacted in an emergency.

Warning Signs of Premature Labour

Symptoms such as:

• menstrual-like cramps 
• pelvic pressure 
• back pain
• increased vaginal discharge 
• and slight vaginal bleeding

may occur during preterm labour. However, they can also be a very normal part of a healthy pregnancy.

Premature Rupture of Membranes

This results in a leakage of clear or pink?stained fluid from the vagina. You should contact your doctor or hospital immediately if this happens.

Other Risks (News Article)?

MISCARRIAGES MAY BE A SYMPTOM OF GREATER HEALTH RISK
Diagnostic Tests Can Uncover Potential Serious, Lifelong Conditions

WOBURN, Mass. (June 8, 2005) – According to the infertility diagnostics experts at Massachusetts-based Repromedix, a specialty testing lab, miscarriage is a painful and, unfortunately, common event, occurring in a reported 20 percent of all pregnancies. Multiple miscarriage (defined as three or more successive losses) is particularly traumatic. Approximately 7 of every 1,000 women who become pregnant will experience multiple miscarriage, known medically as Recurrent Pregnancy Loss (RPL).

Unfortunately, the pain of recurrent pregnancy loss may be compounded by its significance as a symptom of a serious medical condition with lifelong implications for both mother and child.  As an example, miscarriage patients who test positive for Thrombophilia, or abnormally high blood clotting, may not only be at risk for more miscarriages but also for broader health problems such as stroke, pulmonary embolism or deep vein thrombosis.

Are you at risk?  RPL patients’ broader health problems may include:

·       Thrombophilia (abnormally high blood clotting): 40-60 percent of unexplained multiple miscarriage is associated with thrombotic defects.  Each year, more than 600,000 Americans die from abnormal blood clots.  Women with consecutive, unexplained early or late pregnancy losses or a personal or family history of coagulation disorder and one or more miscarriage should be tested.  Potential appropriate tests include Factor V Leiden (coagulation), Protein C Activity, Prothrombin Mutation, Antithrombin Activity and LAC (Lupus Anti-coagulant).

·       Autoimmune Diseases, such as lupus, thyroid conditions, or APS (antiphospho-lipid syndrome): Certain autoimmune conditions such as lupus and APS are associated with RPL and infertility. Autoimmune disorders can affect many aspects of health, from the thyroid to the kidneys to the digestive system. APS can lead to lifelong health problems such as organ damage and circulatory problems.  If you have a personal or family history of autoimmune disease and unexplained recurrent pregnancy loss, ask your doctor about these potentially appropriate tests: ACA/APA, LAC (Lupus Anti-coagulant), ANA, ATGA/AMA and AOA.

·       Endocrine Disorders, such as PCOS (Polycystic Ovarian Syndrome): There appears to be a higher rate of miscarriage, gestational diabetes, and pregnancy-induced high blood pressure in women with PCOS. Women with PCOS are also at higher risk for high cholesterol and heart disease. Women with unexplained recurrent pregnancy loss or inability to get pregnant and physical symptoms such as menstrual disorders, pelvic pain, certain skin disorders, sleep apnea, high blood pressure should ask their doctor about these tests: Glucose (Fasting and Post-Prandial); Insulin (Fasting and Post-Prandial); Testosterone (Fasting Free and Total); Fasting IGFBP1; Fasting SHBG; 17-OH Progesterone and DHEAS-Sulfate.

Diagnostic tests can help your OB/GYN uncover, treat and counsel for these and other conditions.  Visit www.repromedix.com for more information about diagnostic tests and helpful links.