REPEATED PREGNANCY LOSSES
Miscarriage, failure to continue pregnancy, death of the embryo or fetus in the womb, or loss of the fetus due to vaginal bleeding.
Recurrent pregnancy loss ( TGK) are pregnancy losses that occur at least 3 times in a row and are below 20 weeks and weighing less than 500gr.
It can be primary and secondary.
1-Primary TGK: 20. Women who have experienced 3 or more consecutive pregnancy losses below the 20th week of gestation
2-Secondary TGK: Occurs after a pregnancy that has given birth over the 20th week of gestation or ended in stillbirth and postpartum loss. Women who have experienced 3 or more pregnancy losses.
Genetic examinations of miscarriage materials show that chromosomal anomalies are detected in 50% of first 3-month losses, 30% of second 3-month losses and 3% of stillbirths. .
It is accepted that the risk of chromosomal anomaly in the next pregnancy does not increase in couples with normal chromosomes who have a miscarriage due to chromosomal anomaly.
- Factors that reduce the risk of genetic reasons:
1- Young mother's age
2-Multiple recurrent pregnancy losses
3-A previous history of miscarriage with normal chromosomes
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It is possible for a couple who has a pregnancy loss due to another reason to experience a loss with a chromosomal anomaly. For this reason, the finding of fetal chromosome anomaly is not a finding that makes other examinations unnecessary.
The diagnostic value of determining the chromosome structure of the pregnancy material in recurrent pregnancy loss is still a controversial issue.
- Hormonal reasons for recurrent pregnancy losses:
There are many hormonal changes in order for a baby to develop healthily and reach term. There is a factor. It is thought that hormonal factors play a role in 8-12% of all pregnancy losses.
Fast (hyperthyroid) functioning of the thyroid gland is associated with later pregnancy problems, while slow functioning has been associated with recurrent pregnancy loss.
>In severe hypothyroidism, cycles are without ovulation and often result in infertility, so recurrent miscarriage is less common. In mild forms, recurrent miscarriage is observed. Therefore, the upper limit of TSH is reduced from 4.5 mU/L to 2.5mU/L.
It is thought that hypothyroidism makes it difficult for the embryo to implant in the uterus due to luteal phase failure.
Thyroiditis (development of antibodies against the thyroid gland) is a common condition in recurrent pregnancy loss. The presence of thyroid antibodies increases the risk of recurrent pregnancy loss.
Hyperandrogenemia has been detected in 15-20% of patients with recurrent pregnancy loss. Hyperandrogenemia+hyperinsulinemia in polycystic ovary syndrome is being investigated for RPL.
HbA1c in patients with insulin-dependent diabetes. A level below 7.5% reduces miscarriages.
High PRL (prolactin) levels (>100ng/ml) also cause luteal phase failure and prevent the embryo from settling in the uterus.
It is understood that there is no luteal phase failure if the progesterone level measured on the 21st day of the menstrual period is above 10 ng/ml.
Progesterone supplementation in early pregnancy in patients with RPL, whether diagnosed with luteal phase failure or not, reduces the risk of recurrent pregnancy. .
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