Articles on miscarriage

Reasons for Miscarriage

Dr. Yogesh Kumar, Ayurveda
Miscarriage or habitual abortion or recurrent pregnancy loss could be the toughest phase in a women’s life. A pain that no one can understand. The pain generally converts into depression. In this article, we will look closely to understand the causes of recurrent miscarriage.Recurrent Miscarriage or recurrent pregnancy loss is a term simply meaning occurrence of 3 consecutive pregnancy losses before 20 weeks or 24 weeks in some countries. The causes of recurrent miscarriage are complex and most often obscure. There may be many factors which are recurrent and non recurrent and sometimes there are unknown factors present responsible for early and late miscarriage.Causes of miscarriage or Recurrent pregnancy lossThe causes of miscarriage are very complex and obscure. The following are potential causes.Environmental factorsConclusions relating to environmental factors are difficult to prove.Smoking-Increases the risks of miscarriage due to decreased oxygen transfer to the fetus.Alcohol consumption should be avoided during pregnancy.X-rays and anti-cancerous drugs are known to cause miscarriage.Contraceptive Agents like IUD  increases the risk known to cause recurrent miscarriage.Drugs, chemicals, Anesthetic gases, arsenic, aniline, lead, formaldehyde cause miscarriage.Unexplained causesIncreasing maternal age can affect the function of ovaries.In spite of many causes mentioned it is difficult to pinpoint the exact cause of miscarriage.Endocrine and metabolic factorsLuteal phase defect (L.P.D): It results in early miscarriage as implantation and placentation are not supported properly.Deficient progesterone secretion: The cause is deficient progesterone secretion from corpus-luteum or poor endometrial response to the progesterone hormone.Thyroid abnormalities: Overt hypothyroidism or hyperthyroidism is associated with increased fetal loss.Thyroid and Diabetes mellitus when uncontrolled can cause miscarriages.Blood group incompatibilityIncompatible ABO group mating may be responsible for early pregnancy wastage and often recurrent but Rh incompatibility is a rare cause of death of the fetus before 28 weeks. Couple with group ‘A’ husband and group ‘O’ wife have higher incidence of abortion.Immunological disordersBoth Autoimmune and Alloimmune factors can cause miscarriage.Autoimmune disease: Can cause miscarriage usually in second trimester. These patients can form antibodies against their own tissues and placenta. These antibodies ultimately can cause rejection of early pregnancy.Alloimmune disease: Paternal antigens which are foreign to the mother invoke a protective blocking antibody response.These blocking antibodies can prevent maternal immune cells from recognizing the fetus as a foreign entity.Genetic factors Most of the early miscarriages are due to chromosomal abnormality.Polyploidy has been the cause in about 22% of miscarriage cases.Monosomy constitutes 20% of all miscarriage cases. In Monosomy the commonest is Monosomy x.Autosomal trisomy is commonest cytogenic abnormality.Structural chromosomal rearrangements are present in 2-4% of the miscarriages.These include translocation, deletion, inversion and ring formation.Other chromosomal abnormalities are also present like mosaic, double trisomy in about 4% of the cases.Anatomical abnormalitiesCervico-Uterine causes-These are related to mostly second trimester abortions.Cervical incompetence, either congenital or acquired is one of the most common causes of recurrent abortion.Congenital malfunction of the uterus  may be responsible.Reduce intra-uterine volume, increased expensile property of uterus. Reduced vascularity of placenta when implanted on septum.Increased uterine irritability and contraction.Uterine fibroid may also be responsible for infertility and abortion.Intra-uterine adhesion interfere with implantation, placenta and fetal growth.InfectionsInfections can cause late as well as early abortions. Miscarriage due to infection are quite rare in developed countries, but continues to grow in under developed countries. Trans-placental fetal infections occur with most micro organisms and fetal losses could be caused by any infection like:Viral-Rubella, Cytomegalo, Variola or HIV can cause infection.Parasitic: Toxoplasma, malaria.Bacterial: Bacterial infections like Chlamydia, Brucella can cause abortion before 20th week because of effective thickness of placental barrier.What to do when miscarriage happensThe process of expulsion of fetus is like that of mini labor. The fetus is expelled out first followed by expulsion of placenta after a varying interval. Follow these steps right away after 2nd recurrent pregnancy loss or miscarriage.Recurrent pregnancy loss testNew studies have shown that the couple should consider recurrent pregnancy loss test after two consecutive pregnancy loss. Women in their late 30's have more chances of recurrent pregnancy loss. There are many tests to rule out the cause of recurrent pregnancy loss, so consult your Doctor for detailed information.Support programs or support groupsOne can seek help from the various support programs or groups, developed for women suffering from recurrent pregnancy losses, available locally at the gynecology and obstetrics hospitals and clinics or on the internet.

Miscarriage and After: You'll Have Your Baby Soon

Dr. Priyanka Mehta, General Surgeon
Planning pregnancy after miscarriage .25 year old Shreya was on cloud nine after her first scan and had also decided for the baby shower theme and venue. And then suddenly out of the blue she had severe tummy pain bleeding and all her dreams and world shattered before her. She lost her tiny baby forever.. Miscarriage or losing a baby can be the most traumatic experience for a couple and coping after that can be very difficult. Miscarriage is a very unhappy and frightening experience and the couple needs care and counseling about whether to try again and when to try.When is the best time to get pregnant?This is a very difficult question to answer as sometimes the woman wants to desparately get pregnant again whereas a part of her would be terrified even at the thought of going through the entire process . There is no right answer to this question as it is also a decision the couple need to make together. The woman may need to recover physically . It is absolutely normal to have mixed feelings about the next pregnancy of hope mixed with anxiety and excitement mixed with worry.How soon can you start planning?It is advisable to avoid sex till all bleeding has stopped to avoid infection and get at least one period before you can try again.For special conditions like ectopic pregnancy , molar pregnancy or late or recurrent miscarriage your doctor may ask you to wait longer .Thinking about pregnancy after miscarriage? You might be feeling anxious or confused about what caused your miscarriage and when to conceive again. It is normal to feel anxious and worried about pregnancy after a miscarriage .You may worry about conceiving again and possibility of recurrence and it is important to meet your doctor or counselor before you try again.What defines a miscarriage?Miscarriage is the spontaneous loss of a pregnancy before the 5th month. Most miscarriages occur because the baby isn't developing normally. Problems with the baby's chromosomes or genes are typically the result of errors that occur by chance as the baby grows and few times genetic problems inherited from the parents. Sometimes a woman's health condition, such as uncontrolled diabetes or problems with the uterus or cervix, also might lead to miscarriage. Many times however the cause of miscarriage isn't known.About 10 to 20 percent of pregnancies end in miscarriage.What are the chances of another miscarriage?Miscarriage is usually a one-time occurrence. Most women who miscarry go on to have a healthy pregnancy after miscarriage. Less than 5 percent of women have two consecutive miscarriages, and only 1 percent have three or more consecutive miscarriages.Are special tests recommended before attempting pregnancy after miscarriage?If you experience more than two miscarriages, consider testing to identify any underlying causes before attempting to get pregnant again. Blood tests. A sample of your blood is evaluated to help find out any problems with hormones or your immune system. Blood sugar and thyroid tests are also recommended . Chromosomal tests:You and your partner might both have your blood tested to determine if your chromosomes are a factor. Tissue from the miscarriage — if it's available — also might be tested.Ultrasound This imaging method is used to detect any problems with the structure of the uterus which may cause miscarriage.Even if the cause of your miscarriages can't be identified, don't lose hope. About 60 to 70 percent of women with unexplained repeated miscarriages go on to have healthy pregnancies.

Repeated Miscarriage- a Painful Experience for Couples

Dr. Sujoy Dasgupta, Gynecologist/Obstetrician
Pregnancy gives a woman completeness by turning her into mother from a simple woman. It is the thing which makes the couple parents, the dream which they nurture right time from their marriage. Of course there are many couples who are not fortunate enough to achieve pregnancy and they are usually termed infertile and we have discussed it in separate post. But there are other couples who may or may not (as this is the usual case) find difficult to conceive but the pregnancy does not continue to the age of viability. Age of viability means the age, when a baby born can survive. Thanks to the improvement in neonatal care by leaps and bounds and availability of NICU which made it possible to survive even a baby born at 22 weeks. For example last month we delivered a baby at 28 weeks of pregnancy, who is fine now. But if the baby is 'born' before 20 weeks, it is called MISCARRIAGE. This is because these babies who weigh less than 500 gram cannot survive outside the uterus. It is seen that 10-15% couples who conceive successfully may not be able to carry pregnancy beyond 20 weeks. Thus the miscarriage rate for a single pregnancy is 10-15%. But in most of the time this mishap does not recur in future. We call it 'sporadic miscarriage' and often the cause is not known. But almost 1% of the couples who want to get pregnant may suffer from repeated miscarriage. That means the unfortunate events can repeat. These are called 'RECURRENT MISCARRIAGE' or 'REPEATED PREGNANCY LOSS *RPL).Causes of Recurrent MiscarriagesSo, what's the reason for RPL which is equally frustrating for the patients as well as the doctors? First of all let me honestly confess that in most of the cases the cause is not known (50-60%) and this is called 'UNEXPLAINED RPL'. Again we have to admit that despite tremendous advancement in science, the knowledge behind RPL is limited. Many theories and causes have ben proposed but most of them could not withstand the taste of time. That means if a problem is found in husband or wife, we are not certain whether the treatment of that problem will prevent future miscarriage. This should be explained properly to the couples to have realistic expectations and avoid unnecessary frustration s in future. Only factors which are definitely associated with RPL are only two- anti-phospholipid antibody syndrome (APS) and chromosomal problem of either of the couples. Detection and treatment of these problems are often rewarding as after treatment pregnancy continuation rate us very high. The other causes have been proposed but as mentioned above the link between RPL and these causes are not yet very clear and need further scientific research. Please remember according to the timing, RPL may be divided into two categories- the 1st trimester RPL (occurring before 12 weeks in each pregnancy) or second trimester RPL (12-20 weeks in each pregnancy).4-5% cases may be due to genetic or chromosomal problem of the couples. These problems can affect the egg (ovum) and/or the sperms. Even if the couples are normal, the baby may have abnormal chromosome.It is blessing that a genetically abnormal baby is miscarried by the nature, otherwise if it survives there is high chance that it may be mentally or physically handicapped. The reason may be increased age of the mother (above 35 years especially), exposure of mother to some environmental pollutants or sometimes increased age of the father (the latter is controversial). The diagnosis is done by chromosomal analysis of the couple by Karyotyping or FISH from blood samples. If the baby has been miscarried, it may be rational to send the tissue of the baby for chromosomal analysis to find out the cause. The treatment option in next pregnancy in such cases is genetic counseling by an expert and in most cases unfortunately only one option remains- that us IVF and PGD (pre implantation genetic diagnosis) where only genetically tested normal embryos are transferred by IVF ('test tube baby').Anatomical factors are responsible for 12-15% if RPL, in most cases the second trimester RPL. The most common cause is 'CERVICAL INCOMPETENCE'. The cervix is the mouth of the uterus which should remain closed in pregnancy to support pregnancy and should only open during delivery. But in some cases it can open prematurely leading to miscarriage. Usually this causes apparently painless miscarriage. In many women fibroid is found as a tumour of uterus. Whether fibroids cause RPL is again very controversial among the scientists and doctors. In some women who had repeated abortion or surgery to uterus and even tuberculosis (TB) there may be adhesion (binding together) between the walks of uterus. This is called Asherman Syndrome which causes scanty or absent periods and RPL. In few women there may be Congenital Anomaly of the uterus- that is where is some abnormalities inside uterus from birth. Thesr xan sometimes cause RPL, although controversial. These anatomical problems are diagnosed by proper examination, some tests like HSG (hystero salpingogram), SSG (sono salpingogram), 3D ultrasonography (USG), MRI, hysteroscopy and/or laparoscopy, depending on the women and test results. The treatment should be done cautiously as treatment may not always prevent RPL. For cervical incompetence usually we put stitch in the cervix in pregnancy or sometimes before pregnancy. Operation can be done, before pregnancy for fibroids, Asherman and congenital anomalies.In many cases (more than 70%) cases hormonal problems may be there and these may cause both 1st and 2nd trimester RPL. However whether treatment us beneficial or not, is again controversial. The commonest pattern is Luteal Phase Deficiency (LPD) due to deficiency of hormone progesterone. PCOS (Polycystic Ovaries) is also asdociated with RPL. The other causes are uncontrolled diabetes, thyroid problems, high prolactin and high testosterone, high insulin and low ovarian reserve. As mentioned earlier, it is not clear whether they all need testing and treatment but usually tests advised for these are blood for progesterone, TSH, Prolactin, FSH, LH, AMH, Insulin, Testosterone, sugar, HbA1C etc. Treatment is usually progesterone supplement along with correction of hormonal imbalance. It is to be mentioned that these patients need high dose of thyroid drugs (TSH normal for other people may be considered abnormal for RPL) and more tight control of blood sugar in diabetes.In 60-70% cases the cause is Thrombolphilia, that is tendency to thrombosis or blood clotting. The most common is anti phospholipid antibofy syndrome (APS) which nay or may not be associated with thrombosis in other sites but can cause thrombosis if blood supply to the baby and thus causes stopage of its heart and miscarriage. Although more common in the Western World, some Hereditary Thrombolphilia may be found in other family members and commonly cause miscarriage and thrombosis. Deficiency of folic acid and vitamin B12 rarely xan cause thrombosis and RPL. The APS testing is often successful, so as the treatment with aspirin and heparin injection throughout pregnancy. With this 80% women can expect full term pregnancy. Folic acid and B12 vitamin supplement is commonly given to RPL patients. Whether testing for hereditary thrombophilia is needed in our country or not is controversial. But treatment is like APS- that is aspirin and heparin injection.Diseases of mother like diabetes, epilepsy, liver or kidney diseases, SLE etc can cause miscarriage. Exposure of mother to harmful substances like environmental pollution, radiation, chemotherapy and some toxic drugs, smoking, alcohol, cocaine, cannabis etc are also responsible but the latter usually cause sporadic miscarriage rather than RPL. So these drugs should be stopped and replaced by safer drugs and the diseases must be treated properly. Even exposure of father to some drugs can cause RPL. Again some abnormalities of sperms may cause RPL. So, semen analysis of the husband is usually done as a test for RPL.The most controversial topic for RPL is the infections. But itbis the fact proved by scientific studies that only infection in current pregnancy causes miscarriage. So infection is a cause of sporadic miscarriage, not RPL. In the past TORCH testing was very much popular but nowadays it is obsolete test and there is no scientific ground for tests or treatment of TORCH. Only test we recommend is rubella testing. If rubella IgG is negative that means you may get infection in pregnancy so we advice to take rubella vaccine and avoid pregnancy for one month. On the other hand, rubella IgG positive means you are already immune and thus you can never get rubella. So vaccine is not useful in those cases. If any genital infection is found in husband or wife, both if them should be tested and treated aggressively.TESTS REQUIREDFirst of all we need to know when we should advise tests. Assuming that most cases of miscarriages are SPORADIC, we usually do not advise investigation after single miscarriage unless the couple insists or there is some reason by the doctor to suspect some abnormalities that might cause future miscarriage. In the past testing was started after 3 miscarriages. But nowadays we do not want to give the couple, especially the woman a third trauma. So we usually advise tests after 2nd miscarriage. The tests usually start with checking for chromosome of the baby. It is followed by chromosome analysis of both the partners along with proper history taking and physical examination. Semen analysis is done for the husband. The wife is advised ultrasonography, routine blood, thyroid testing, testing for APS and blood group. These are tests usually dine everywhere. Further tests are done depending on the results if initial tests and especially if no cause is found after initial tests. It should be mentioned to the couples that the 2nd group if tests often do not have scientific grounds and are done only on benefit of doubt. They may not change the management plan. TORCH test is not done in modern era.TREATMENTThe basic treatment is support if the couples, reducing stress as stress can be responsible for RPL. When a cause is found this should be treated. While an optimistic approach should be taken with expectations for normal pregnancy in future but this should be based on scientific and realistic approach to avoid future frustration. The treatment may not be 100% effective and most treatment may not have scientific base but are usually not harmful. Treatment may not guarantee a successful future pregnancy but a positive attitude is necessary. This is called TENDER LOVING CARE (TLC) where proper support and discussion can help more than explanation if mere statistics. Treatment should be continued both before and after pregnancy confirmation, as mentioned above. This is to be mentioned that even after 6th miscarriage, the chance that future pregnancy will be normal is more than 50%. So, the message should be not to give up hope.

Choice Between Surgical and Medical Abortion

Dr. Niraj Mahajan, Gynecologist/Obstetrician
There are two methods by which abortion can be doneMedical Abortion -non-surgical abortion in which medicines are used to induce abortionSurgical Abortion - Use of trans-cervical procedures for terminating pregnancy, including vacuum aspiration, and dilatation and evacuation (D&E).Surgical or Medical Abortion for Unwanted PregnancyIf pregnancy is <= 7 weeks; medical Method with Mifepristone with misoprostol is favorable as success rate is as high as 97%.If pregnancy is between 7-12 weeks; surgical abortion is the only option.If pregnancy is beyond 12 weeks – 20 weeks, then woman needs to be hopsitalized and will be given either Mifepristone followed by Misoprostol tablet or only misoprostol tablets and woman will then abort like a miscarriage in the Hospital. If any products are remaining then it will be evacuated surgically.Surgical abortion is preferred if patient desires concurrent tubal ligation or IUCD (CuT) insertion.If a woman fulfills the criteria for selecting either method i.e. Before 7 weeks), final choice to be given to the woman.Summary of Choice between Surgical or Medical abortion in India<= 7 weeks – Medical method or Surgical method7-12 weeks – Surgical abortion 12 – 20 weeks – Medicines with or without surgical procedure in Hospital.Advantages of Medical AbortionAvoids surgery. Controlled by the woman and may take place at home. No need for admission to the Hospital. Usually well tolerated by women if properly counselled and motivated. No need to take leave from work, as bleeding can be manged with menstrual pads even while in office or at work.Disadvantages of Medical abortionTakes time (hours to days) to complete abortion, and the timing may not be predictable. Women experience bleeding and cramping, and potentially some other side-effects (nausea, vomiting, fever, and shivering). May require more clinic visits than surgical abortion.Advantages of Surgical AbortionQuick procedure. Complete abortion easily verified by evaluation of aspirated products of conception. Takes place in a Hospital so Sterilization or placement of an intrauterine device (IUD) may be performed at the same time as the procedure. It can be performed under local anaesthesia if woman is properly motivated and counselled.Disadvantages of Surgical abortionRequires instrumentation of the uterus. Small risk of uterine or cervical injury. Timing of abortion controlled by the Doctor and Hospital. Anaesthesia needs to be administered. Most doctors perform this procedure under short general anaesthesia. Woman needs to be in the Hospital for at least 6 hours. Effect of sedation will be there through out the day.

How to Get Your Life Ready for a Baby

Dr. Rushabh Mehta, Gynecologist/Obstetrician
What should we think about before we start trying?Before you take the plunge, you and your partner may find it helpful to ask yourselves these questions:Are you both equally committed to becoming parents?Have you thought through how you'll handle childcare responsibilities and balancing work and family?Are you ready to give up sleeping in on Sundays or line up a babysitter every time you want to go out without your baby?Have you thought about how becoming parents may change you, and your relationships with those closest to you?Are you prepared for the possibility that your child may have special needs?If you have religious differences, have you discussed how they will affect your child?Having a baby won't just have a small impact on your life, it's going to shift the centre of your universe. Some new parents find this a shock. Think about how you'll feel, how you usually cope with change, and how you can prepare yourself for the highs (and lows) of parenthood.When should we stop using contraception?For some people, stopping contraception is as easy as shoving the condoms or diaphragm to the back of a drawer. If you're on the pill and want to get pregnant, you can stop taking it and start trying straight away if you're ready to. Or you may want to wait until you've had at least one post-pill period. Knowing the date of your last period can help your midwife or doctor to estimate your due date when you do get pregnant. It can also give you time to make other changes to your lifestyle before you conceive. You may find it takes up to six months for your menstrual cycle to get back on track. If you do get pregnant while you're still on the pill, stop taking it and see your doctor. There's no evidence of an increased risk of miscarriage or abnormalities for women who conceive while taking the pill. But you may want to reassure yourself by talking it through with your doctor. If you've been using the contraceptive injection, it may take up to a year for you to return to your usual fertility.Do I need to change what I eat if I'm trying for a baby?Eating well is essential if you're intent on baby-making. Aim for a balanced diet of three meals a day, including at least five daily portions of fruit and vegetables. Four of the most important nutrients for a healthy start to pregnancy are:folic acidcalciumironvitamin DTo ensure you have these important nutrients, include the following in your meals:dairy producefruit and vegetableswhole grains and cerealsprotein in the form of lean meat, fish, eggs, pulses or nutsYou can take multivitamins designed for women who are trying to conceive or an antenatal supplement. These will contain 400mcg of folic acid. This is a B vitamin that helps to prevent neural tube defects, such as spina bifida in developing babies. Some women need to take more folic acid and have a 5mg dose prescribed by their doctor. However, apart from folic acid, supplements shouldn't be a substitute for a healthy, balanced diet. You shouldn't take high-dose supplements to build up your reserves.Some studies have suggested that having a lot of caffeine may affect your fertility. Although the evidence isn't conclusive, if you're trying for a baby it makes sense to keep your caffeine intake below 200mg a day. Caffeine levels in drinks vary, but two cups of instant coffee contain about 200mg of caffeine.Will my weight affect my fertility?Being either underweight or overweight can cause hormone imbalances. This can affect your fertility by making you less likely to ovulate. It can also increase the risk of complications in pregnancy. If you can, try to achieve a healthy weight, with a body mass index (BMI) of between about 19 and 25, before you conceive. This will increase your chances of conception and of having a healthy pregnancy. You can calculate your body mass index (BMI) with our BMI calculator. If you have irregular periods and your BMI is 30 or higher, try to bring down your BMI. Losing between 10 per cent and 20 per cent of your body weight can help to regulate your menstrual cycle. This, in turn, will improve your chances of conceiving. It's best not to crash diet, though, as this can deplete your body's nutritional stores. Aim to lose between 0.5kg and 1kg (between 1lb and 2lb) a week, which is a safe rate of weight loss. For best results, stick to a healthy, balanced diet of low-fat and low-sugar foods, combined with an exercise programme. If you're underweight, try to put on a few pounds. Being underweight can affect ovulation. And when you do conceive, your risk of miscarriage increases if you're underweight. Just as it's best not to crash diet if you're overweight, it's best not to gorge on sugary, fatty foods to put on weight fast. These types of foods won't give you the important vitamins and minerals you need. Try to get your extra calories from healthy food choices.Should I start exercising more before I conceive?Getting fit before you conceive lays the foundations for a healthy pregnancy. Building your stamina, strength and flexibility can help you to:maintain an active lifestyle during pregnancy and enjoy those nine monthsimprove your mood and energy levelsachieve a healthy pre-pregnancy weightcope with the hormonal shifts of pregnancycope with the rigours of labour, when the time comesBeing active and taking regular exercise that strengthens your back muscles may help to stave off lower back pain later. If you can, build exercise into your everyday life. Try walking or cycling to work instead of taking the bus, or using the stairs instead of the lift. Running and jogging are other good ways to get in shape before pregnancy. If you're not already a runner or a jogger, you may like to start now. Running and jogging shouldn't be started for the first time during pregnancy. Reaching a level of fitness now means you can either continue or tailor your routine once you are pregnant. Start slowly and don't push yourself too hard. If you have a conceptual check-up at your local surgery, you could have a chat with your doctor or nurse about starting an exercise programme.Is smoking, drinking and taking drugs harmful when you're trying?Yes, these can all be harmful when you're trying for a baby. There are many good reasons to stop smoking, stop taking drugs and drink little or no alcohol. Making these changes to your lifestyle is good for your own health and, once you're conceived, for your baby's health and development. Smoking is likely to reduce your fertility and recreational drugs, such as marijuana and cocaine, can affect your ovulatory and tubal function. This can make it harder for you to conceive. Even drugs that are available over-the-counter or by prescription can harm your fertility. It is, therefore, important to discuss your medication with a doctor before you start trying for a baby. Alcohol can also affect your ability to conceive. While trying for a baby, it is best to reduce the amount you drink to no more than one or two units per day. Try not to get drunk during this time. This will help reduce any risk of harm to your baby if your attempts are successful. During pregnancy, smoking, taking illegal drugs and drinking alcohol are connected to an increased risk of miscarriage. Further into your pregnancy, you're more at risk having a low-birth-weight baby and premature birth. Too much alcohol during pregnancy can seriously affect your baby's development. Because experts can't be sure about a safe level of alcohol for an unborn baby, it is best to stick to no more than one or two units, once or twice a week, and don't get drunk.What if my job could be harmful once I get pregnant?Some jobs can be hazardous to you and your unborn baby. If you are exposed to chemicals or radiation often, you may need to consider making changes before you conceive. Likewise, if you fly a lot or stand all day, think about how you might cope if you became pregnant. If possible, tell your employer that you're planning a pregnancy and ask about ways to avoid or eliminate hazards in your workplace. If you don't want to let your employer know that you're trying for a baby, the Health and Safety Executive has information about how to make your work environment safer.

10 Things to Avoid in Pregnancy

Dr. Sujoy Dasgupta, Gynecologist/Obstetrician
Pregnancy is a journey of a woman from womanhood to motherhood. Each and every pregnancy is precious and so women usually remain anxious about their lifestyle and food habits. Most of the pregnant mothers do not hesitate to sacrifice their comfort and habit, only to keep their baby safe. Here are the few tips which describes what are the common food items that must be avoided in pregnancy.  1) Some fishesFishes are integral part of most of the non-vegetarian Indian dishes. Majority of the fishes are not harmful, rather most of them (particularly fresh water fishes) are rich in protein and omega-3 fatty acid, that helps in brain development of the baby.You must take those. But remember, always take well cooked fishes. Avoid raw fishes like “Sushi” as they are likely to contain bacteria and parasites, causing stomach upset, that can lead to early labour and even damage the baby by causing premature delivery. Avoid refrigerated and smoked sea fish and other seafood as they are likely to be infected with a harmful bacteria, called listeria. Listeria infection is notorious for causing fever and infection in mother. More importantly, it can pass into the baby causing miscarriage, serious infection and even death, either before delivery or immediately after delivery.Avoid fishes containing mercury and other pollutants,particularly, big fish like shark, shellfish,  salmon, tilefish, king mackerel etc because they contain higher levels of mercury which can harm an baby’s immature nervous system. 2) Some dairy productsWhile intake of properly pasteurized and boiled milk is highly recommended, if you can tolerate it, because of high energy, carbohydrate, protein, fat and mineral content; raw milk, unpasteurized milk should be totally avoided, as they may contain harmful bacteria, particularly listeria, as mentioned earlier. Similarly, soft cheeses should not be taken in pregnancy.  3) Alcohol and smokingExcessive alcohol in pregnancy can cause ‘fetal alcohol syndrome’, characterized by abnormalities in face, heart, brain etc and evenmental retardation. These babies are likely to have growth disturbances. . Smoking can cause miscarriage and low birth weight of the baby that may even cause still birth. Passive smoking is also equally important. So, both mother and father should avoid smoking. 4) CaffeineExcessive caffeinated food can be a cause of miscarriage. Do not take more than 2 cups (or 200 mg) of coffee per day. 5) Under-cooked meat and eggsThese can cause food poisoning, as well as listeriosis. Also, there is chance of transmission of a parasite, toxoplasma, which can cause miscarriage, still birth and abnormalities in the baby (problems in heart, brain, eye, intelligence etc). Cook eggs until the yellow and white parts are firm. It’s better to avoid restaurant foods. 6) Unwashed fruits and vegetablesThese items may carry certain bacteria that can lead to stomach upset. They are also known cause of causing listeriosis, as explained above. Avoid long refrigerated vegetables and salads made in restaurant. Raw vegetable sprouts, often taken for high minerals and protein, should be avoided as they may also harbor harmful bacterias.   7. Some juicesAvoid fresh and raw juices as they may contain harmful bacteria like listeria and even toxoplasma. Choose packaged juices as they arepasteurized and are kept under refrigeration.8. Fatty FoodsWhile some fat is needed for brain growth and energy of the baby, excess fat may cause excessive weight gain that may increase the risk of high blood pressure and even diabetes, both can affect mother and baby. Mothers with excess weight are more likely to have premature delivery, problems during delivery and infection. Again repeated cooking of fatty food should be avoided, as it is more harmful to both.9. Herbal supplementsBecause their safety during pregnancy is not known, it’s best to avoid herbal supplements during pregnancy. This also includes herbal tea. . 10. DrugsDo not take any drugs without consulting your doctors, whatever problem you are having.Even avoid excessive vitamin use as excess dose of vitamin A can damage the heart, face and brain of your baby and make it mentally handicapped. Some painkillers can cause heart defects in the baby. Some antibiotics may also be unsafe.

Savoring Rightly – 12 Food Items to Eat With Caution During Pregnancy

Dr. Pallavi Vasal, Gynecologist/Obstetrician
Pregnancy is one of the magnificent event in a woman's life. In midst of pregnancy, a common enigma is - what to eat and what not to eat. While new cravings emerge, it is also important that selection of food is safe for your baby. Everyone who comes  to know about your pregnancy gives you a piece of advice that too especially on food, which creates confusion. In such a situation its better to ask your doctor to clear doubts. Its important to start with healthy eating habits early in pregnancy to have a healthy outcome.Some foods which must be avoided in pregnancy are:    Raw (Unwashed) / undercooked vegetables – these should be avoided as if the vegetables are not properly washed and cooked it might contain eggs of a parasite called Toxoplasma Gondii which causes malformations in baby; so better to avoid them. Moreover the pesticides used in them are also harmful.Undercooked Egg/ meat/poultry- these may contain typhoid bacteria and listeria which can lead to food poisoning and vomiting and diarrhea. Unpasteurized dairy products, soft cheese and juices - Do remember to be careful with their manufacturing and expiry dates. These may contain bacteria like E.Coli and Salmonella which upsets tummy and can lead to gastroenteritis and typhoid. Few Sea foods - Fishes like mackerel, tilefish, sword fish and shark contain high content of mercury which affects mental development of fetus. Fishes grown in polluted water, refrigerated and smoked sea foods should also be avoided.      5.  Nuts – In case of allergies.      6.  Caffeine - Tea and coffee intake should be limited to a maximum of 3 cups/day.      7.  Herbal tea - Herbal tea’s may contain unwanted supplements, so better to avoid it.      8. Canned food/juices/Fizzy drinks/ Refrigerated foods and left overs - they all contain preservative bi-phosphenol A which affects    baby’s endocrine activity.      9. Nitrate rich food like bacons, diet soda, sausages, artificial sweetener.     10. Alcohol - it leads to fetal alcohol syndrome (small size of brain, face and mouth), miscarriages, preterm births and small babies.     11. Smoking - Its very harmful for you whether you are pregnant or not. In pregnancy it leads to miscarriages, growth restriction of baby and preterm birth.    12. Food which should be used in moderation include rice, potato, refined flour, fatty food and sugar.Take care and all the best for the most eventful journey of your life!

Bleeding in Early Pregnancy

Dr. Pallavi Vasal, Gynecologist/Obstetrician
Vaginal bleeding in early stages of pregnancy is common. It can be due to many reasons.The important causes  are-1) IMPLANTATION BLEEDING- bleeding due to attachment of the newly formed fertilized mass of cells which are destined to form the baby to the womb. It usually occurs at the time of expected period. It is normal and is not heavy bleed.2) MISCARRIAGE- 1 in 5 pregnancies(20%) has the risk of miscarriage in the first three months. Most miscarriages occur as a "one -off"(sporadic) event and there is a good chance of having a successful pregnancy in the future. Most common cause is chromosomal problems. Chromosomes are tiny thread like structures which make our body cells. Risk of miscarriage increases with increasing age, health problems like poorly controlled diabetes and lifestyle factors like smoking and heavy drinking. It can be managed by -                   (a) Expectant management- Letting the nature take its course                   (b) Medical management- Taking tablets                   (c) Surgical management- Having an operation called D & E(dilatation and evacuation)Depending on your case doctor will offer you treatment most suitable for you.3) ECTOPIC PREGNANCY- It is when the pregnancy is growing outside the womb; usually in the fallopian tubes. A pregnancy cannot survive in this situation and sadly cannot lead to birth of a baby. You may have symptoms like abnormal bleeding, pain in lower tummy, pain in the tip of the shoulder, upset tummy, severe pain/collapse. If you had previous ectopic, previous surgery over fallopian tube, using progesterone only pills for contraception, IUD/Coil, IVF, are more than 40 yrs or smoker you are at high risk of having an ectopic pregnancy. It can be managed in three ways-(a) Expectant management- Letting nature take its course, but with serial blood tests for beta HCG (pregnancy hormone) and ultrasound monitoring (b) Medical management- with injection Methotrexate which is an anti cancer drug which also dissolves the pregnancy tissue. This is also given with proper monitoring and serial blood tests and ultrasound. (c) Surgical management-usually done laparoscopically (key hole) surgery and removal of the tube may be required.Your doctor will offer you treatment according to your condition considering all pros and cons.4) MOLAR PREGNANCY- It is much rarer condition where the placenta is abnormal. Once diagnosed this pregnancy needs to be terminated and requires long follow-ups.5) LOCAL CAUSES- Can be due to local injury, cervical (neck of the womb) erosion.When you see your doctor for bleeding in early pregnancy, your doctor will offer you-A) Consultation and Examination- which will include details of your symptoms, date of last menstrual period and your medical history. Vaginal examination to see where the bleeding is coming from. A vaginal examination will not cause you to miscarry.B) Tests-            Urine test to confirm pregnancy            Test for Chlamydia             Blood tests to check your blood group and pregnancy hormone (beta-hcg) levelsC) Ultrasound - Either Transvaginal or Tranabdominal Scan. Repeat scan may be necessary after 7-10 days if the pregnancy is very small or has not been seen.WARNING SINGS-1) Heavy bleeding2) Severe pain not relieved by pain reliving drugs3) Smelly vaginal discharge4) Shivering or flu like symptoms5) Feeling faint6) Have pain in your shoulderIf you have any of the above , please consult your doctor immediately.

Effects of Smoking in Pregnancy: A Serious Threat

Dr. Sujoy Dasgupta, Gynecologist/Obstetrician
You all know that tobacco causes cancer - cancers in almost all the organs of our body.But what else? can it affect your sexual and reproductive life?In females - it causes problems in menstruation, irregular periods and abnormal amount of bleeding. In addition, it causes difficulty in having baby - by interfering with normal hormone release. Even if pregnancy occurs, the ending may not be a happy one. It is responsible for repeated pregnancy loss (repeated miscarriages), ectopic pregnancy (pregnancy outside the uterus - that cannot survive, on the other hand it can endanger the mother's life). It also causes abnormal bleeding in pregnancy by early separation of placenta (the flower) and thus endangering life of both mother and baby. It is also responsible for inadequate growth of baby inside the uterus. This can result in early delivery (premature baby), low birth weight, permanent damage to baby's brain (mental retardation) and other organs, even death of the baby before or soon after birth. Tobacco also causes early rupture of membranes during pregnancy ("breaking of water") causing preterm delivery and infection. As a result of hormonal deficiency caused by tobacco, there may be infertility and other hormonal problems like sexual dysfunction (dryness especially), discomfort in passing urine and bone pain (all due to hormone deficiency). In older women it can cause prolapse (coming down of uterus outside).In males- tobacco is responsible for low sperm count, low motility and abnormalities in sperms. The result is male infertility.It can also cause hormonal problems in males leading to sexual dysfunction and bone loss.It is responsible for erectile dysfunction and also premature ejaculation. So, the decision is yours whether to choose tobacco or to choose life.

What is an NT Scan?

Dr. Sudhir Pudi, Radiologist
Introduction:NT scan also called Nuchal Translucency scan is a non-invasive ultrasound scan done on pregnant women between 11-13.6 weeks gestational age to detect risk of chromosomal abnormality.How is the test done?The test is performed when the fetus is 11 weeks to 13 weeks 6 days old. The test is performed using a high end ultrasound scanner machine which uses sound waves to form images of the fetus. The scan is done by a Radiologist or sometimes by the gynaecologist or trained sonologist. The image needs to be very precisely taken and multiple criteria are taken to ensure that the image is optimal. The skin in the back of the neck forms a lucent band on the scan image and this is measured. Other structures such as the nasal bone are simultaneously looked for.What is the use of the test?The test is done to ensure that the baby born is free of chromosomal defects such as Downs syndrome, Turner syndrome, Trisomy of 18th and 13th chromosome and Triploidy. While no test can give a 100% guarantee, this test along with few blood tests (triple marker test), can give a reasonable detection rate for these problems.Who is the scan for?There are certain high risk populations where there is increased chance of chromosomal anomalies. These include maternal age aver 35 years, and previous fetus with abnormality. However in practice even young mothers can undergo these tests as even they have a small risk(1 in 1400) of having children with chromosomal abnormality, and the benefit of knowing far far outweighs the cost of the test.How accurate is it?Nuchal scanning alone detects 62% of all Down's Syndrome with a false positive rate of 5.0%; the combination with blood testing gives corresponding values of 73% and 4.7%.When screening is positive, Chorionic Villus Sampling (CVS) or amniocentesis testing is required to confirm the presence of a genetic abnormality. However this procedure carries a small risk of miscarriage so prior screening with low false positive rates are needed to minimize the chance of miscarrying.