Losing a fetus in a sudden miscarriage is always devastating to parents. Even without any known cause of the tragedy, they often blame themselves because they think the loss was due to something they did wrong. About a third of all pregnancies end in miscarriage, often without the woman being aware of it.
There are numerous possible triggers to a miscarriage, including the single-most-common cause – abnormal chromosomes in the fetus, as the egg or sperm’s chromosomes created an error during embryo formation. In such a case, the miscarriage is almost always a blessing. More than half of miscarriages in the first 13 weeks of pregnancy occur because of a problem with the fetus’s chromosomes. As one gets older (the father as well as the mother), especially after age 35, the risk for chromosome problems specifically, and miscarriage in general, increases.
Although doctors advise couples interesting in a pregnancy to optimize their health before conception – such as having normal weight, taking prenatal vitamins such as folic acid pills, visiting an obstetrician, making sure they have received all necessary vaccinations, stopping smoking and drugs and minimizing alcohol consumption – there are only a few causes of miscarriage that are completely preventable.
In many cases, particularly with early miscarriages, it can be difficult to determine exactly what went wrong. But according to experts, it’s amazing how often it actually goes right. When you think about a pregnancy and the beginnings of a human being forming and all the things that have to go perfectly, it really and truly is a miracle when it happens. There are two sets of genetic material fusing together that have to divide, and sometimes things go wrong. The simplest way to think about it is that miscarriage is sort of nature’s way of making sure that a human being is compatible with life.
Less common, but still significant occurrences of miscarriage can be caused by physical problems in the mother, such as uterine abnormalities fibroids, an infection such as cytomegalovirus or German measles; an abnormally shaped uterus or a cervix that opens and widens too early, clotting disorders; immunological disorders; diabetes; and thyroid problems.
After a miscarriage, the woman is likely to undergo a dilation and curettage (D&C) to make sure that nothing remains in the uterus. D&C is carried out in about 10 or 15 minutes to remove tissue from the uterus or small pieces of the placenta. This helps prevent infection or heavy bleeding. It can also help diagnose or treat growths such as fibroids, polyps, hormonal imbalances or uterine cancer. A sample of uterine tissue is viewed under a microscope to check for abnormal cells.
But now, Hillel Yaffe Medical Center in Hadera north of Tel Aviv has become the first hospital in Israel to offer a test to determine the cause of miscarriage. Dr. Sagi (Sergio) Haimovich, head of the hospital’s ambulatory and hysterectomy service, performs a special experimental test. “The examination helps identify the cause of the abortion, thus helping to deal with the unfortunate event, as well as preventing possible future abortions,” he said.
“When a fetus miscarries, it is usually during the first 10 weeks of pregnancy. In most cases, the mother hasn’t a clue about the cause. I often hear the woman thinking out loud: ‘What have I done wrong?’ And my heart goes out to them. The examination we are conducting is now done exclusively in Hillel Yaffe, as part of the Helsinki Committee on Medical Experimentation.
It is performed just before the D&C and therefore does not create further discomfort for the woman. It can create a “small revolution,” in terms of doctors – who receive more correct tools and perform the procedure in a more focused way. It provides an answer that gives the parents comfort and also the hope that the next pregnancy will be different.”
The doctors scan the uterus by means of a hysteroscopy, examine the fetus, see the uterine cavity and collect findings that allow them to find out what was wrong with the fetus, explained Haimovich, who initiated the test.
One case was that of a woman who came to perform D&C at 10 weeks due to lack of a fetal pulse. In the hysteroscopy performed prior to the D&C, the fetus was found to have a clear physical defect in his head. A biopsy and genetic mapping were performed to determine the cause.
“The genetic mapping was normal, so the main directive for this woman was to systematically take necessary supplements such as folic acid, which studies have shown to help prevent fetal abnormalities. “It’s true that the guidance for women who want to become pregnant is to take a folic acid supplement,” Haimovich noted, “but what is important here is that the woman also received an answer that if she takes folic acid before her next pregnancy, she is unlikely to miscarry again.”
The research data on the test were presented at an international conference on hysteroscopy held in Barcelona in May of this year. “Our research results were very well received,” concluded Haimovch. “We have created a tool providing a clinical answer that helps later, especially emotionally, easing the parents’ fears and anxieties in the future.”