PREGNANCY & RECURRENT  MISCARRIAGES

All Heavenly religions promote marriage as the seed of life with the  supreme motive of  procreation.

The question is:  Do the parties entering into marriage, after however long a  period of engagement, know any of each other's secrets?  By that, we  particularly  mean those related to their ability to produce children or their contraction of venereal diseases which may cause repeated miscarriages, or any of the hereditary diseases which may produce mentally retarded or physically handicapped children.  Of course not.  That is why a set of pre-marital , pre-natal medical tests is always recommended.

Premarital Tests:

Women should be tested for blood grouping & Rh typing, TORCH profile, Thyroid screen & Hepatitis B & C. In addition  Hormones, advanced Immunologic tests and cytogenetic tests  are sometimes needed.

1- Rh Blood Group. 

The  problem is raised  if the husband is Rh+ and the wife is Rh- while the fetus is Rh+.  This occurs when part or whole of the placenta is detached during pregnancy, miscarriage or labor, which results in a leak of the fetus' positive blood to the mother's negative blood resulting in the formation of antibodies against the fetus blood causing                        hemolysis in its red blood cells.  If the rate of these antibodies produced in the blood is high,  miscarriage may occur. 

Usually at the beginning of the pregnancy the rate of  these antibodies  is low, and causes jaundice to the natural born baby.  This may be treated by exposing  the newborn to ultraviolet rays or by Exchange blood transfusion.

All of the above may originally be avoided if the mother knew her Rh factor before giving birth and took a special injection (anti D), provided this is done during the 48 hours immediately following delivery.

2-  (TORCH) which briefly denotes:

- Toxoplasma
- Rubella
- Cytomegalovirus
- Herpes Simplex

Blood tests may determine if the expectant mother has been exposed , provided  the laboratory is equipped to run these tests and the doctors have sufficient experience to know the significance interpretation of results.

If one or more tests are positive, it is required that the test be repeated after 2 weeks to compare results and determine the relative level of the antibodies .  If the rate is high (more than a two fold increase), this is a clear indication of disease activity and the patient must refer to her treating physician.

* Toxoplasma
The disease is transmitted via foods contaminated with cat secretions or  infected raw meat.  This may result in the birth of a child who is mentally challenged, blind or suffers hydrocephalus.
As for adults, no symptoms may appear although they are infected.  The only sign may be high fever, enlarged lymph glands particularly in the neck area which may cause miscarriage or stillbirth.

* Rubella
This virus is dubbed "German measles" since   the first to discover it were a group of German physicians.  It is transmitted through saliva specks ( رذاذ   )       .  Women's chances of being infected are five times more than men if a  family member who lives in the  same place has it.
The most important symptoms in adults are skin rash, enlarged lymph glands, particularly behind the ears and pain of the joints.  If the disease occurs during the first 3 months of pregnancy,  it may cause miscarriage or the birth of a child with cataract,  or mentally challenged or who has congenital heart disease.

* Cytomegalovirus
The most important sources of infection are:  Blood, semen, cervical secretions, urine and saliva.  In adults, no symptoms may appear except slight rise in body temperature or enlargement of some lymph glands. However when  the infection  reaches the fetus, it causes jaundice, enlarged liver and pancreas, reduced head size as well as mental retardation.

* Herpes Simplex
This virus is classified as a venereal disease, i.e. diseases which spread through intercourse.
The most important symptoms in adults, range between slight increase in temperature and enlargement of the lymph glands, to ulcers of the genitalia.  It has also been found that  the statistics of cervical cancers are highest among women with this virus, and if the disease  reaches the infant during birth, he/she gets jaundice.

2- Thyroid screen

In newborn infants,  the reduction of thyroid gland hormone secretion is always  accompanied by mental retardation and certain manifest changes in the physical appearance of the infant.
Reduced secretions of the thyroid gland in children or youth also leads to short stature
Screening can be carried out by a blood sample for Free T4 and TSH

     
  4-  Hormones

* Prolactin, which is produced by the frontal lobe of the pituitary gland.  If its rate increases in the blood,  automatically the FSH decreases.  Prolactin is responsible for the "healthy": formation of the ova, especially the corpus lutum which in turn is responsible for producing progesterone.

* Progesterone which is produced by the ovary implants the fetus for 3 months    until the placenta  is formed and can take over this task.  Therefore the decrease of progesterone in the blood will not allow placenta implantation and miscarriage may occur.

1- Immunologic Tests

* Autoantibodies which can attack the fetus and cause abortion
* Anticardiolipin which forms clots at the placental vessels which interfere with the passage of nutrition from mother to fetus and eventually abortion

2- Cytogenetics

Sometimes, recurrent miscarriages during early pregnancy may be the result of  structural chromosomal disorders which do not themselves produce any apparent symptoms in the patient since all inherited genes are in tact.  The symptoms appear only at the division of the ova because the resulting parts are unequal, which leads to the formation of a fetus with incomplete or duplicated genetic inheritance which do not allow the fetus to survive.

The most important benefit of Cytogenetics to the Obstetrician is test the amniotic fluid chromosomes    surrounding the fetus  at an early stage of the pregnancy in order to discover any hereditary defects and allow for a decision whether to proceed with the  pregnancy a procedure known as amniocentesis.
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These types of tests must be recommended by all specialists to women, over 35 years of age, during their pregnancies since the chances of hereditary diseases increase from that age onwards.  In the U.S. there are many lawsuits by women against their physicians because they were not advised to carry out those tests.

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