Recurrent Pregnancy Loss: Understanding the Causes, Diagnosis, and Treatment Options

Running head: HEALTHCARE HEALTHCARE Name of the Student Name of the University Author Note 1 HEALTHCARE Introduction Recurrent Pregnancy Loss or habitual miscarriages are common in the first trimester, which is up to 13 weeks of pregnancy, and accounts for 15 to 20% of all pregnancies. However, while one or two miscarriages are indicative of future infertility, there are avariety of other factors that can lead to habitual miscarriage. In New Zealand, one in every four women has had amiscarriage, and nearly 20,000 women lose apregnancy each year due to stillbirth or miscarriage (Dimitriadis et al., 2020). Half the time, the couples want to have a healthy child and plan the same without any assistance, even after losing two pregnancies in the past. Recurring miscarriage in the first trimester highlights that the common reason behind miscarriage is the chromosomal issue of the embryo or some genetic defects (Dimitriadis et al., 2020). Thus, itis important to closely understand the cause of miscarriages and the prevention and treatment options that are available in Western Medicine (WM) and Traditional Chinese Medicine (TCM). The paper defines the term recurrent pregnancy loss or habitual miscarriage, the ethology, pathology, and diagnosis in the view of TCM and WM. It further explains the treatment in TCM and WM views, followed by the prevention, as well as the conclusion. Discussion - Define Recurrent pregnancy loss (RPL), also known as a habitual miscarriage or recurrent miscarriage, is defined as 3 consecutive loss of pregnancy occurring before twenty weeks from the last menstrual cycle (Li & Marren, 2018). 2 HEALTHCARE Pathology and Aetiology The Kidney Essence (Jing), Yin, Qi, and Yang, according to TCM, provide energy, direction, and substance to the reproductive system. Quality of these three energies determines the health of the female egg and the health of the sperm in the male. According to the TCM theory, adecrease in vital energies is one of the major contributing factors in the case of miscarriage, although it is not the main reason (Dimitriadis et al., 2020) .Multiple miscarriages, which is also called aslippery foetus or Hua Tai, also occur due to pathological factors. Yang, essence, Yin, and Qi decline with age naturally, but the rate of declination can be accelerated because of overworking, poor self-care, poor diet, substance abuse, excessive stress, and unresolved emotions. According to the Chinese medicine theory, miscarriage occurs due to various differential diagnoses that are Qi and blood deficiency, kidney deficiency, heat in the blood, trauma, and disorders of the Ren, Dai, and Chong channels. Given western medicine, the presence of abnormalities in the uterus of pregnant women can be acommon issue. Uterine abnormalities include endometrial polyps, fibroids, or intrauterine adhesions. The common uterine abnormality that leads to miscarriage is linked to aseptated uterus where the tissue wall is present that divides the uterine cavity (American Society for Reproductive Medicine, 2020). Next, hormonal disorders, which include thyroid disease, uncontrolled blood glucose, or the development of polycystic ovary syndrome as aresult of oestrogen imbalance, can lead to recurrent pregnancy loss (Dimitriadis et al., 2020). A proper level of hormone is required for ahealthy and successful pregnancy in pregnancy, which is also contributed by an increase in prolactin levels. In 50% of miscarriage cases, pregnancy loss is linked to an abnormal chromosome number in the embryo (Li & Marren, 2018) .These issues occur spontaneously 3 HEALTHCARE during conception, but they can be inherited occasionally from the parents. Other potential causes for recurrent pregnancy loss are sperm problems and infection. However, they are less well-defined. Other factors like alcohol intake, exposure to toxins, being obese, caffeine intake, physical inactivity, stress, etc are contributors to the development of this issue of multiple miscarriages (Dimitriadis et al., 2020). Types - There are various causes of miscarriage, but they are generally divided into 2 major groups and they are: Recurrent early miscarriages: occurs within the first trimester due to genetic or chromosomal issues of the embryo, with 50-80% of the losses occurring spontaneously due to having an abnormal chromosomal number. Structural problems of the uterus also contribute to early miscarriage (Li & Marren, 2018). Recurrent late miscarriage: it occurs mostly after the first trimester as a result of uterine abnormalities, premature labour, autoimmune problems, or incompetent cervix, resulting in miscarriage or stillbirth (Li & Marren, 2018). Diagnosis - Blood Tests In western medicine, the doctors generally draw blood for testing the level of progesterone, which is a hormone that thickens the uterine lining and nurtures the development of embryos, afew proteins which affect the ability to maintain pregnancy, and thyroid hormones. The patient might also be tested for identifying pelvic inflammatory disease, which is arisk factor for miscarriage (Velasco & Taylor, 2018). 4 HEALTHCARE Ultrasound An ultrasound that utilizes sound waves for creating the organ image, as well as other body structures, can enable adoctor for detecting polyps or fibroids, and uterine growths that lead to miscarriage. Here the doctor uses atransvaginal ultrasound to collect adetailed image of the patient ’sreproductive organs. FemVue is atest that involves injecting air bubbles and a saltwater solution into the uterus as well as fallopian tubes for viewing the same with the use of ultrasound (Li & Marren, 2018). Genetic Screening As a majority of the miscarriages occur due to aneuploidy, meaning an irregular chromosome number of the embryo, karyotype tests are suggested. This blood test helps determine whether the patient has the correct number as well as the configuration of chromosomes or not (Dimitriadis et al., 2020). Hormone Tests Women who are more than 35 years of age suffer from low levels of FSH. FSH stimulates the production of ova, or eggs, which decreases with a woman ’sage, causing infertility. Diagnostic tests include testing the level of FSH as Low FSH levels cause severe stress, contributing to miscarriage. An anti-Mullerian hormone (AMH) test is done to gauge ovarian reserve, that is, the number as well as the quality of eggs for the process of fertilization (Li & Marren, 2018). Hysterogram A hysterosalpingogram helps the doctors to view the reproductive organs to identify any anatomical problems like fibroids, which might result in miscarriage. It can further reveal the tissue of the scar occurring due to endometriosis or infection, which might obstruct the 5 HEALTHCARE fallopian tubes, the passageways that assist in transferring the eggs from the ovaries to the uterus (Dimitriadis et al., 2020). A dye is injected into the uterus with the help of asmall catheter, that is ahollow tube. The images of the X-ray of the uterus, as well as the fallopian tubes, help to locate the obstruction. HSG can cause discomfort and, thus, an over-the-counter pain reliever is given to the patient. Endometrial Biopsy The doctor removes asmall tissue from the uterine lining for testing irregular cells that can indicate polyps, infections, fibroids, and other problems with the uterus' ability to conceive apregnancy (Gon çalves et al., 2018). Treatment based on Western and Chinese medicine- In traditional Chinese medicine, the deficiency of the kidney and spleen is the major cause of recurrent miscarriage. Various herbal formulas have been indicated in the TCM system for protecting the foetus. Shou Tai Wan, a foetus-protecting pill that works by supplementing the kidney, enhancing qi, fortifying the spleen, and nourishing blood, has been used as a treatment for recurrent miscarriage since the Qing Dynasty, according to TCM (Bruno et al., 2018). Yin Protecting Decoction is aclassic herbal medicine used for treating heat in the blood, which is a major cause of miscarriage. Si Wu-Tang is the next most common herbal formula for treating trauma that affects afetus. Bu Shen Gu Chong Tang, which is a Kidney Reinforcing and Chong Channel Consolidating Decoction), is a herbal formula that can help to treat chronic miscarriages (Bruno et al., 2018). Bao Yin Jian is the most common title at present in the field of TCM, which comprises the Shu Di Huang, Sheng Di Huang, Bai Shao, Xu Duan, Huang Bai Shan Yao, Huang Qin, and Gan Cao. Its function is to nourish Yin, clear heat, calm the foetus and cool the blood. Indications for using this 6 HEALTHCARE formula are during pregnancy, the presence of bright red colour bleeding, red lips and cheeks, experiencing dry mouth, excessive heat in the soles and palms, scanty urination, concentrated urination, and dry throat. The tongue appears dry with ayellow coating and is usually red and The pulse is rapid and slippery (Bruno et al., 2018). According to recent studies, Chinese herbal medicine combined with acupuncture can help in reducing the occurrence of recurrent pregnancy loss. It helps to enhance fertility as well as prevent miscarriages (Liao et al., 2020). Acupuncture can be a supportive treatment that imparts beneficial effects on the levels of prolactin and cortisol. It reduces the impact of stress on pregnancy, which is also arisk factor for miscarriage. Stress in early pregnancy causes overactivity of the hypothalamus-pituitary- ovarian axis, resulting in decreased progesterone levels. (Dimitriadis et al., 2020). Acupuncture is generally done with the use of ahair-like thin needle. People generally feel little pain, and inserting the same into a pint produces an ache or pressure sensation. Acupuncture allows the uterus to rebuild asmooth uterine lining while cleansing fully for implantation (Pinar et al., 2018). According to the theory of TCM, the vital energies that are Jing, Yin, Qi, and Yang need to be balanced for healthy living and healthy pregnancy. The 4 common causes of pregnancy are excess heat, injury, blood deficiency, and kidney deficiency. Other causes are medications, food poisoning, etc. Based on the symptom being presented, an acupuncturist will create atreatment plan (Nassour et al., 2020). Acupuncture treatment is an effective treatment option in Western medicine that also helps in treating miscarriage by balancing the hormones, improving endometrial lining quality, and reducing anxiety and stress, which are the major risk factors for infertility, treating PCOS, preventing clotting, improving blood flow and regulating immune responses. Other treatments linked to western medicine include low molecular weight heparin (LMWH) and low doses of acetylsalicylic acid for recurrent spontaneous miscarriage. 7 HEALTHCARE LMWH is an anticoagulant that improves live births as well as reduces the miscarriage rate .Aspirin inhibits cyclo-oxygenase and suppresses TXA2 production in platelets, thus improving the live birth rate and miscarriage. Prevention In pregnancy, it is important to prioritize self-care and wellness. Eating healthily and getting enough rest is essential for both the child and the mother. Because the majority of miscarriages occur during the first trimester, eating well and leading ahealthy lifestyle can help reduce the risk of miscarriage. During pregnancy, the patients must eat cooling foods. This is because pregnant women often feel hot and carry more heat in their bodies in comparison to non-pregnant women. It is recommended to not eat foods that are too spicy as this might result in bleeding and trigger contractions. It is recommended that pregnant women eat. Cooling foods like cucumbers, celery, melons, citrus fruits, leafy greens, mung beans, soy, eggs, millet, whole wheat, buckwheat, etc. (Hofmeyr et al., 2019). The next prevention strategy includes warming foods that should be avoided because they increase yang energy as well as body temperature. The patient should be moderated by: coconut, leeks, deep-fried onions, pine nuts, roasted walnuts, pistachios, and spices such as cinnamon, cloves, garlic, mustard, chili pepper, pepper, ginger, or adding cooling food in case they had warming food (Young, 2019). Furthermore, it is recommended to be less stressed and get involved in deep breathing exercises as this will help in promoting relaxation and improve the mood and wellbeing of the patient. Staying away from coffee and alcohol and consuming chrysanthemum tea can help in reducing the risk of miscarriage. Ensure that you get the right balance of calcium and magnesium is maintained (Young, 2019). Foods with high magnesium content like beans, brown rice, spinach, and fish like halibut and 8 HEALTHCARE salmon, etc. are important. In case the patient experiences bleeding or cramping, it is important to cease all activities like exercise, sex, manual labour, etc. (Sharif et al., 2018). Conclusion : Recurrent pregnancy loss occur due to variety of factors such as genetic issues, sperm problems, and infection. In TCM, Qi and blood deficiency, kidney deficiency, heat in the blood, trauma, and disorders of the Ren, Dai, and Chong channels all contribute to the loss of pregnancy. Diagnosis can be done through blood tests, genetic screening, ultrasound, hormone testing, hysterogram, etc. In Traditional Chinese Medicine, 'Shou Tai Wan is a foetus-protecting pill that works by supplementing the kidney, enhancing qi, fortifying the spleen, and nourishing blood can also be effective in this process. Western medicine includes acupuncture along with LMWH and low doses of acetylsalicylic acid. It is recommended to maintain ahealthy lifestyle, eat healthy food and reduce the consumption of caffeine so that the risk of pregnancy loss can be decreased. 9 HEALTHCARE References American Society for Reproductive Medicine. (2020). 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