Monique Rainford

IN THE Roman Catholic Church, and in some other Christian denominations, the period preceding Christmas is called Advent. It is a time of expectant waiting and preparation for the birth of Christ. A woman who is pregnant at this time of year may have a closer identity with this meaning of Christmas as she is, in fact, expecting the birth of her child in the same way that Mary, the mother of Jesus, was expecting His arrival so many years ago.

But, what if this is not her first pregnancy? What if she has been pregnant three, four, even more times and yet, has never had a baby? What if she has lost every pregnancy which she has carried before this time?

Shortly before I left Washington D.C., I was counselling a woman for surgery. She had come to the emergency room of the hospital where I was working as she was in the process of having a miscarriage. She required a dilation and curettage (emptying of her womb) I do not recall the exact number of prior losses, I remember being struck by the high number. It turned out that I had met her elsewhere and she was friendly, despite her circumstance. As I offered her my recommendation of a specialist to improve her chances of a successful pregnancy, she was eager and open to the suggestion. She was not too afraid to try again.

Spontaneous abortions

In private practice, I have a unique view into the lives of some of these women. I meet, in my opinion, wonderful women and couples whom I believe would be good parents, who lose multiple pregnancies. In obstetrics, recurrent abortion is defined as three or more spontaneous abortions or miscarriages. This occurs in about one to two per cent of women.

Some of the causes of recurrent miscarriages include chromosomal rearrangements that parents may carry, thyroid problems or diabetes that are not well controlled. Testing the chromosomes of the parents and the foetal tissue may be helpful in ascertaining a cause. Women should have their diabetes or thyroid problems well controlled infectious agents and certain toxins in the environment, such as cigarette smoke, can be associated with miscarriages, it is less likely to be a major cause of recurrent miscarriages. However, toxins should be avoided where possible and the infections can be tested and treated.

The body makes certain proteins, called antibodies, whose purpose is to eliminate substances that are alien to the body. Unfortunately, some of these antibodies can fight against the body's own cells. Some such antibodies, called antiphospholipid antibodies, are associated with recurrent miscarriages. They are also associated with other pregnancy complications, such as death of the foetus in the second or third trimester, pre-eclampsia and growth problems of the foetus in the womb. Women with this condition can be treated with heparin and low-dose aspirin to reduce their risk of another loss.

Fortunately, most women with recurrent abortions will have a successful pregnancy. What do I admire about these pregnant women who have had recurrent miscarriages? It is their hope that one day they will carry home a beautiful, healthy baby. In our country today, with our many problems, I trust that you will be inspired by their hope.

I would like to take this opportunity to thank you, my readers, and to wish you all a happy and blessed Christmas and a healthy and successful New Year.

Dr. Monique Rainford is a consulting obstetrician and gynaecologist. Email: yourhealth@gleanerjm.com.