Bad Obstetric History (BOH Profile): The journey towards a peaceful pregnancy

Termination of pregnancy is a sensitive issue that leads to a lot of emotional barriers. Counseling may be needed for a couple experiencing spontaneous abortions. About 3/4th of such cases occur before Week 16 of pregnancy, and almost 20% of recognized pregnancies terminate as a spontaneous abortion.

Causes of spontaneous abortion:

  • 60% of such events arise from chromosomal or genetic issues in the parents
  • 15% occur due to infection in the mother, diabetes, dietary issues, anatomic issues or hypothyroidism
  • 25% of these cases go unlabeled for the cause.

What are Recurrent Abortions?

When 3 or more early pregnancies are lost successively, it is known as a recurrent abortion. If a woman has lost a fetus recurrently thrice, then she may still have a 60% or a higher chance for a viable pregnancy.

Identifying the Cause (BOH Profile testing)

  1. Causes of spontaneous abortions are usually linked to genetic reasons that occur randomly. The defect can be in the sperm, the ovum or even the embryo.
  2. Advanced maternal age is another issue that may lead to spontaneous abortions.
  3. Poor blood supply or infections of the uterus may also cause unsuccessful pregnancies.
  4. Immune problems and hormonal problems (thyroid, diabetes)
  5. Issues with the clotting of blood.
  6. Stress may be a result of recurrent abortions of pregnancy, but there is no empirical evidence that strongly suggests it. Environmental factors at work (pesticides, heavy metals) that expose individuals to hazardous substances may also lead to this.
  7. Cessation of smoking or excess alcohol consumption (leads to fetal alcohol syndrome) is advised to a lot of couples with RPL, as this may be a cause.
  8. Maternal obesity or cases of being severely underweight may also cause a loss of pregnancy.

Tests conducted in a BOH Profile:

The psychosocial needs of couples really need to be considered while offering help in case of recurrent pregnancy losses. The following tests are usually included:

  1. A medical and family history to assess genetic issues.
  2. Genetic examination of the fetus needs to be conducted using array-based comparative genomic hybridization to assess these factors.
  3.  Chromosomal analysis of the parents may be required, but usually, the parental abnormality is not a significant predictor of lost pregnancies.
  4.  Screening for the autoimmune Antiphospholipid syndrome(APL) that causes damage to body cells is quite important. This issue is commonly associated with lupus. Antinuclear antibodies that attack the body’s cells also need to be assessed.
  5. In females, assessment of the uterus is important, and in males, exercise habits, and lifestyle choices (smoking, drinking) need to be looked at.
  6.  Screening for hormonal defects in the thyroid needs to be conducted
  7.  A Sperm DNA fragmentation test can be done in the male semen to see whether damaged DNA is a cause for RPL.
  8. Testing for Prolactin, AMH, PCOD can help to assess the condition of the ovaries and associate it with recurrent abortions.

Treatment for Recurrent Pregnancy Loss:

There are various treatment options available for couples experiencing RPL, and these depend on what the BOH panel interprets. Genetic testing after miscarriage is, of course, one of the most important factors to decide the treatment. Some suggestions include:

  1. For women who show a history of three or more losses of pregnancy, aspirin can be used with heparin, once a positive pregnancy test is seen. Low doses of aspirin and heparin are not considered appropriate to combat this issue.
  2. Anti clotting treatments for women with e or more losses is often recommended.
  3. Hypothyroidism is often regarded as a cause for RPL, and hence this should be treated with levothyroxine to bring thyroid levels to normal.
  4. For those with subclinical hypothyroidism, TSH (thyroid-stimulating hormone) levels must be checked at 7-9 weeks, and hypothyroidism must be treated.
  5. Bromocriptine treatment is often used to increase the live birth rate
  6. Vitamin D supplementation may also help increase the chance of successful pregnancy.

Recurrent pregnancy loss is not only traumatic physically, but has a lot of emotional effects on the to-be parents of a child. The hopes and plans invested in a child are crushed by pregnancy termination, and these feelings of grief need to be assessed, especially in the case of recurrent loss. Evidence-based testing is the best way to deal with such issues and make sure they do not recur.

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