Friday, April 13, 2012

In which I speculate madly on 2nd and 3rd trimester pregnancy loss

2nd trimester loss can happen, from what I've seen, from one of 3 causes- placental abruption/rupture of membranes and incompetent cervix.

Because I've seen so many cases of 2nd trimester hell breaking loose, I've been trying to read up on this. The really horrible news, nobody has a clue and worse, no rigorous, meaningful research is being done here, mostly because its a very difficult situation to reproduce.

One thing jumps out at me- PROM/placental abruption  is strongly linked to local inflammation. Local inflammation can be triggered by infections. So UTIs, or bacterial or fungal  vaginosis, are bad news.  A pubmed search yielded this interesting study- a trial looking at whether treating women with an  infection with anti-fungal agent decreased the adverse outcome incidence- while they did not see statistical significance, there was trend toward reduction.

Interestingly, becoming vitamin D replete has been shown to help prevent bacterial vaginosis. It also decreases the risk of preterm labor.

Moving on to incompetent cervix: as a scientist the one question that jumps out for me is- is incompetent cervix merely a mechanical issue as the name suggests, or are there biological/physiological events leading to the cervix opening and labor starting?

While there is a clear link, IMO,  placental abruption and local inflammation, from what anybody can see, there is no established link between abruption /infection/inflammation and incompetent cervix.  But, because nobody has a darned clue as to what is happening here, I'd say its not outside the realm of possibility. The fact that cerclage I think has been scientifically shown to help, or rather, I hope it has, suggests that the problem may be indeed only mechanical. Nonetheless, I think even women who have been diagnosed with an incompetent cervix are definitely better off making sure they are doing everything possible to avoid local inflammation the next round.

The stuff that, IMO, is a very good idea for all pregnant woman

-Have regular tests and treatment if necessary to make sure you are both bacterial and fungal infection free
-Making sure you have 'good' bacteria -- ie take probiotics.
-Disturbances in glucose metabolism can be linked to infection--make sure your PCOS/diabetes is as well controlled as possible--metformin, vitamin D, and sadly, diet (Just FYI: Sunny at "Cease and Decyst" has a fascinating post on her elimination diet and Candida(yeast) infection)

None of this stuff is a surefire way to make sure late pregnancy loss never happens to you. We are all clueless and groping blindly here-- but I do believe all of these are simple things, which may just help a little. God knows, it can't hurt--well, except for the diet. That elimination diet (which is pretty darned extreme and I'm definately not advocating it for everybody) sounds like hell, but may do wonders for certain individuals.

Now- moving on to the non-science stuff-- I'm doing well, enjoying life, still dating that guy, have no clue whats going to happen in the future but I'm doing some very boring and difficult things to ensure that if I do want to stay in this country and skip the return to India bit, I retain the option. Sigh.


  1. It is AMAZING to me how little research there is into things like this.  And the studies that are out there are often too small to be able to do more than suggest that something *might* do something.  

    The best bet still is to be as healthy as you can and pray for the best, huh?

    Exciting that you're still dating the guy!  

  2. Very RE ran tests (swabbed) for vaginal infections prior to both my IUIs. I was on a round of anti-biotics prior to my 1st. I wonder if this is what he was checking for.

    Nice to hear you're still seeing the guy! Aw, romance :)