http___www.kinderwunschklinik.at_hr_uzroci_neispunjena_zelja_za_djetetom_kod_zena_ponovni_pobacaji__1.xml
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Habituelle Aborte - Recurrent miscarriages A miscarriage is the dying of the embryo or the premature birth of a child before it achieves the ability to survive independently. Miscarriages are a frequent occurrence: about 8% of all pregnancies terminate prematurely. After IVF treatment the miscarriage rate is even higher. The definition of recurrent miscarriages is applicable after three abortions have occurred in a continuous sequence (defined by the WHO = World Health Organization). Which examinations are meaningful? Examination of the uterus A malformation of the uterus or benign growths (mucous membrane polyps within the uterine cavity) can inhibit the blood circulation of the endometrium and thereby prevent the nidation of the embryos or negatively impact the development of the embryo after successful nidation. With the help of a hysteroscopy, this can be detected and treated. During this examination a camera is inserted into the uterine cavity. In some cases, an additional laparoscopy is necessary. Genetic testing Genetic abnormalities occur in approximately 3 to 5 % of couples who are experiencing recurrent miscarriages. Most frequently, these are so-called “translocations”, a “transfer” of genetic information within a chromosome pair. This may be present in the woman or in the man and does not result in any health problems. However, after the fusion of egg and sperm cell, this may lead to repeated miscarriages. Although in this case there are no available treatments, it is at least reassuring to find the cause for the miscarriages. Human genetic testing by a specialist can help clarify a couple’s chances of a normal pregnancy and the probability of a renewed miscarriage. If the woman wishes to fall pregnant, a diagnosis (e.g. a trophectoderm biopsy before inserting the embryo) should be considered. Hormone analysis Hormone dysfunctions can be identified in women suffering from recurrent miscarriages, like for example a lack of progesterone in the second half of her cycle. An increased LH value (LH = luteinizing hormone, which triggers ovulation) is also related to miscarriages. This imbalance in the hormonal system can be treated. A hormone assay between day 1 and day 4 of the cycle therefor is part of every miscarriage diagnosis. This not only determines the sex hormones, but also serves to check the thyroid gland function. Examination of the blood clotting Changes in the blood clotting can also trigger a miscarriage. This is because the blood circulation of the placenta can be disturbed by the smallest blood clot. A special blood test can examine the function of various blood clotting factors. Women affected by this are advised to take blood thinners during the pregnancy, in order to prevent a further miscarriage. Searching for special antibodies Approximately 20% of all women who suffer from the so-called “antiphospholipid syndrome” may suffer from recurrent miscarriages. These women have certain antibodies in their blood that negatively affects the blood clotting, and therefore disrupts the healthy development of the pregnancy. Here the women are also advised to take blood thinner during the pregnancy. Infections Infections in the female genital tract are less often considered in the case of recurrent miscarriages. In an advanced pregnancy it can however lead to premature contractions and in turn to a premature delivery. A vaginal smear can be taken to diagnose the infection. Treatment is carried out using special antibiotics that can be taken without hesitation during the pregnancy. A definite cause for recurrent miscarriages can only be found for about 50% of the couples. And not every cause can be treated. This may appear very disappointing, yet still 75% of the affected women sooner or later give birth to a healthy child.
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Ponovljeni spontani pobačaji Pobačaj je smrt embrija ili prerano rođenja djeteta prije postizanja izdržljivosti. Oko 8% svih trudnoća završava prerano. Nakon in vitro oplodnje, stopa pobačaja blago je porasla. O uobičajenom pobačaju se priča nakon tri pretrpljena pobačaja za redom (WHO definicija). Koji testovi su korisni? Ispitivanje maternice Malformacije maternice, ili benigne izrasline (polipi ili miomi sluznice unutar šupljine maternice) mogu utjecati na protok krvi sluznice maternice/materice, čime se sprječava implantacija embrija ili negativno utječe na njegov razvoj nakon implantacije. Korištenjem histeroskopije to se može otkriti i liječiti. U ovom istraživanju, kamera je umetnuta u šupljinu maternice. U nekim slučajevima, potrebna je dodatna laparoskopija. Genetička istraživanja Genetske abnormalnosti se nalaze u 3-5% parova koji su pogođeni ponavljanjem pobačaja. Najčešći su takozvani "izgon", "prijenos" genetskih informacija unutar kromosoma paru. Iako nije zdravstveni problem može dovesti do ponavljanih pobačaja nakon fuzije jajašca i spermija. Iako za ovo ne postoji nikakvo liječenje, ohrabrujuća je činjenica da su pronađeni uzroci pobačaja. Genetičko savjetovanje od strane stručnjaka može educirati parove zabrinuti izgledima za normalnu trudnoću i vjerojatnost ponavljanja pobačaja. Hormonska analize U žena s ponavljanim pobačajima zabilježeni su hormonalni poremećaji kao što su nedostatak progesterona u drugoj polovici ciklusa. Također, povećana vrijednost LH (luteinizirajući hormon LH = izaziva ovulaciju) je povezana s pobačajem. Takve "neravnoteže" u hormonalnoj ravnoteži su izlječive. Pregled zgrušavanja krvi Promjene u zgrušavanju krvi također mogu izazvati pobačaj. Razlog tome je poremećaj cirkulacije posteljice zbog najmanjih krvnih ugrušaka. Poseban test krvi može provjeriti funkciju nekoliko čimbenika zgrušavanja krvi. U potrazi za specifičnih protutijela U otprilike 20% svih žena, "Antifosfolipidni sindrom" može uzrokovati opetovane pobačaje. Kod tih žena, postoje određene antitijela u krvi koje negativno utječu na zgrušavanje krvi i na taj način ometaju zdrav razvoj trudnoće. Također u ovom slučaju, predlaže su antikoagulansi tijekom trudnoće. Infekcije Infekcije genitalnog trakta rijetko se povezuju s ponovljenim pobačajima. Međutim, u naprednoj trudnoći može dovesti do preranog poroda i na taj način izazvati prerani porod. Otkrivanje infekcija može se izvesti vaginalnim štapićem. Tretman se provodi određenim antibioticima koji su sigurni u trudnoći. Samo kod 50% parova pronađen je uzrok ponavljajućih pobačaja. Zbog toga što se ne zna uzrok kod nekih parova neplodnost nije lječiva. Iako ova statistika izgleda razočaravajuće pozitivno je što 75% pogođenih žena prije ili kasnije rodi zdravo dijete.