I am going to write to you about this topic because it is a very common condition that we frequently come across in our gynaecological practice. You will agree with me that it is a very sad and difficult time for the patient and her husband or partner, particularly if the pregnancy was planned or conceived after a great deal of struggle. Besides physical inconvenience it also causes enormous mental scarring that lasts for a long time and in some cases, it permanently damages the relationship between the couple. Some of you may become angry or frustrated and eventually start to blame yourself or someone else. Much of this happens as a result of lack of proper explanation or support by the healthcare personnel at that time when you need them the most. Your doctor may be too busy or is attending a far more serious patient and you may have felt neglected.
I have, therefore, opted for being your friend to come forward and explain a few things in a stress free surroundings where I can raise a question and then try to answer those. These are actually your questions which I have learnt from you over thirty five years of practising the speciality in India and abroad. Imagine these conversations are happening not in my hospital but in your house with a cup of tea in our hands. Please remember one thing though that I am not your doctor who knows everything about you ( we say your medical history) and I have not carried out a checkup on you ( we say examination findings ). So your doctor or nurse knows more about you than me. My role will be to pass on as much information to you as possible so that you start to feel more confident and knowledgeable. Perhaps, you may be able to ask the right questions to your doctor or be able to prepare yourself better in case you unfortunately suffer from this condition.
I will communicate with you with question and answer format, that is, I will be the dummy patient asking questions and then I will be the doctor answering those as well. You just have a fun time and keep enjoying the good tea in front of you. Firstly, there will be easier questions followed by some complex questions and finally, some controversial questions to make you think. Unless you think you may not be able to retain the information in your head at the time when you need the most. I will try to include ten questions at a time and go on to the next post to put the next lot. I think I will be able to talk to you every fortnight so that you are not overburdened and lose interest. I have to see later if you can ask me any questions on this topic and whether we can make it interactive. It will be a lot of fun. We’ll see what happens in the future but currently, let us make a beginning at least. So here we go – your first question is coming up and it is easy-peasy.
Q.1. What do you mean by early pregnancy loss?
A.1. Early pregnancy means pregnancy up to three months or twelve weeks from the time a patient has become pregnant. Early pregnancy loss means loss of pregnancy has happened within this period.
Q.2.When I say there is early pregnancy loss then is there something called late pregnancy loss?
A.2. Yes, you got it right. There is something called late pregnancy loss. It happens when the loss happens after twelve weeks but before twenty four weeks of pregnancy.
Q.3. So it is easy. There are only two types of pregnancy losses, early and late, isn’t it?
A.3. Sorry, no. There is another type of loss of pregnancy. It happens time and again, one then two then three. We call it recurrent pregnancy loss. Although these repeated losses takes place during the same time frame i.e. from the first day of pregnancy up to twenty four weeks.
Q.4. Why do you keep repeating the expression ‘pregnancy loss’. Is it not the same as abortion or miscarriage?
A.4.Yes, you are kind of right. Many people and even the doctors used these words without thinking much about it. But we can choose our words more thoughtfully. Let’s say, if I ask you ‘Have you had an abortion?’ You may think I am talking about a pregnancy that you have terminated because you decided to go ahead for any reason. I am sure if you haven’t terminated any pregnancy but rather failed to continue the pregnancy for some medical reasons you will be angry with me. I have seen many patients protested and corrected the doctor when words are chosen insensitively. For me the word ‘abortion’ is a bit harsh, it may implicate guilt or criminality in some cases. So I avoid using this word for not hurting the sentiments of my patients. Miscarriage is a better term than abortion in my opinion but it is too technical. Many patients may not understand its meaning if their mother tongue is not English. So I prefer to avoid it as well.
Q.5. Why do you have to separate early from late? Is there a particular reason?
A.5. Yes, indeed. There are reasons. We found out that reasons for early pregnancy loss is not the same as late pregnancy loss and more importantly, the tests and treatments for one are not the same as the other. That means if you have an early pregnancy loss I will arrange different tests and offer different treatments than if you have a late pregnancy loss. That means the first thing for me to do is to find out how many weeks or months you have been pregnant.
Q.6. Are you a magician that you can find out how far I am into my pregnancy? Even I don’t know it for certain.
A.6. Well, surely it is tough to know sometimes but it is not always that difficult. You know that there are some specialists called embryologist who fertilise eggs with sperm in a laboratory. They actually know the exact date when the embryo (the earliest baby) is born and then there are other doctors who puts the embryo in the womb (uterus) and so we can find out exactly when one has started the pregnancy. If you conceive naturally then there are many ways to find out reasonably certainly when the pregnancy started. For example, your doctor may check with you your period details and try to work out the approximate age of the pregnancy. Now a days we rely more on Ultrasound scan to estimate the age of pregnancy and I am sure you have heard about Ultrasound scan already. We will talk about this later in more detail when we reach there.
I hope you have enjoyed the writings and I will take your leave now but promise to come back soon. Have a healthy and enjoyable life.