In line with its mission, the Editorial Board of MedTvoiLokony makes every effort to provide reliable medical content supported by the latest scientific knowledge. The additional flag “Checked Content” indicates that the article has been reviewed by or written directly by a physician. This two-step verification: a medical journalist and a doctor allows us to provide the highest quality content in line with current medical knowledge.
Our commitment in this area has been appreciated, among others, by by the Association of Journalists for Health, which awarded the Editorial Board of MedTvoiLokony with the honorary title of the Great Educator.
– Before I gave birth to Zuzia, I had three miscarriages and one stillbirth. I wouldn’t have gone through this hell if I had been diagnosed with immune system disorders right away. They caused changes in blood parameters, and only during pregnancy. What was the result of these changes? Blood clots and infections. That’s why I was losing my children … – Joanna confesses.
Little Zuzia has a mother and a father. He also has a brother, Michał, and three other siblings. Michał is visiting with his mum and dad at the cemetery, he will never know the names of the other three …
In order for Joanna to finally give birth to a healthy daughter, it was enough to take appropriate blood thinning medications from the first days after conception. Just enough and enough for her to become a mother. That is why the woman still resents the doctors that they were not able to diagnose her properly. They risked the loss of their children and a mental pain that cannot be erased from the heart.
– One of the more and more frequent causes of death of children during pregnancy or premature births are the so-called autoimmune diseases including antiphospholipid syndrome. Simply put, they cause the mother’s body to treat the embryo as a foreign tissue that needs to be combated. The problem is that specific antibodies only become active during pregnancy, so by then the woman is confident in her good health. Treatment consists of administration of acetylsalicylic acid and low molecular weight heparin throughout pregnancy. These are injections that are given every day, usually in the stomach – explains Małgorzata Bronka, board member of the Parents’ Association after a Miscarriage.
– For women suffering from disorders of the immune system (and there are more and more of them in the population!) It is a proven and the only way of treatment, and therefore a chance for a happy solution and getting offspring – adds Bronka. – To make matters worse, the treatment is not complicated and with good cooperation with the doctor and the mother’s self-discipline, it is enough for the daily intake of medications and injections to end in a happy birth. That is why it still amazes me that autoimmune diseases are so rarely diagnosed as the cause of premature loss of a child in the scale of female tragedies. The second miscarriage in a healthy woman should be a signal to the doctor that it is also worth checking this lead. Meanwhile, confused mothers hear; “Miscarriage? It happens. Please keep trying until you succeed. Only at what cost?
It’s true, I wouldn’t have given birth to Zuzia without the injections, Joanna confesses. – In July 2010, I finally found a doctor who first offered me bacteriological and hematological tests. He noticed that during pregnancy my blood parameters change, there is a different clotting condition that is dangerous for the fetus. He set me up on medications that I had been taking throughout my pregnancy. From the first day after you get a positive pregnancy test until the day you give birth. No reduced fare. I had lumps on my thighs and abdomen after the injections, but it was a breeze compared to the hell I was going through with miscarriages. After the first miscarriage, the doctor reassured me – it happens. Forget about everything, do not investigate, relax … When a year later I was expecting a baby again, I was already more vigilant. Spotting bothered me. I talked to my mom about it. We decided it needed to be checked. But it’s idyllic in the hospital. The doctor praises my results, smiles friendly. I am young, she repeats, I am strong and the spotting will pass by itself. There is nothing to fear … A dozen or so moments later I was splashing my blood down the corridor. Over the course of the next few weeks, I had a 12-week-old miscarriage.
The third pregnancy is already a real swing of emotions. Asia and her husband think for a long time. They weigh the pros and cons, stuff their fears at the bottom of their heads. After all, it cannot be that both healthy and young, with the results of five, cannot have their own child!
However, no doctor has been able to explain to them why Asia is dying. When it turned out that the third pregnancy was ectopic, Joanna was furious.
– I had to separate emotions from reason. Emotions drove me into a black hole and despair, but my mind was telling me there must be some reason for it! Every examination, ultrasound, every blood and urine analysis, everything they referred me to and what they examined me for, I carefully stored in a binder. Though I cried bitterly at the thought of losing another baby, I was glad the ectopic pregnancy was laparoscopically removed. Thanks to this, I preserved my reproductive organs. I could try for a child again – says the woman.
Attempt number four. Joanna is running around the doctors with a binder. He still hears a mantra: don’t worry too much. Pregnancy is going well. So the joy of waiting for a baby is mixed with the panic medicine. The three lost children left their mark. Asia is counting down the days. When the 10th week is up, he is relieved. Even greater when it exceeds twelve. He is happy because the belly is finally visible. He comes home from work on a warm afternoon in April. At home, she eats a meal with her husband, then takes a nap. A sudden blast of heat puts her on her feet. The husband measures the fever, calls the ambulance, it’s bad. At night, Asia gives birth to her 23-week-old son in the maternity ward. The boy is dead, but the midwives allow her to stay with the baby until morning.
– What a mother feels at such a moment cannot be told – confesses Joanna. – I was furious that I could not convey my breath to my son, my heartbeat, that I could not warm up his tiny hands, lift the tiny covers and see the life in them. What a woman I am!
The fifth child, Zuzia, Joanna reported without any problem. She gave birth to a daughter by caesarean section. Says:
– My pregnancy was bookish, even… boring. The discomfort was that I had to inject myself every day. My stomach and thighs were blue from punctures, in tumors. But I also remembered that it was the tiny blood clots in the uterine arteries that caused the infection and caused Michał’s death. This is how my body reacted to pregnancy, I had no influence on it …
Joanna also wants to emphasize that multiple miscarriages burden the mother’s psyche forever. – People tell me how happy I must be because I finally have a daughter. Then I just want to howl. Sure, Zuzia is our greatest treasure, but I am also a mother of four other children who were not born. And with this “not given”, I can not accept. These were unnecessary deaths….
Małgosia Bronka: We all want to create happy families. Children want wise parents, parents – joyful and happy children. It is much harder for a woman who has had two, three, five or even more miscarriages to find the role of a calm and joyful mother! We admire the determination of women who, after such terrible experiences, finally gave birth to the child they wanted. But does it have to come at such great physical and mental cost? That is why we appeal to doctors: each miscarriage is a great trauma for the mother. But it does not eliminate the chance of becoming a parent. Be more attentive to your patients. It is about our common good – children.
An interview with Dr. Maciej W. Socha, a specialist in obstetrics and gynecology
– What are autoimmune diseases that pose such a great threat to the life of a child in the womb? Why do they only become active during pregnancy?
– Autoimmune diseases are a group of disease syndromes often referred to as autoimmune diseases, which seems to reflect the definition of these diseases. In most cases, proteins – antibodies are produced that are directed against certain cells or groups of host cells. In some cases, antibodies made to fight the real enemy of the body can cross-react with normal cells in the body, causing them to become damaged or destroyed, with characteristic symptoms. Pregnancy is a specific health condition of a woman in which the organism is retuned in order to maintain the pregnancy and the well-being of the pregnant woman. In a way, a fetus can be treated as a transplant, due to the partly different genetic material from the maternal. In order for the pregnant woman’s body not to identify the fetus and the structures of the fetal egg as foreign, the woman’s immune system changes, which allows her to tolerate foreign tissues and preserve the pregnancy. This immune re-tuning sometimes causes exacerbation or disclosure of autoimmune diseases. This is explained by a specific weakening of the body’s defenses against the antibodies circulating in the body, which react more easily with healthy tissues.
– Are autoimmune diseases a common cause of multiple miscarriages?
– Autoimmune diseases are a large group of disease syndromes and in many of them the increased risk of miscarriage is closely related to the condition of the woman’s body. Recurrent miscarriages are many times the same symptom of an autoimmune disease as other ailments in its course. Specific antibodies contribute to miscarriages, among which antiphospholipid antibodies and lupus anticoagulant deserve special attention. These antibodies are present in the Antiphospholipid Syndrome (AFS, Hughes Syndrome) and this disease is the most common autoimmune disease leading to miscarriage. Despite the fact that the titer of the tested antibodies does not always meet the disease definition criteria, it is found in even 50% of women with recurrent miscarriages (depending on the adopted research criteria).
– Can a woman, before the planned pregnancy, somehow test herself in this direction? Use any preventive measures?
Unfortunately, there is no screening for autoimmune diseases or preventive measures. The indications for such tests are only symptoms indicating suspected autoimmune disease or subsequent miscarriage. It should be remembered that the vast majority of miscarriages are caused by abnormalities in the genetic material of reproductive cells and, secondarily, the fetal egg, therefore even the first miscarriage is not an indication to extend the diagnosis by immunological tests. However, it is worth consulting a specialist in obstetrics and gynecology and broadening the medical history in order to look for possible indications for additional tests.
– Why, in the opinion of some mothers, after multiple miscarriages, is the correct diagnosis in the doctor’s office so late?
– The problem of miscarriages is related to the limited fertility of humans as a species. It is estimated that up to 40% of the reproductive cells contain abnormal genetic material, and so-called genetic causes are the most common cause of miscarriage. If the general gynecological and physical examination, together with the ultrasound examination, does not indicate the presence of the disease, then both the first and the second miscarriage may be due not so much to the presence of diseases in the mother or father, but to the biologically ascribed bad luck in trying to get pregnant. Unfortunately, the imperfection of diagnostic methods also makes it difficult to interpret the test results, because, for example, not all patients with antibodies present will have a miscarriage. We also do not know the titer of antibodies that would definitely indicate that the patient will have a miscarriage. Thus, prophylactic treatment does not make much sense and, unfortunately, recurrent miscarriages should be treated when clinically indicated, i.e. after three or, as some medical publications indicate, after two miscarriages.
– Is LMWH treatment always effective in pregnant women with immune system disorders? What are the side effects of such treatment?
– Treatment of pregnant women with autoimmune diseases with low-molecular-weight heparins reduces the risk of miscarriage, although it will not be possible to prevent them in all cases. The mechanism of low-molecular-weight heparin action is related to the modulation of the coagulation response and changes in the proportion of plasminogen activators and its inhibitors, which reduces the risk of thrombosis in the utero-fetal-placental unit. Low molecular weight heparins also affect the reactivity of vascular endothelium and change the receptor response in the presence of anticardiolipin antibodies and lupus anticoagulant. Rare complications in the form of a decrease in the level of platelets (HIT 1 and HIT 2 syndromes) are relatively easy to treat and are not a cause for concern among doctors. Side effects reported by patients include the inconvenience of subcutaneous administration of low molecular weight heparin and skin ecchymosis.
Joanna Weyna Szczepańska