KARACHI, Aug 4: Twenty per cent pregnancies end prematurely because of chromosomal abnormalities in the foetus while introduction of laparoscopic surgery to end ectopic pregnancy marks a major leap ahead from the extended recovery period required after common surgery.
Addressing a public health awareness programme at the Aga Khan University Hospital on Saturday, doctors discussed the issues surrounding early loss of pregnancy and highlighted the recent advancements in the field of obstetrics.
“Miscarriage is pregnancy loss prior to 24 weeks gestation. It occurs in 10 to 20 per cent of all pregnancies and may be associated with significant psychological sequel,” said Dr Rozina Sikandar, consultant obstetrician and gynaecologist at Aga Khan University Hospital, in her presentation on Early Pregnancy Loss and Recurrent Miscarriage.Foetal chromosomal abnormality (error in development of baby in utero) is the commonest cause of early miscarriage (i.e. pregnancy loss before 12 weeks) while late pregnancy loss (between 12 and 24 weeks) occurs less frequently and constitutes less than three per cent of all pregnancy outcomes.
She said all couples with a history of recurrent miscarriage should be evaluated for a possible cause although a significant proportion of cases remain unexplained despite detailed investigation.
While this is frustrating both for the patient and the doctor, it is reassuring that the prognosis in these women for a successful future pregnancy with supportive care is 65 to 75 per cent.
Dr Nadeem Faiyaz Zuberi discussed the ectopic pregnancy and its laparoscopic treatment.
In ectopic pregnancy, he said, the baby grew outside the uterus, most commonly in the uterine tube. Pre-existing uterine tubes damage was a significant risk factor for ectopic pregnancy and about 50 per cent of ectopic pregnancies were associated with some degree of tubal disease due to pelvic infection, endometriosis, appendicitis, previous pelvic surgery, reversal of a tubal ligation or fertility treatment, he said.
At times there is no obvious explanation for why an ectopic pregnancy has occurred. However, once a woman has had an ectopic pregnancy, she has a higher likelihood of having another one and should be monitored carefully if another pregnancy is attempted or suspected.
According to him, surgical treatment of ectopic pregnancy historically requires a laparotomy using a skin incision. However, with advancements in laparoscopic surgery, the foetus can now be removed using two to three small button-hole incisions. Following operative laparoscopy, patients are generally able to go home within 24-hours of surgery and return to normal in three to seven days at home.
The presentations were followed by a question and answer session.—APP