Dear doctor;

My last pregnancy ended in a miscarriage. I am pregnant again but it worries me that things might not go well again. I don’t even know what happened last time because I don’t smoke or drink although my boyfriend does both. How should I avoid a miscarriage? Nina, 26.

Dear Nina,

It is unfortunate that you lost a baby in womb. Was that the first pregnancy or the first time miscarriage in a second or third pregnancy? Technically, miscarriage is loss of fetus before 20 weeks of pregnancy. It is said as many as 50 per cent pregnancies end in miscarriage. Often, a miscarriage can occur as early as before the pregnancy is diagnosed.

A miscarriage may occur due to hormonal abnormalities where the balance of estrogens and progesterone is not sufficient to sustain the pregnancy. Uterine abnormalities like fibroids uterine malformations, where uterus cannot keep the growing baby can result in miscarriage. Incompetent cervical opening, which can open itself without causing pain as pregnancy progresses, can result in miscarriage.

Severe malnutrition, thyroid disease, uncontrolled diabetes, severe kidney and cardiac disease, infections like measles, mumps, toxoplasmosis, vaginal infections, some collagen vascular disorders, exposure to heavy metals, radiation exposure, all cause miscarriage. Drugs like anti depressants, ACEI used for hypertension can cause fetal abnormalities as well a miscarriage in early pregnancy.

Get a complete medical examination done, including hemoglobin estimation, a full blood count, blood glucose, thyroid function tests and uterine ultrasound. Balanced diet and regular light exercises are also useful. Try to avoid strenuous physical work. Avoid use of any medicine, particularly in the first trimester .and consult an obstetrician for regular monitoring of the baby. There is no reason to worry because all the risk factors are treatable.