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Phone

(03) 9416 2802

 

Email

info@drstephencole.com.au

 

Fax

(03) 9495 6491

 

Address

Suite 207, 320 Victoria Parade

East Melbourne, VIC 3002 

 

My private consulting rooms are located on the ground floor of the Epworth Freemasons Day Procedure and Maternity Centre in East Melbourne.

 

Getting There

Underground parking is available for a fee. There is also limited on-street metered parking in the area.

 

The number 12 and 109 trams stop right outside the building, and the number 11 and 30 tram stop is a 5 minute walk away.

 

The number buses also stop right outside the building.

 

Train access is via Parliament station, which is a 10 minute walk away

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Miscarriage

 

 Miscarriage is defined as the loss of a pregnancy at less than 20 weeks gestation, although most miscarriages actually happen in the first 10-12 weeks of pregnancy.  Miscarriage is very common.  In fact many people fail to appreciate just how common.  Approximately 15% of women who realise that they are pregnant will experience a miscarriage.  But miscarriage is even more common than this.  Most miscarriages actually happen before women even realise that they are pregnant.  When you include these events, it is apparent that up to 50% of all conceptions end in miscarriage.

 

Miscarriage can be a traumatic experience, causing significant disappointment and distress.  Not everyone responds in the same way however, and women can experience a range of different emotions after miscarriage.  There is no "right" way to feel after a miscarriage.  Some women may feel that no-one understands what they are going through.  There is not a single approach that is right for every person, but for most women, sharing their experience with trusted family or friends who have had similar experiences is a positive, helpful thing.

 

The most common cause of miscarriage is a chromosomal (genetic) abnormality in the baby.  This is almost always a random, unpredictable event, and something which you have no control over.  It occurs at the moment of conception.  In almost all cases of sporadic miscrriage, there is nothing that the woman, or her health professional could have done differently to change the outcome of the pregnancy.  The risk of chromosomal abnormality increases as women get older, so the risk of miscarriage also increases as women get older.

 

 

 

 Recurrent Miscarriage

 

Recurrent miscarriage (sometimes also called recurrent pregnancy loss) is defined as 3 or more consecutive miscarriages.  It occurs in approsximately 1% of women.

 

One miscarriage can be distressing.  Having multiple miscarriages can be paritcularlydevastating and demoralising.  Not only are there feelings of loss and disappointment for each of the failed pregnancies, but in addition there can often be feelings of anxiety and uncertainty about the future, and the fear that a successful pregnancy is never going to happen.

 

Thankfully, most women who experience recurrent miscarriage will still have successful pregnancies.  In fact, over 80% of women with recurrent miscarriage will give birth to a healthy baby.  

 

Causes of Recurrent Miscarriage:

  • Chromosomal abnormalities in either parent
  • Stuctural abnormalities of the uterus
  • Cervical incompetence
  • Autoimmune conditions
    • In particular the antiphospholipid syndrome
  • Advanced maternal age
  • Hormone imbalances

Investigations looking for an underlying cause of recurrent miscarriage are usually performed after 3 consecutive miscarriages. Sometimes investigations may be considered after 1 or 2 miscarriages in the following settings:

  • Later miscarriage (after 12 weeks)
  • Advanced maternal age
  • Co-existing impaired fertiltiy (taking a long time to get pregnant, or requiring fertility treatment)

In approximately 50% of cases fully investigated for causes of recurrent miscarriage, no underlying cause is found.  This can often be frustrating, as many people feel better if they have an explanation for why the problem has occurred.  However it is worth remembering that finding nothing wrong is generally good news.  In unexplained recurrent miscarriage,  pregnancy success rates are generally higher than when an underlying cause is identified.

 

There are many theories about other potential causes of recurrent miscarriage.  including things such as NK (natural killer) cells in the lining of the uterus, disturbances of blood clotting mechanisms, and immune system incompatability between the parents.  Whilst there is some evidence to support some of these theories, they are not yet considered proven, or definitive causes.

 

Lifestyle factors such as obesity, smoking, excessive caffiene intake and stress are not thoguht to be major causes of either miscarriage or recurrent miscarriage, but may increase the risk somewhat.  Paying attention to, where possible correcting these factors is something that you can do which will not only minimise your risk of miscarriage, but will also optimise a healthy environment for your pregnancy.

 

 

 Treating Recurrent Miscarriage

 

There are numerous treatments described in the management of recurrent miscarriage.  Some of these include:

  • Low dose aspirin
  • Heparin
  • Cervical Suture
  • Uterine surgery
  • Immune suppression or modulation
  • Hormone support
  • IVF, +/- pre-implantation genetic diagnosis

Not surprisingly, the specific treatments that may be recommended for you will depend on what the underlying cause for your miscarriages is thought to be.  Sometimes more than one treatment may be recommended at the same time.

 

It is important to appreciate that there are different amounts of evidence to support the use of different treatments.  Some treatments have been shown to be effective or beneficial, and others have no or little evidence to support their use.  It is not always possible to be certain which treatments are of proven benefit, and which do not have sufficient supporting evidence by simply searching the internet.  If you have read about certain treatments which sound reasonable, or if they have been suggested to you, it is important to discuss these with your doctor before deciding whether they are appropriate for you.  Don't be afraid to ask about what evidence there is to support specific treatments.

 

One intervention that research has shown to be effective is to provide expert supportive care during the first trimester.  This includes expert medical care, psychological support, and regular utrasounds.

 

 

 My Practice

 

For over 15 years I have been committed to caring for women who have suffered pregnancy loss, including miscarriage, recurrent miscarriage and stillbirth.  I can arrange for all of the investigations you require.  I am also able to advise you regarding appropriate treatment strategies.  I will discuss with you the relevent evidence supporting the different treatment options, and recommend those that are most likely to be beneficial for you.  Treatments that have a solid evidence base are preferred.  Where these have been unsuccessful, I will discuss with you the rationale for newer therapies, including discussing the potential risks and disadvantages of these therapies as well as the proposed benefits, so you are as well informed as possible.  

 

I understand the anxieties of embarking on a new pregnancy in this situation.  I strive to provide a supportive environment, acknowledging and addressing the stresses of being pregnant when you have previously experienced pregnancy loss.  At the same time, I try to create a positive, normalising atmosphere for your pregnancy.  I will develop a clear plan with you, discussing all of the investigations and treatment strategies that are appropriate for you.  I will also provide  the regular ultrasounds that give added reassurance, and which have been shown to be beneficial.  I can arrange additional psychological and genetic counselling counselling services should they be required.

 

If you would like to make an appointment to discuss your miscarriage history, or plans for a future pregnancy, please feel free to make an appointmentby contacting my rooms, or by completing an online enquiry form on this website