If a woman has a fibroid inside the womb cavity and she is planning to conceive, should she be operated on to have the fibroid removed?

If it is obvious that the fibroid has contributed to the woman's fertility problems and that the procedure can be carried out without seriously compromising the womb's ability to carry a pregnancy, then the doctor should proceed with the operation . On the other hand, if this evidence is lacking or weak, it may be more prudent to encourage the woman to try for a baby without the operation.

It is important for the parents to be aware that the surgery may sometimes so seriously weaken the uterine wall operated on as to make future safe pregnancy impossible. Moreover, occasionally scarring may follow the operation, potentially reducing the ability to conceive even further. All the pros and cons should be discussed so that the prospective parents are fully in the picture.

Womb position

Some women are known to have wombs that tilt backwards. Can this cause miscarriage?

Wombs normally tilt gently towards the front. A substantial minority of women, however, do have wombs which tilt towards the back. The common term is "retroverted uterus". This does not cause miscarriage or pregnancy loss.

There is an exceedingly rare complication of this anatomical state, where a growing uterus may be trapped in the pelvis and will fail to rise into the abdominal cavity. This

will cause increasing pain and an operation will easily correct the problem. This complication is very rare.

Infections and miscarriage

What is the role of infections in early pregnancy loss?

Any acute infection which causes the woman to have a high temperature and be generally ill has the potential to cause miscarriage.

 Urinary tract infections, especially if they affect the kidneys, frequently lead to uterine activity and miscarriage.

 Syphilis is now of largely historical interest in the western world, but is still a menace in many developing countries; it is known to cause miscarriage and stillbirth.

 Conditions such as acute hepatitis, by causing high fever may lead to miscarriage, as can the more common condition of appendicitis.

 Malaria remains a significant cause of miscarriage in tropical countries.

Remember: Infections do not have to be in the genital tract to pose a risk to the pregnancy.

Alcohol and miscarriage

What about alcohol and miscarriage?

There is evidence that sustained alcohol abuse can lead to pregnancy loss. Binge drinking has not been associated with this problem.

Smoking

Can smoking increase the risk of miscarriage?

Yes. The risk increases with the the number of cigarettes smoked. This is dealt with in greater detail in Chapter 20, "Smoking and alcohol use in pregnancy".

Hormone injections

Some obstetricians will recommend a course of hormone injections in the early phase of pregnancy if a woman has a history of unexplained repeated miscarriage. How useful is this?

The practice of administering progesterone injections weekly (or more frequently) throughout the first trimester, sometimes even beyond was a rather common practice in the past.

It is known that progesterone is crucial in the maintenance of pregnancy and it was assumed that somehow, for these women, this hormone was deficient and hence, supplements could resolve this problem.

Evidence of this theory in naturally conceived pregnancies is tenuous, to say the least; and evidence to the effectiveness of this treatment is lacking. This practice is now rare.