Recurrent Miscarriage in SubSaharan Africa Exploring Causes, Challenges, and Future Solutions

Introduction

Recurrent miscarriage is a pressing but often underreported reproductive health issue in Sub-Saharan Africa. With limited diagnostic resources and poor access to specialized care, many women experience repeated pregnancy loss without clear explanations or effective interventions. A recent review sheds light on the prevalence, causes, and potential solutions to recurrent miscarriage in the region.
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Understanding the Scope of Recurrent Miscarriage

• Defined as the loss of two or more consecutive pregnancies, recurrent miscarriage affects around 5% of couples globally.
• In Africa, the definition is adapted to local resource constraints, considering pregnancy losses of fetuses over 500g or before 24 weeks.
• Studies indicate the condition remains poorly managed in Sub-Saharan Africa, often misdiagnosed or undetected.

Genetic and Immunologic Etiologies

• Genetic factors, such as balanced chromosomal translocations, are rarely diagnosed due to limited access to cytogenetic testing.
• In a rare reported case from Rwanda, a balanced translocation [46.XX, t(13p,21p)] was found in a woman with four consecutive miscarriages.

Anatomical and Endocrine Factors

• Uterine anomalies like bicornuate or septate uterus contribute significantly to infertility and miscarriage.
• Endocrine issues including diabetes mellitus and thyroid dysfunction were also highlighted. Poorly managed diabetes (HbA1C >8%) correlates with higher risk of early miscarriage.

Infectious Agents

• Pathogens such as Listeria monocytogenes, Rubella, Cytomegalovirus, and Herpes simplex are suspected contributors, though their role in recurrent loss is still debated.

Unexplained Losses and Resource Gaps

• Up to 70% of RM cases in the region are classified as unexplained, likely due to limitations in diagnostic infrastructure.
• Many patients lack access to immunogenetic testing or chromosomal screening.

External Medical Insights

The American College of Obstetricians and Gynecologists (ACOG) recommends comprehensive evaluation after two losses, including endocrine and anatomical screening, especially in high-risk populations.

Further Reading and Resources

Read the full study at: https://doi.org/10.29328/journal.cjog.1001173

For similar content, explore:

• Pregnancy & Reproductive Health Section
• Latest Review Articles

A detailed analysis can be found in our main journal article URL.
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Solutions and Future Directions

• Early chromosomal testing and immunogenetic profiling can help personalize care.
• Cervical cerclage has shown significant success, with up to 89.4% child take-home rate in elective procedures.
• More localized studies are necessary to establish region-specific protocols.
• Genetic counseling and lifestyle modifications such as folic acid supplementation are simple, impactful interventions.

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