What is Bad Obstetric History?
Bad Obstetric History" (BOH) refers to a woman's history of previous pregnancies that had problems and resulted in unfavorable outcomes such as miscarriages, stillbirths, congenital anomalies and intrauterine growth retardation.
Classification of Bad Obstetric History
An obstetrician, a doctor who specializes in delivering babies, caring for pregnant women, and postpartum care, considers whether a woman has a history of any of the following outcomes during previous pregnancies when classifying her under BOH:
Recurrent miscarriages: A woman who gets pregnant but experiences repeated miscarriages, particularly in the first or second trimester of her pregnancy.
Intrauterine deaths: The baby passes away while still in the uterus.
Neonatal deaths: The infant passes away within a month after birth.
Birth defects: The fetus has certain structural and functional prenatal abnormalities.
Pre-term labor: Labor starts earlier than usual, which usually happens between 20 and 37 weeks of pregnancy. Premature birth from pre-term labor puts the baby at a higher risk of health issues.
Stillbirths: The infant passes away prior to or during the delivery.
Severe intrauterine growth restriction (IUGR): When a fetus does not grow normally, it is known as IUGR, or fetus growth restriction.
A woman is deemed to have a BOH if she experiences any of the aforementioned outcomes. It is important to determine the cause of BOH as well as its severity in order to provide the best possible treatment.
Causes of Bad Obstetric History
BOH is caused by a variety of factors including:
Genetic factors: About 50% of miscarriages are caused by chromosomal abnormality. The normal process of cell division and growth get disrupted due to extra or missing chromosomes which can result in pregnancy loss in the first or second trimester. Additionally, a genetic disorder called thrombophilia can stop fetus growth by causing abnormal blood clots, which ultimately results in miscarriage.
Hormonal disorders: In order to maintain the baby's growth and health inside the womb, pregnancy hormones are necessary. Unbalanced hormone levels can result in problems and unfavorable pregnancy outcomes.
Autoimmune response: It is a condition where the mother's immune system starts attacking the fetus abnormally because the immune system perceives the fetus to be dangerous. This could result in frequent miscarriages.
Infections: Some maternal infections, such as cytomegalovirus, herpes, hepatitis B, rubella, and syphilis harm the fetus and can cause miscarriages or congenital abnormalities.
Pre-eclampsia: It is a condition of high blood pressure that affects pregnant women and interferes with the placenta's ability to get enough blood and oxygen. A lack of blood and oxygen may hinder the fetus's growth and lead to unfavorable pregnancy outcomes.
Diagnosis of Bad Obstetric History
The first step in trying to become pregnant after experiencing back-to-back pregnancy losses is to identify the underlying cause and switch to a more suitable course of treatment. An obstetrician will typically advise getting a BOH profile blood test done to determine a women’s obstetric history.
Bad Obstetric History profile test aims to identify the underlying factors behind repeated miscarriages. The following are some typical BOH-inducing factors that are evaluated in a BOH profile test:
Anti-nuclear antibodies (ANAs): ANAs are antibodies that target healthy proteins in the nucleus of a cell. The healthy fetus is attacked by these ANAs, causing unfavorable pregnancy outcomes. BOH profile test aids in the diagnosis of several autoimmune disorders that may affect the developing fetus, including autoimmune hepatitis, systemic lupus erythematous (SLE), scleroderma, and Sjögren's syndrome.
Anti-phospholipid antibodies (APAs): APAs aid in blood clotting in expectant mothers. Women who have anti-phospholipid antibodies in their bodies experience repeated miscarriages because the placenta cannot receive enough blood. This affects the fetus's ability to receive the required supply of oxygen, nutrients, and blood.
APAs are found in about 15-20% of pregnant women who experience recurrent miscarriages. BOH profile test includes detection of antibodies such as lupus anticoagulant (LA), anticardiolipin antibodies (ACAs), and anti-beta-2-glycoprotein I antibodies (AB2GPI).
TORCH infections: Toxoplasmosis, syphilis, hepatitis B, rubella, cytomegalovirus, and herpes are all included in the group of infections known as TORCH. These infections are all harmful to the developing fetus. BOH profile test involves detection of group of infections that may pass down from an infected mother to her developing or new born baby.
Thyroid hormone test: Hypothyroidism can increase the risk of miscarriages in the second trimester. BOH profile test can identify various hormones linked to thyroid function.
Karyotype analysis: Karyotype analysis, also referred to as chromosome analysis, is a test used to look at the chromosomal abnormalities in the patient and her partner. Each parent contributes 23 chromosomes, and a typical fertilized egg has a total of 46 chromosomes.
Now, the fetus may not survive and miscarry if a chromosome is missing (monosomy), there is an extra chromosome (trisomy), or if its structure is flawed. Accordingly, an appropriate treatment plan can be developed based on the karyotyping results such as in vitro fertilization of embryos and Preimplantation Genetic Testing (PGT), which has an 80% reduction in miscarriage rates.
Endocrine monitoring: Certain hormones, such as prolactin levels, anti-thyroid antibodies, and thyroid-stimulating hormone, are monitored to determine whether the BOH is caused by abnormal production of some hormones by the endocrine system.
Management of BOH
A treatment plan for BOH management is dependent on the cause/causes of BOH diagnosed through the tests. It may consist of treatment of infections, hormonal disorders and other corrective actions.
Women can manage BOH and have a healthy pregnancy by identifying its underlying cause. BOH profile test can assist in the diagnosis of BOH and help the doctor in treating the patient effectively by identifying the infection or antibodies responsible for the unfavorable pregnancy outcomes. After receiving the appropriate treatment for BOH, women can seek the assistance of a fertility specialist to aid in their pregnancy journey.
