About Aspirin and Recurrent miscarriage

As part of my MPH programme, I was able to perform a Systematic mini-review on the effectiveness of aspirin in treating women with recurrent miscarriage. I got a pretty good grade in it so I would like to share it with the more academically minded readers.

The summary is below:

Recurrent miscarriage is distressing, affecting 1% of all women and in a significant proportion no cause can be identified. Aspirin is recommended for abortion prevention and is often used empirically. The aim of this review was to determine if the empirical use of anticoagulants in women with unexplained recurrent miscarriage is justified.

Data sources included MEDLINE, DARE and the COCHRANE databases plus the reference lists of eligible studies.

Two randomised controlled trials and two prospective cohort studies of low-dose aspirin or enoxaparin compared with placebo/no treatment administered to pregnant women with history of unexplained recurrent miscarriage with a primary outcome measure of live birth rate were selected.

The results revealed 0.81 of participants on 20μg enoxaparin and 0.82 of participants on 40μg enoxaparin had live births while 0.70 of participants on 50mg aspirin, 0.68 on 75mg aspirin and 0.84 on 100mg aspirin had live births. The control groups had proportion with live births of 0.48 (questionable methodology), 0.70 and 0.64.

There is therefore a good chance of live birth with supportive care alone and the addition of anticoagulation may be unnecessary. More research in this area is needed.

I can't paste the whole study obviously, but I will be willing to answer any questions about my findings.

A Letter from Heaven

Sharon Jaynes writes in Girlfriends In God about how she struggled for three months after her miscarriage with feelings of grief. One day, she heard God speak to her heart a letter from her unborn child and that's what I want to share with you now.

Dear Mommy,

I asked Jesus if it would be all right for me to write you a letter. He said it would be OK.

First of all, I want to thank you for loving me and giving me life. I remember how happy you and daddy were when you found out that you were going to have me. I remember how you prayed that I would come to know Christ at an early age. I remember how you prayed that I would have a mission in life to help others.

Mom, I know that you and dad were sad when God decided to take me to heaven before I was born. I saw the tears that you cried. But Mom, what I wanted to tell you is this: Your prayers were answered. I am healthy. I am strong. I do know Christ, and He lets me sit on His lap every day. And mom, I do have a mission. Everyday new babies come to heaven who were never born. Many of them never knew the love of a mother or father. When they come to heaven, they always ask the same question; 'Baby Jaynes, tell me, what was it like to have the love of a mother?' And I can tell them. Oh, how I can tell them.

Thank you, mom, for loving me. I know you miss me. But one day we will be together and what a time we will have. Until then, imagine me happy and whole, playing at the feet of Jesus, and telling other babies about what it feels like to have a mommy that loves them.

See you soon,

Baby Jaynes

The uniqueness of a miscarriage

Every person is different and was created unique. And so, when a woman has a miscarriage, her experience is as unique as she is. You cannot predict what the miscarriage process will be like for her and you cannot predict what her feelings will be after the miscarriage.

Bearing this in mind, it is therefore very important to avoid projecting your expectations on the woman on how she should deal with the loss. Some women hate the idea of a D&C and would rather miscarry naturally while others will rather have the pregnancy end once and for all than endure days of bleeding and a prolonged good-bye. Some women are relieved when their pregnancies end, others feel a sense of loss that eases with time while still others deal with heightened feelings of depression, anxiety and guilt for much longer.

If we are going to offer support and encourage complete healing after a miscarriage then we should acknowledge and respect each mother's autonomy and the uniqueness of her experience; that miscarriage is common doesn't mean we should make it common.

This too shall pass

For anyone who is struggling, this poem really helped me when I struggled with grief after my miscarriage.

THIS TOO SHALL PASS

If I can endure for this minute Whatever is happening to me,No matter how heavy my heart is Or how dark the moment may be ...

If I can remain calm and quiet With all the world crashing about me,Secure in the knowledge God loves me When everyone else seems to doubt me ...

If I can but keep on believing What I know in my heart to be true,That darkness will fade with the morning And that "this will pass away, too!" ...

Then nothing in life can defeat me For as long as this knowledge remains I can suffer whatever is happening For I know God will break all the chains That are binding me tight in "the darkness"And trying to fill me with fear ...For there is "no night without dawning"And I know that "my morning" is near.
~ Helen Steiner Rice ~