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Can I have a normal pregnancy after multiple abortions?

Tuesday, 18 November 2008
Answered by: Dr. Puneet Bedi
Consultant Obstetrician and Gynaecologist,
Indraprastha Apollo Hospitals,
New Delhi
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Q. I am a 33 years old woman and I got married at the age of 16 years and had 3 medically terminated pregnancies (MTPs). Two were at the age of 16 years and one was done at the age of 18 years. The earlier 2 MTPs were done without any blood group checkup but the third time my blood group was checked and it was B-negative. The doctor advised to go for MTP again for the 3rd time and asked me to take Anti-D. My relationship with my husband got strained and we had a divorce. I had severe pain and inflammation in the right side of the abdomen. Then I underwent laparoscopy after 8 years, which revealed intestinal adhesions (due to the MTPs), adhesionolysis was also done. My health has been perfectly normal for the last 4 years. But for the past one year, I am facing same kind of pain at the same location. Is it the recurrence of adhesions? I got married a second time and I am planning to conceive now. I am taking Novelon for the last 10 months. I do not know the condition of my uterus. My periods are very regular with a cycle of 35 days except one or two times in 10 years. Nowadays, I have observed that my discharge is of flesh colour on the first day and black on the fifth day. I haven't yet tried to conceive but am worried about my condition. Will I be able to have a normal pregnancy? Do I need to go for adhesionolysis again before conceiving?

A.  Nature never gave the choice to man of controlling fertility. Till 1950s a woman had a choice of remaining celibate or have many children now that contraception is available some people think that all pregnancies should be (or could be) planned and wanted. This is not true. There is no prefect contraceptive and if you have sex and do not want too many children, sooner or later you will require abortions. Even married couples have abortions if contraceptives fail. These days, abortions are relatively safe and in most cases the main morbidity of an abortion is the emotional trauma (and not physical injury), and that is what you seem to have (A lot of emotional injury though you may have some physical affects as well). I need to know more about your abortions before I comment. I would like to know at what stage these abortions were done (how many weeks of pregnancy) and if all three were surgical abortions (or was medication used), was anaesthesia and antibiotics used? Were they followed by complications like excessive bleeding, fever and infections or were they without too many complications? Since you have not yet tried to conceive in this marriage, (and you have proven fertility in the past), it would be inappropriate to assume that you are infertile in any way, or that there has been any permanent damage on account of your abortions. So you need not worry on that account at this stage, as most abortions do not have any bearing on future fertility. To start with you have an Rh Negative blood, but you have not written whether any test for antibodies have been done. In all probability you should not have any, but please get an IDCT (indirect Coombs test) done on your blood and this would tell you whether there has been any effect of the first 2 abortions. Logically if Anti D was used in the third abortion then obviously you were OK till then but if the anti D was given without testing it is possible that you have had some reaction. The chances are low even if you ex-husband was Rh Positive (obviously there is no problem if you ex or current husband, or both, are Rh Negative). Anyway this can be sorted out with a simple test IDCT and only if you have reacted to the first two abortions should that become a problem, the risk of that having happened is less than 5 %. In all probability Rh reaction should not have occurred so far, so please do not worry too much on that account. There should be no problem with your uterus and infection following delivery or abortion causes problems with the tubes and sometimes the ovary, which may lead to problems in conception, but generally infection of the uterus clears relatively easily and does not cause infertility. You have also not written where exactly the pain in the abdomen is. Since pelvic or lower abdominal pain is the one which can be because of pelvic pain. Anything above or around the umbilicus is likely to be because of intestinal infection. So please do not blame everything that is wrong in your life and body on the abortions. The adhesion could have been due to many reasons and they need to be removed only if they are causing obstruction, in all other cases the role of surgery is limited. There should be no need for the surgery again. Please get your abdominal pain with a GI surgeon and treat accordingly. In case it is in the lower abdomen please check with a gynaecologist and antibiotics may be the only things you require. You also do not need to worry about the pain once you do get pregnant; the pain generally gets better in pregnancy. But if it is due to an intestinal cause please get it treated before you plan a pregnancy. So please stop worrying about things that have not happened to you yet and dwelling too much on the past. You have a new marriage and a life ahead of you. It will be unfair both to you and your husband to keep thinking about your past. Like you said most of what you did at 16 was because of your age. Now is the time for you to grow up and be mature. There is a lot of self-blame self-pity and remorse in what you have written. Please get out of this cycle of regret and guilt. It will not get you anywhere. We all have problems and the only thing we can do is learn from our mistakes and cope with the problems. You seem to think you have done some great crime by getting abortions done. Well you did what was best for you at that stage. BE POSITIVE! (Even if you blood group is B Negative) and think ahead. I am sure you will have a good life (as you have had more than your share of bad happening to you in the past), but I fail to see how you can have a good life if you continue to be as negative as you are right now. If you do have problems in the future we will tackle them as they come. As for now please enjoy your new life. You have become cynical about love and marriage after your bad first experience but there is no need to be dejected. Statistically speaking second marriages generally fair well (at least much better).

A.  Nature never gave the choice to man of controlling fertility. Till 1950s a woman had a choice of remaining celibate or have many children now that contraception is available some people think that all pregnancies should be (or could be) planned and wanted. This is not true. There is no prefect contraceptive and if you have sex and do not want too many children, sooner or later you will require abortions. Even married couples have abortions if contraceptives fail. These days, abortions are relatively safe and in most cases the main morbidity of an abortion is the emotional trauma (and not physical injury), and that is what you seem to have (A lot of emotional injury though you may have some physical affects as well). I need to know more about your abortions before I comment. I would like to know at what stage these abortions were done (how many weeks of pregnancy) and if all three were surgical abortions (or was medication used), was anaesthesia and antibiotics used? Were they followed by complications like excessive bleeding, fever and infections or were they without too many complications? Since you have not yet tried to conceive in this marriage, (and you have proven fertility in the past), it would be inappropriate to assume that you are infertile in any way, or that there has been any permanent damage on account of your abortions. So you need not worry on that account at this stage, as most abortions do not have any bearing on future fertility. To start with you have an Rh Negative blood, but you have not written whether any test for antibodies have been done. In all probability you should not have any, but please get an IDCT (indirect Coombs test) done on your blood and this would tell you whether there has been any effect of the first 2 abortions. Logically if Anti D was used in the third abortion then obviously you were OK till then but if the anti D was given without testing it is possible that you have had some reaction. The chances are low even if you ex-husband was Rh Positive (obviously there is no problem if you ex or current husband, or both, are Rh Negative). Anyway this can be sorted out with a simple test IDCT and only if you have reacted to the first two abortions should that become a problem, the risk of that having happened is less than 5 %. In all probability Rh reaction should not have occurred so far, so please do not worry too much on that account. There should be no problem with your uterus and infection following delivery or abortion causes problems with the tubes and sometimes the ovary, which may lead to problems in conception, but generally infection of the uterus clears relatively easily and does not cause infertility. You have also not written where exactly the pain in the abdomen is. Since pelvic or lower abdominal pain is the one which can be because of pelvic pain. Anything above or around the umbilicus is likely to be because of intestinal infection. So please do not blame everything that is wrong in your life and body on the abortions. The adhesion could have been due to many reasons and they need to be removed only if they are causing obstruction, in all other cases the role of surgery is limited. There should be no need for the surgery again. Please get your abdominal pain with a GI surgeon and treat accordingly. In case it is in the lower abdomen please check with a gynaecologist and antibiotics may be the only things you require. You also do not need to worry about the pain once you do get pregnant; the pain generally gets better in pregnancy. But if it is due to an intestinal cause please get it treated before you plan a pregnancy. So please stop worrying about things that have not happened to you yet and dwelling too much on the past. You have a new marriage and a life ahead of you. It will be unfair both to you and your husband to keep thinking about your past. Like you said most of what you did at 16 was because of your age. Now is the time for you to grow up and be mature. There is a lot of self-blame self-pity and remorse in what you have written. Please get out of this cycle of regret and guilt. It will not get you anywhere. We all have problems and the only thing we can do is learn from our mistakes and cope with the problems. You seem to think you have done some great crime by getting abortions done. Well you did what was best for you at that stage. BE POSITIVE! (Even if you blood group is B Negative) and think ahead. I am sure you will have a good life (as you have had more than your share of bad happening to you in the past), but I fail to see how you can have a good life if you continue to be as negative as you are right now. If you do have problems in the future we will tackle them as they come. As for now please enjoy your new life. You have become cynical about love and marriage after your bad first experience but there is no need to be dejected. Statistically speaking second marriages generally fair well (at least much better).

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