ARC I The Arthritis and Rheumatology Clinic


Reflections

Recurrent Miscarriages

Ten years ago I had the privilege of working with Professors Graham Hughes and Munther Khamashta, who headed the Pregnancy Clinic at the Lupus Research Unit, Rayne Institute in St Thomas' Hospital in London. Their work on pregnancy and antiphospholipid syndrome (sticky blood syndrome) was extraordinary, transforming outcomes for women with the condition by using blood-thinning agents such as aspirin and heparin. The result of their approach increased the chances of a successful pregnancy from less than half to more than 90%. The joy of couples with their newborns after years of heartbreak with miscarriages made an indelible impression on me.

When I returned to Singapore, I saw that there was a dire need to support couples with recurrent miscarriages. Although statistics show that only 3% of couples trying for a family are affected, this figure is far too significant in terms of its psychological and emotional impact.

Over the years as I helped couples, I soon appreciated that the scope extended far beyond sticky blood syndrome and women with autoimmune diseases such as lupus. Pregnancy is indeed nothing short of a miracle. The changes in a mother's immune system that enable her to accept a fetus that has only half of her genetic makeup are profound, with a complex and wonderful blend of immune and vascular changes that enable the pregnancy to progress successfully.

It was in 2009, in collaboration with Professor Mahesh Choolani and his team that the Pregnancy Loss Clinic was set up at the National University Hospital. At that time, scientists in the field of Reproductive Immunology were making great advances in understanding the complex interaction between mother and fetus. Our team was awarded a research grant that year and pioneered the work in Reproductive Immunology in Singapore and the Asia-Pacific region. Our multidisciplinary program was the first to offer evaluation and management for couples with recurrent miscarriages.

Although we have had many heartening successes helping couples have families after repeated, heart-breaking losses, we acknowledge that current therapy does not help all. More needs to be done and it is the patients and their journeys that compel us to press on.


Dr Sheila Vasoo
MBBS, MRCP (UK), FRCP (Edinburgh), FAMS (Rheumatology)
Senior Consultant Physician & Rheumatologist

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