Miscarriages

My interest into the topic of miscarriages came about through work experience at Broomfield Hospital, where I spent time with woman going through a miscarraige, caused by an immune response, which was heartbreaking for the couple, who had experienced it a number of times before. It struck me how a such a devastating experience so big, could stem from something so small, on a molecular level. Miscarriages are very common occurrence with around 30% of pregnancies ending up unsuccessful. This was a shocking statistic for me to see, as I had not realised how prevalent they were in society.

Most early miscarriages are caused by a random genetic problem in the foetus, causing the mothers body to reject the foetus, as it may have too many or not enough chromosomes. They can also be caused by problems with the development of the placenta, that links the mother's blood supply with that of the baby's.This type is non-reccurent and most people who experience this can then go on to have a normal healthy pregnancy. 

On the other hand some recurrent miscarriages are caused by other issues which is obviously upsetting and frustrating for the potential mother. Causes of recurrent miscarriages are:

• anatomical, such as a misshaped uterus, large fibroids, dramatic scarring within the uterus or a weakened cervix. This is when the muscle opens too early during pregnancy causing a miscarriage and can be treated with a "cervical stitch" and removed near the end of pregnancy.
• genetic defects in the egg or sperm, which is more common in men and women over 35.
• blood clotting in the uterus which can leave the placenta cut off so the foetus receives no nutrients or oxygen.
• high homocysteine levels (Sulfur-containing amino acids) causes hypercoagulability where your blood clots more easily, putting you and the baby at risk
• This can lead to hormone imbalances in the womb.
• Immunological disorders.

Immunological disorders as a cause of miscarriage

Some people with autoimmune diseases such as lupus, are at higher risk of a miscarriage. This is a poorly understood condition where, for reasons not clearly known, the immune system attacks healthy tissue. This means that when you get pregnant, antibodies fight off the developing pregnancy tissue as if it was foreign, therefore causing a recurrent miscarriages to occur.

Ebola Virus Disease

This virus has recently taken over science and medically related news pages, due to fears of an impending outbreak in the UK. With no licensed treatment or vaccine, an outbreak has already occurred in Sierra Leone and as a result they have had to announce a four day lock down. Overall over 2000 people have died already.

Ebola Virus Disease (EVD), formally known as Ebola haemorrhagic fever, is a severe or fatal illness with a fatality rate of up to 90%, with the current outbreak having a mortality rate of 55%. Outbreaks occur as the virus is transmitted from wild animals to people and then continues to spread via human-to-human transmission, through direct contact with bodily fluids. Fruit bats are the natural host of the virus. Infections have also been known to come from chimpanzees, gorillas, monkeys, forest antelope and porcupines.

Genus Ebolavirus is composed of five distinct species:

1. Bundibugyo ebolavirus (BDBV)

2. Zaire ebolavirus (EBOV)

3. Reston ebolavirus (RESTV)

4. Sudan ebolavirus (SUDV)

5. Tai Forest ebolavirus (TAFV)

BDBV, EBOV and SUDV are the species that have caused the large outbreaks. On the other hand RESTV species are found in the Philippines and can infect humans without causing illness or death, as known so far.

The problem is that symptoms may only show from 2 to 21 days from initial contraction. During this period you are unknowingly contagious leaving the virus open to spread to people close to you. In addition, after someone has recovered they can still be contagious. Men can transmit the disease by their semen for up to seven weeks after they have recovered from the illness. This is why WHO are encouraging educational health messages to be put out to prevent and control the disease. They focus on reducing the risk of transmission by telling people not to handle animals with bare skin or eat raw meat. People should avoid close physical contact and wear gloves when caring for patients at home, as well as regular hand washing. 

Symptoms

It is a severe viral illness, characterised by sudden onset of fever, intense weakness, sore throat, muscle pain and headache. This is then followed by rash, vomiting and diarrhoea, impaired liver and kidney function. In some cases there is internal and external bleeding. There is also central nervous system damage. Labs find that there's low platelet and white blood cell count and elevated liver enzymes.

Current Treatments
This sudden outbreak has caused researchers to concentrate their efforts on finding a suitable vaccine. The trouble is that, like HIV and influenza, Ebola's genetic code is a strand of RNA. Therefore the Ebola virus has a high rate of mutation and with mutation comes the possibility of adapting. 

Nevertheless WHO have announced that a vaccines could be in use in November. This is after, 150 experts have been investigating how to fast-track experimental drugs to make them available for use in West Africa. If proved safe they may be in use by November for use in West Africa. Unfortunately there would be limited supply of the drugs and to increase production could take several months by which time the disease would be much more widespread.

Fortunately, very recently the World Health Organisation have announced that an Ebola survivor's blood can be used to treat patients with Ebola. Antibodies produced in the survivors blood should be used and transferred to a patient. They cannot be sure of effectiveness just yet. From the 1995 outbreak in the Democratic Republic of Congo seven out of eight people survived who were given the therapy.