Vos questions sur les fausses couches - La Maison des maternelles #LMDM

Dr. Manon Marmouzé de La Taille, hello, thank you for being on the set of La Maison des Maternelles. We have a lot of questions to ask you. We've heard quite a rare testimony. Eight miscarriages in seven years, two of which are female. You are a gynecologist at the Hôpital des Bluets, in the PMA unit, and you have just set up two day hospitals, one to explore fertility, and the second for repeated miscarriages and miscarriages in PMA. Exactly. So you are really the specialist in these subjects. What can be the different causes of miscarriages? Almost all women experience one, but we always wonder what are the factors that increase the risks, what are the general causes? So, to define miscarriage, it is an early pregnancy loss that occurs before 12 weeks of pregnancy, and unfortunately it affects 10% of pregnancies. It's huge. It's huge, it's huge. In most cases, we find anomalies in the number of chromosomes, like, for example, in trisomies, and not just those that affect chromosome 21. And the parents are not the carriers of this modification, it is the embryo that is the carrier of an abnormal number of chromosomes. It's the lack of chance. Exactly. Can we say that the body does its job well, that is to say that it says to itself, there is something wrong, so I eliminate it? That's it. It still represents 60% of miscarriages, so it's huge, and it's often related to the quality of the egg of the mother. And so, like the quality of the egg, the egg is related to the age, it is related to the age of the mother. Okay, good. So, the other causes? The other causes, so if we stay in the anomalies, the modifications of the chromosomes, there can sometimes be, in repeated miscarriages, parents who are carriers of chromosome modifications, they have no symptoms, it is not seen in them, and yet it bothers during fertilization. It represents about 5% of miscarriages. Afterwards, I imagine that there are also structural anomalies in women. That's it, we have a lot of other causes too, which we find especially in repeated miscarriages. So, for example, the anomalies of uterus, fibromes, polyps, malformations, vitamin deficiencies, B6, B9, hormonal problems too, autoimmune diseases that can be found. And sometimes there is no explanation, as we had with Céline, where everything seemed totally normal. Exactly, so we know that it is almost two-thirds of the situations where there is no cause, which is very difficult, it does not mean that nothing happens. It is very difficult for women and for couples. In these cases, we do even more in-depth research, including a study of the immune receptivity of the endometrium, and we can also explore parameters in the partner, especially at the level of sperm, looking at oxidative stress. It's crazy, because we talked a lot about the anomalies in women, it's not just the mother. Fortunately, we also explore men. And then, what is terrible, we mentioned it earlier with Céline, it's a moment when we have no answer and we say, well, it's in your head. There are fewer and fewer doctors who do that, but that's still very guilty, because it's something we can't control. It's very, very difficult. It is true that in the other causes that must be taken into account, and which we also discuss with couples, stress, even if we can't tell someone it's in their head, is obviously impossible. Weight problems, we know that women who suffer from obesity have about 10% more risk of having a miscarriage, and women who are exposed to tobacco also have about 10% more risk of miscarriage. It's good to say it again. So there are a lot of questions, we don't have a lot of time, so go ahead. Yes, we will start with Laurence's, very concrete. Are bleeding and pain at the beginning of pregnancy necessarily worrying? So it's not necessarily worrying. We know that there is about a quarter of pregnant women who will bleed at the beginning of pregnancy. Half of them will have a well-evolving pregnancy, fortunately, and the other half can be the symptoms of early pregnancy loss. There is also, we must not forget, 1% of pregnant women who are at risk of having an extra-uterine pregnancy with bleeding. So it's really important to consult a doctor at that point, already to be able to be reassured about what's going on, make a diagnosis, eliminate a possible pregnancy that develops outside the uterus, which is called an extra-uterine pregnancy, check that the woman does not bleed too much, that she does not suffer too much, of course, and then if she ever loses a pregnancy, to be able to support her psychologically in such a difficult event. We consult, we consult. Nathalie asks you, how do we explain that there are incompatibilities between partners and that the two can become parents separately but not together? Does incompatibility exist or is it a language issue? So it's a difficult question. There are really incompatibilities of rhesus, right? So yes, we will really stay on the subject and the question as such. Let's say it's a bit of a language habit that we've been doing for a long time in medicine. To explain a little, so that things are clear, an embryo is made up of 50% of the genetic heritage of its father and 50% of its mother. And so, in this case, you have to imagine that the embryo, on its surface, it carries small patterns that will actually be keys, which come from both its father and its mother. These keys, when it arrives in its mother's uterus, must interact with sea locks, with which it will be able to implant itself. To put it in words, the keys, we call it, in medical vocabulary, the HLA-C2, and the locks, the KIR receptors. We won't say more about that exactly. So, in fact, the embryo, thanks to these very particular keys, by introducing itself to its mother, it will tell it, I am of your species, do not destroy me. And the mother will react to this first contact by recognizing it and saying, indeed, you are not exactly like me, but I will still help you implant yourself, I will feed you and I will help you develop. Thanks to this interaction between the key of the embryo and the lock of the mother, so the locks are carried by the cells of the innate immunity, it will allow the development of the placenta, that is, the placentation. We realized, indeed, that there were certain combinations of keys and locks, because it's not exactly the same for everyone, that we realized that sometimes there were combinations that worked a little less well and that the placenta was developing a little less well. It's not an incompatibility, it's just a hindrance to the development of the placenta. So, incompatibility is really an abuse of language. Nevertheless, it is important to have this notion, between these keys and these locks, the HLA and the KIR, because when we are going to make a sperm donation or an egg donation to a couple or a woman alone, it is important to be able to help her optimize the implantation of her embryo. That's it. Well, it's exciting. You manage to popularize, we are hanging on your lips, doctor. Thank you very much for this enlightenment.