Recurrent miscarriage: What you need to know

Losing a pregnancy can be a difficult and painful experience. Having one pregnancy loss can shatter you, but having one loss after another can be very traumatic for a woman.

Recurrent miscarriage is defined as two or more pregnancy losses and around 1% of women experience it. There are many possible causes of a recurrent miscarriage, but a good supportive antenatal care in these circumstances can make a big difference.

Why does it happen?

Recurrent miscarriage could be due to any of the following reasons:

1. Anatomical changes:

Uterine problems

If your uterus is abnormally shaped it may increase your risk of a miscarriage and in some cases could be a cause of recurrent miscarriage. Only a few types of uterine malformations can increase the risk of miscarriage and require treatment.

Cervical insufficiency

Cervical insufficiency is also known as cervical incompetence, this means your cervix is weak, begins dilating and opening too soon. Your obstetrician may offer you a scan or advise for a cervical stitch early in your pregnancy to avoid further complications.

2. Physiological changes:

Hormonal abnormalities –

Hormonal abnormalities including thyroid disease and diabetes may also impact pregnancy loss. These conditions do not cause miscarriage as long as they are treated and kept under control.

 Blood clotting disorders

If you have blood clotting disorders like systemic lupus erythematosus or antiphospholipid syndrome they can be the cause of your recurrent miscarriage. These rare disorders of the immune system can affect the flow of your blood to the placenta and may cause clots that prevent the placenta from functioning properly.

Due to this, your baby may be deprived of oxygen and nutrients, which may lead to a miscarriage. Your obstetrician may advise you treatments which may include aspirin or heparin therapy to thin your blood.

Genetic –

Most of the miscarriages (about 60%) occur when the embryo receives an abnormal number of chromosomes during fertilization. This type of genetic problem happens by chance and there is no medical condition that causes it.

In a small number of couples, one partner may pass the abnormal chromosome repeatedly causing repeated miscarriage. In such a case, both you and your partner will be offered a blood test to detect for any chromosomal abnormalities.

Infections

Uterine infections could be another possible cause for miscarriage. Any untreated or severe infection may trigger the spontaneous loss of your pregnancy, that may include:

  • Bacterial vaginosis
  • Candida infections
  • Chlamydia
  • Gonorrhoea

3. Miscellaneous:

Abdominal trauma

Any trauma such as accident, fall or being hit in your abdomen can hurt you and your developing baby causing a miscarriage.

Lifestyle factors –

Lifestyle factors such as smoking, drinking excessive alcohol or use of drugs may contribute to the likelihood of a miscarriage. It can affect your baby’s development and your obstetrician will suggest you to avoid or limit their consumption.

What are the commonly seen signs and symptoms?

Signs and symptoms of a miscarriage include spotting or vaginal bleeding similar to a menstrual period. The bleeding will often have more clots than your regular period, appearing as tiny lumps in the vaginal discharge. You may also notice abdominal cramping.

It is important to know that, in the first-trimester spotting or bleeding is common in 20% of the pregnancies. Hence, bleeding is not necessarily a sign of a miscarriage but it is advised to get yourself checked.

What to do?

 If you have experienced more than two miscarriages consult your obstetrician immediately to help narrow down the possible causes and determine what can be done to prevent future losses. Your obstetrician will advise you a series of tests  like:

Karyotype

Your chromosomes will be checked to diagnose any genetic defects that may be responsible for a miscarriage.

Hysterosalpingogram –

The size and shape of the inside of your uterus and presence of any polyps or fibroids that could cause miscarriage are checked.

Hysteroscopy

If there is any concern about your uterine cavity, a Hysteroscopy /3D or 4D Ultrasound of pelvic organs is done.

Endometrial biopsy –

A sample of your endometrial tissue is examined under a microscope to determine if an infection is present that is preventing your pregnancy from progressing.

Immunological tests –

Blood tests are done to detect any immune system abnormality that can cause pregnancy loss.

 

If a specific cause of your repeated miscarriage is identified, your obstetrician will suggest a treatment that will address the cause. Close monitoring during early pregnancy by your obstetrician may help to reduce further pregnancy losses.


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