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Recurrent Miscarriage – Causes, Diagnosis and Treatment

4 min read

Recurrent Miscarriage

What is Recurrent Miscarriage?

If a woman experiences miscarriages for more than two or three times, the condition is termed as recurrent miscarriages. Recurrent loss of pregnancy (RPL), habitual abortion or recurrent miscarriage is defined as the loss of pregnancy before the fetus is 20 weeks old. Besides being a medical issue, it is also a serious disturbing psychological condition. This condition can make the woman depressed and tremendously drained of hope. However, it may be of some relief that most women who have experienced recurrent miscarriages go on to become happy mothers under medical supervision. The chance of a woman with a history of recurrent miscarriages to have a baby is a good 60%, especially if the reason of the miscarriage cannot be concluded. About half the cases of recurrent miscarriages go without the cause being ascertained by doctors.

What Causes Recurrent Miscarriage

Increasing maternal age or paternal age, multiparty or repeated pregnancies and chromosomal abnormalities are the main risk factors of recurrent abortions. Various factors are accountable for the recurrent miscarriages. But sometimes the cause is unknown as well. As sad as it is, a miscarriage does increase the chances of a subsequent miscarriage may also add to the problem. Please bear in mind that these causes are not common
Common Causes Of Recurrent Miscarriage

    • Uterine conditions: Around 15 percent of recurrent miscarriages are caused by uterine malformations. A septate uterus (uterus having septum internally hence divided in cavity by a partition) is the commonest uterine abnormality is the commonest uterine abnormality and is diagnosed by combined laparoscopy or MRI
    • Cervical conditions: Cervical conditions such as cervical incompetence or weak cervix is the next common condition resulting in recurrent abortions. Cervical incompetence can lead to preterm deliveries or miscarriages
    • Chromosomal disorders: Genetic disorders are also responsible for repetitive abortions. Here are a few genetic or chromosomal reasons:
      • Translocations: Robertsonian translocation in either of the partners can cause non-viable fetus and abortion. This is the reason karyogram is done for both the partners
      • Aneuploidy: This chromosomal disorder is frequent with increasing reproductive age and depicts germ cell quality
    • Endocrine disorders: Hypothyroidism can result in recurrent miscarriages or untimely loss of pregnancy. Untreated diabetes mellitus can also cause miscarriages. Females affected with PCOS or polycystic ovarian syndrome experience higher risk of untimely termination of pregnancy
    • Thrombophilia: Thrombophilia or tendency for blood clotting is another risk for miscarriages
    • Immune factors: Lowered maternal immune tolerance for the fetus is another factor causing miscarriages
    • Antiphospholipid syndrome: This is an autoimmune disease and accounts for 15 percent of all recurrent miscarriages. Usually aspirin or heparin is given to women having antiphospholipid syndrome

Doctor explaining miscarriage

  • Thyroid antibodies: Anti-thyroid antibodies are also concerned with recurrent miscarriages
  • Ovarian factors: The susceptibility to miscarriage increases with a advancing age as the ovarian reserves are also depleted with increasing age and they become vulnerable to miscarriages. The actual cause is the poor quality of maternal eggs
  • Luteal phase defect: Progesterone is released during the luteal phase and if it is produced in insufficient quantities from the corpus luteum. The inadequate amount of progesterone does not sustain pregnancy and miscarriage is the obvious outcome
  • Lifestyle factors: Excessive exposure to toxins, smoking or consuming alcohol can also cause recurrent miscarriages
  • Infection: Many infections such as toxoplasmosis, listeriosis and viral infections (rubella, measles, herpes, cytomegalovirus) etc. are also among the notorious causes of miscarriages

Diagnosis Of Recurrent Miscarriage

Thorough clinical examination is done to find out the underlying cause. Ultrasound scans are done to assess the condition of the uterus and ovaries. Blood tests of both the partners are done to rule out the presence of any chromosomal abnormalities. If anything is detected, you will be sent for genetic counseling.
Specialized tests like TORCH are done to find out any underlying viral or bacterial infection. Tissues from the placenta may also be tested for signs of a problem.
Sometimes, the tests do not yield any results. If the miscarriages cannot be explained, chances are that you will get through your pregnancy the next time.

Treatment For Recurrent Miscarriage

Treatment depends upon identification of the cause but unfortunately there is no actual treatment for unexplained recurrent pregnancies.

    • Genetic counseling
      Abortion counseling is done with the primary objective to empower the woman. Do not force the decision and allow the couple to make their decision. Restrict rigorous activities and exercises. Intercourse is not advised while you are expecting particularly in the first trimester and third trimester. Some experts advise progesterone but it is a bit controversial. It relaxes smooth muscles but raises the threat of abnormal pregnancy or even incomplete abortion. Progesterone should only be used if there is luteal phase defect or if your obstetrician is sure about the use.
      In patients having antiphospholipids syndrome (APS), heparin administration can increase birth rate up to 70 percent. According to some experts the administration of metformin in pregnancy can lower the risk of abortion especially in patients having polycystic ovarian syndrome

Losing a baby

  • Surgical management-
    McDonald stitches or cervical cerclage (procedure in which stitches are used to close the cervix during pregnancy to help prevent pregnancy loss or premature birth) is done for cervical incompetence patients. The cerclage however poses a potential threat of inducing uterine contractions. The process is beneficial to women having cervix less than 25 mm

Will I Be Able To Have A Healthy Baby?

Unexplained miscarriages do carry a good chance of having a successful pregnancy in future. Though your pregnancy will be very closely monitored, yet it will be this close care that will boost your chances of having a healthy baby. Some causes of recurrent miscarriage are treatable, your gynecologist is the best person to answer you. There cannot be complete certainty in such cases, but you will be closely ascertained. If you have been emotionally drained because of repeated losses and are feeling low and scared to loose another baby, it would be wise to seek support and help from family, friends and support groups. Keeping a positive mind and an optimistic attitude can help you have a normal pregnancy.

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