Recurrent Miscarriage – Causes, Diagnosis and Treatment

Top 14 Reasons For Recurrent Miscarriage

Various factors are accountable for recurrent miscarriage. Find out the top 14 reasons that could bring about this traumatizing issue:

1. 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
2. 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
3. Chromosomal disorders: Genetic disorders are also responsible for repetitive abortions. Here are a few genetic or chromosomal reasons:
4. 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
5. Aneuploidy: This chromosomal disorder is frequent with increasing reproductive age and depicts germ cell quality
6. 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
7. Thrombophilia: Thrombophilia or tendency for blood clotting is another risk for miscarriages
8. Immune factors: Lowered maternal immune tolerance for the fetus is another factor causing miscarriages
9. 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
10. Thyroid antibodies: Anti-thyroid antibodies are also concerned with recurrent miscarriages
11. 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
12. 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
13. Lifestyle factors: Excessive exposure to toxins, smoking or consuming alcohol can also cause recurrent miscarriages
14. 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

A thorough clinical examination is done to find out the underlying cause. After that,

• Ultrasound scans are done to assess the condition of the uterus and ovaries.
• Blood tests of both 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 the 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 the smooth muscles, but raises the threat of abnormal pregnancy or even incomplete abortion. Progesterone should only be used if there is a luteal phase defect or if your obstetrician is sure about the use.

In patients having antiphospholipid syndrome (APS), heparin administration can increase the birth rate by up to 70 percent. According to some experts, the administration of metformin in pregnancy can lower the risk of abortion, especially in patients having a polycystic ovarian syndrome

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 with 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 the 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 lose 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.