“Loss of much-wanted pregnancy can be devastating, even more so if it happens again” 

Our aim for you to know: 

• About the reasons for recurrent miscarriage and late miscarriage
• About recommendations for tests and treatments for couples in this situation

Early miscarriages (within 3 months of pregnancy) are more common than late (after 3 months but before 24 weeks of pregnancy)

What is recurrent miscarriage: 

When a miscarriage happens 3 or more times in a row, it is called recurrent miscarriage. It affects 1 in 100 couples trying to have a baby.

Why it happens:

There are numbers of factors that may play a part in causing recurrent and late miscarriage:

• Age: older you are, greater the risk.
• Genetic factors: any of the partners having abnormality on one of their chromosomes. Although this may not affect the parent, it can sometimes cause a miscarriage.
• Weak cervix: neck of the womb opens without pain during pregnancy, is known to be a cause of late miscarriage. It is suspected when if in previous pregnancy your waters broke early or baby was expelled without pain.
• Infections
• Shape of uterus
• Diabetes or thyroid problems
• Developmental problems of baby
• Thrombophilia
• Antiphospholipid syndrome (APS): A syndrome that makes your blood more likely to clot.

What investigations might be offered : 

Number of investigations are available, advised depending on patients history and outcome of previous pregnancies, medical and genetic condition of patient of both of partners.

• Blood tests:

for APS, thrombophilia, to check your or your partner’s chromosomes for abnormalities, infections.

• Test for abnormalities of baby:

Postmortum examination and karyotyping of baby. It is not always possible but may help to determine your chances of miscarriage again.

• Test for abnormalities in shape of your uterus:

Pelvic ultrasound to check any abnormalities, and further diagnostic laparoscopy and hysteroscopy if any abnormality suspected in ultrasound scan in ultrasound scan.

 

What are the treatment options: 

• Treatment of APS:

Having APS means you are at increased risk of complications during pregnancy such as preeclampsia, baby’s growth and premature birth. Pregnancy should be carefully monitored, treatment with low dose aspirin tablets and heparin injections increase your chances of having baby.

• Treatment of thrombophilia:

If you have tendency of blood clotting, you should be offered treatment with heparin.

• Referral for genetic councelling:

If either you or your partner has a chromosomal abnormalities, your chances for future pregnancy should be discussed with geneticist.

• Monitoring & treatment of weak cervix:

You may be offered an operation to put a stitch in your cervix. This is usually done through the vagina at 13 to 14 weeks of pregnancy under general or spinal anaesthesia.

• Surgery to the uterus:

If any anatomical abnormalities is found in your uterus, corrective surgery may be offered.

• Hormonal treatment:

Progesterone and human chorionic gonadotropin hormones early in pregnancy have been tried to prevent recurrent miscarriage. More evidence is needed to show whether tis works.

Women who have supportive care and treatment under experts from beginning of pregnancy,

will have a better chance of a successful birth.

For couples where not cause of recurrent miscarriage has been found,

75% will have successful pregnancy with this care.