RECURRENT MISCARRIAGE

Most Common Causes & Preventive Tips

Loss of much wanted pregnancy can be absolutely soul crushing and devastating for the couple even more so if it happens again.

Recurrent pregnancy loss is defined by the loss of two or more clinical pregnancies.

Multiple miscarriages happen in 15 to 20% of pregnancies. In women who have 2 or more previous losses, the risk of yet another miscarriage increases to about 40%

It is important to remember that 75% of these couples eventually have a successful pregnancy, whether or not the cause is discovered.

What are the common causes?

• Genetic/ chromosomal causes

50-60% of all losses in first 3 months of pregnancy are due to chromosomal abnormalities passing from either or both partners.

• Conditions affecting reproductive organs

Structural problems like polyp, fibroids, and structural defects can result in miscarriage or complications later in pregnancy. 

• Abnormal hormone level & immunological causes

When uterine lining doesn’t develop sufficiently, fertilized egg/embryo doesn’t get best environment for implantation and nourishment. This can be attributed to abnormal hormonal level. Also women with thyroid problems, diabetes mellitus, elevated prolactin level and antiphospholipid antibodies (APLA) are at the high risk of miscarriage.

• Weak cervix ( cervical insufficiency/ incompetent cervix)

When cervical muscles are weakened and can’t remain closed when developing fetus grows and puts pressure on its opening.

• Infections

Infections like rubella, Herpes simplex virus, Cyto megalo virus, Chlamydia.

• Environmental factors

Marijuana, tobacco, caffeine and alcohol affect fetal development and may result in miscarriage.

What investigations might be offered?

• Blood tests

For blood disorders, karyotype and for hormones thyroid, prolactin, progrsterone and for diabetes mellitus.

• Tests for the shape of uterus

Pelvic ultra sound, diagnostic laparoscopy and hysteroscopy, hysterosalpingography (HSG)

• Endometrial biopsy

Preventing miscarriages

• Visit a high-risk obstetrician for pre-conception counselling and regular antenatal checkup
• To start prenatal vitamins (folic acid 5 mg )
• Optimization of blood sugar levels with oral hypoglycemic drugs( Metformin ).
• Optimization of thyroid hormone levels with thyroid medication is essential.
• You may be asked to take low dose aspirin ( 75 mg) in pregnancy.
• Daily subcutaneous injection of blood thinner low molecular weight heparin (in case of thrombophilia and autoimmune disease) may be required.
• Surgery for correcting anatomical abnormality of the uterus or to put a stitch on cervix to keep its opening closed.
• Eat a well-balanced diet.
• Do regular exercise and Weight management.
• Avoid drugs, smoking and alcohol and limit caffeine intake.
• Avoid stress and maintaining a healthy lifestyle with proper sleep and a positive approach is a key to success in managing recurrent miscarriages.
• Genetic counseling if either or both partners are having chromosomal abnormalities.

Dr. Vandana Binwal, Dr. Vandana Binwal, Sr. Consultant, Obstetrics & Gynecology, Swastik Hospital and Research Centre, jaipur.