Did you know that approximately 15% of pregnancies end in a miscarriage? Miscarriages usually occur in the first trimester, and some women experience more than one, known as recurrent miscarriage.
Well, it is fine to have one spontaneous miscarriage as the cause may be because of a chromosomally abnormal fetus. But, in case, a woman faces two or more consecutive miscarriages, they require proper evaluation and treatment.
Let’s take a look into what a recurrent miscarriage is, why they occur, and what the possible treatments are, below:
What is Recurrent Miscarriage?
‘Recurrent Miscarriages’ is also known as ‘habitual pregnancy loss’ and is defined as two or more consecutive losses of pregnancy. When miscarriages occur frequently, there can be an underlying cause, i.e., a genetic defect. There can be various other causes, such as an abnormally shaped uterus, uterine fibroids, and scar tissue in the womb. Hormonal imbalance of prolactin, thyroid hormone, or progesterone can also result in miscarriage.
Let us discuss the causes of recurrent miscarriages in detail –
What are the causes of Recurrent Miscarriages?
Miscarriage is a process that protects a woman from an abnormal pregnancy. Mostly, the losses are due to a chromosomal abnormality of the embryo. However, several other factors can also contribute to the continuous failure of pregnancy.
The causes of recurrent miscarriages are –
- Genetics — A genetic abnormality with a developing embryo that affects one or both parents can result in recurrent miscarriages. Usually, it is believed that 50–70% of all early pregnancy losses are caused by defects in the chromosomal makeup of an embryo. These embryos tend to occur more during the oocyte (egg) maturation process and less during sperm mutation.
- There can be a huge possibility that one or both parents may have a chromosomal abnormality, which can result in an embryo with little genetic material. A karyotype analysis can be done to evaluate a couple’s chromosomes. But, there is a very low possibility that parents have an abnormal karyotype.
- Conditions that affect the uterus — The implantation process is hormonally regulated and requires an active interaction between the implanting embryo and lining of a woman’s uterus. The factors that change in this process can result in pregnancy losses.
- Structural problems with a woman’s uterus — There can be anatomical problems such as polyps, fibroids, or congenital disabilities, which can result in miscarriage or pregnancy complications. Several tests like an ultrasound, X-ray can reveal many structural abnormalities of the uterus. Those abnormalities can be rectified through surgery.
- Problems affecting the immune system — It is quite evident that there is a special bond between the uterus and the immune system. Two antibodies cause clotting in early placental circulation — Lupus Anticoagulant (LAC) and Anticardiolipin Antibodies (ACA).
- The testing for LAC and ACA are performed on all recurrent pregnancy loss patients. The treatment involves administering a low dose of aspirin and other anti-clotting medications.
- Environmental Factors — Women who face repeated miscarriages often have doubts about the link between miscarriage and ecological factors. Several environmental factors are harmful such as smoking, caffeine, alcohol use, and exercise. Although some studies suggest that environmental factors may cause sporadic pregnancy loss, it is advised that pregnant women should avoid alcohol and smoking.
- Hormonal Disorder — The diseases that affect the endocrine system are mild and do not increase the chances of a miscarriage. However, certain disorders, such as uncontrolled diabetes or thyroid diseases, can increase the risk of miscarriage.
What are the symptoms of Recurrent Miscarriage?
Most miscarriages occur before the 12th week of pregnancy. The signs and symptoms of a miscarriage are –
- Vaginal spotting or bleeding
- Pain or cramps in your abdomen
- Fluid passing from the vagina
If you have passed tissue from your vagina, place it in a container and take it to your doctor so that they can do the necessary analysis.
What are the diagnostic tests to determine the causes of recurrent miscarriage?
Your doctor will do tests to determine the cause of recurrent miscarriage, such as –
- Pelvic Exam — Your doctor will check if your cervix has begun to dilate.
- Ultrasound — Ultrasound checks for a fetal heartbeat and determine if the embryo is developing typically. If a diagnosis cannot be made, another ultrasound can be done.
- Blood Test — Your doctor may also check the level of pregnancy hormones in your blood and compare it to previous measurements. If there are any abnormal changes to hormone levels, this could indicate a problem.
- Chromosomal Test — If you have had two or more miscarriages, the doctor may order blood tests for you and your partner to determine if your chromosomes are one of the factors.
- Antibody Test — It is a test that is used to analyze a patient’s sample for the presence or absence of a particular antibody or the amount of antibody that is present. They are a part of the body’s immune system and are immunoglobulin proteins that protect people against invaders such as viruses, bacteria, chemicals, or toxins.
- Thrombophilia Test — Thrombophilia is a condition where patients form blood clots. It can be dangerous if the blood clots obstruct blood flow and it can be an inheritance problem as well. If one is facing recurrent miscarriage, this could be one of the issues as well. Hence, it is advised to undergo a Thrombophilia test and know the correct status.
What treatment is available for recurrent miscarriages?
Many women who suffer two or more miscarriages, decide to get pregnant naturally. However, your doctor might suggest several treatments to reduce the risk of recurrent miscarriage.
Did you know there are more than 80% of women who have had two or more miscarriages and can still have a successful pregnancy with tender love and support? Most women may not find an identifiable cause for their recurrent miscarriages. But, there are some recommended treatments to limit the chances of recurrent miscarriages:
- Surgery — Surgery can fix problems in the uterus (womb) by putting extra tissues and rectifying the shape of the uterus in cases with a septum in the uterus, adhesions in the uterus, some uterine anomalies, etc.
If the form of the inside part of the uterus is corrected, it can lower the chance of a miscarriage. The surgeon uses a unique tool with a camera (hysteroscope) to perform the surgery. This is a one-day procedure, and recovery time is a few days.
- Blood-thinning medicines — Women with clotting problems can be treated with a low-dose of aspirin and heparin. These medicines are taken during pregnancy to lower the risk of miscarriage. Consult your doctor before using these medicines.
- Genetic Screening — The parent’s blood is studied to check if they have a translocation. If a chromosomal issue is found, the doctor would suggest genetic counseling. While many couples can conceive naturally, your doctor might suggest fertility treatments such as in-vitro fertilization (IVF).
- IVF with PGS — PGS test determines whether the cells in an embryo contain the normal number of chromosomes which is 46. Once the embryo grows in the lab, it is biopsied on 5th day i.e. blastocyst age. Few embryo cells are sent to the lab which uses technology to count the number of chromosomes within each cell.
PGS is a good option for those experiencing multiple miscarriages or may have different types of translocations.
- Lifestyle Choices — Making healthy choices in your day to day life can improve the chances of a healthy pregnancy. A pregnant woman can also take psychological support to cope with the emotional pain of miscarriage.
Bleeding in pregnancy when you had a previous miscarriage –
In case you are bleeding in your current pregnancy after recurrent miscarriages, then progesterone treatment can be beneficial.
Progesterone is a hormone that thickens the womb lining and helps the mother’s body to accept a growing baby. It is given as pessaries (tablets) and taken twice a day in the vagina.
According to research, the study has shown that progesterone can be an effective treatment and did not have any safety concerns as well.
Consult your doctor
If you have a history of a previous miscarriage and early pregnancy bleeding, progesterone treatment will be very beneficial. You can always consult your doctor, and she will suggest the best possible solution.