What are the causes of recurrent miscarriage?

What is miscarriage?

A normal pregnancy lasts from 37 to 42 weeks with the average being 40 weeks, and the discontinuation of pregnancy before the twentieth week is considered a miscarriage. Approximately 20% of pregnancies end in miscarriage, with the majority occurring within the first twelve weeks in the first trimester.

Causes of miscarriage

There are many reasons that remain unknown to us. About half of miscarriage cases occur due to abnormalities in sperm or eggs, resulting in a fertilized egg with chromosomal anomalies, preventing the embryo from developing correctly.

Myths about the cause of miscarriage

• Miscarriage occurs in the first pregnancy – some people never have miscarriage and some have multiple miscarriages. It is unrelated to whether it is the first or second or any other pregnancy.
• The woman's body rejects pregnancy because she does not want a child. There is no strong evidence for this, but we know higher parts of the brain can affect the hormones so there may be small contributary factors related to the woman’s psychological state.
• Incompatibility of the parent's blood: The HLA differences between the woman and man’s bloods can contribute to an increased risk of miscarriage but not simply because the have different blood types.

What is recurrent miscarriage?

It is the occurrence of three consecutive miscarriages without any successful pregnancy in between. For example, if a woman experiences two successive miscarriages, then has a successful third pregnancy resulting in a safe delivery, and later conceives again but miscarries, this cannot be considered recurrent miscarriage due to the successful pregnancy experience between them.

Risk factors for recurrent miscarriage

• Thyroid problems.
• Uncontrolled diabetes.
• Uterine inflammation.
• Presence of HLA antibodies
• Antiphospholipid syndrome.
• Polycystic ovary syndrome.
• Maternal age over 35.

Further examinations can be done to investigate the causes of recurrent miscarriages after two consecutive occurrences. These are detailed blood and ultrasound assessments as well as chromosomal analyses.

The impact of recurrent miscarriage

Recurrent miscarriage has a significantly negative impact on the emotional and psychological well-being of women. It is a profound loss just like any bereavement and it is a grief that requires time to heal. Therefore, I always advise any woman who experiences miscarriage to wait at least three to six months before trying to conceive again.

Medical Management

• If a miscarriage occurs before the sixth week of pregnancy, there is no need for any medical intervention or dilation and curettage procedure.
• If the miscarriage happens between the sixth and ninth weeks, medications can be administered to facilitate dilation and curettage and complete the miscarriage.
• After six weeks have passed, a dilation and curettage procedure is done. It is worth noting that at all stages, there is an option to let the miscarriage happen without medical intervention, except if an ultrasound examination following the cessation of bleeding reveals the need for dilation and curettage.

Can Pregnancy Occur After Miscarriage?

The dilation and curettage procedure must be carried out with a skilled and experienced surgeon to avoid impacting the uterine lining. Excessive intervention may lead to adhesions in the uterus, preventing future pregnancies (Asherman’s syndrome). Complications may also include the possibility of infections affecting the uterine lining or pelvic inflammation, causing adhesions in the fallopian tubes, which can also impact future pregnancies. The doctor must inform the patient of potential complications before the procedure and request her consent on operation instructions containing possible risks.

General Pregnancy Tips

• There is no need to visit a gynecologist for an ultrasound and pregnancy examination four weeks into the pregnancy, as nothing can be seen at this stage.
• In case of spotting or the observation of brown or red discharge in the first five weeks of pregnancy, there is no need to rush to the emergency room. Often, the course of action is to administer hormonal therapy, with no evidence that it will stop bleeding or prevent a miscarriage.
• Occasional minor bleeding can occur during pregnancy without other complications, and the pregnancy can still be successful with the mother delivering a healthy baby.
• Shopping for doctors every few weeks during pregnancy is not advisable. Continuous monitoring is crucial; changing a doctor is only necessary if the care is inadequate.
• There is no need for strict bed rest in the case of light bleeding at the beginning of pregnancy. The only recommendation is to avoid high-impact activities such as jumping or running.

 

This is just an overview of miscarriage and recurrent miscarriage. For more detailed information please discuss it with your physician.