Recurrent Miscarriage

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    Recurrent Miscarriage

    Everything you need to know about Recurrent Miscarriage

     

    What is Recurrent Miscarriage?

    When a miscarriage happens three or more times in a row, it is called a recurrent miscarriage. Recurrent miscarriage affects 1 in 100 (1%) couples trying to have a baby.

    Losing a baby before 24 weeks of pregnancy is called a miscarriage. If this happens in the first 3 months of pregnancy, it is known as an early miscarriage. Unfortunately, early miscarriages are common, with 10–20 in 100 (10–20%) pregnancies ending this way.

    Late miscarriages, after 3 months of pregnancy but before 24 weeks, are less common: 1–2 in 100 (1–2%) pregnancies end in a late miscarriage.

Causes

  • Age: If you are over 40 yrs old, there is a 50% chance of a miscarriage.
  • Miscarriages may also be more common if the father is older.
  • Antiphospholipid syndrome (APS): APS (a syndrome that makes your blood more likely to clot).
  • Thrombophilia: Thrombophilia (blood clotting) may cause recurrent miscarriage and in particular late miscarriages.
  • Genetic factors: In about 2–5 in 100 couples (2–5%) with recurrent miscarriage, one partner will have an abnormality on one of their chromosomes (the genetic structures within our cells that contain our DNA and the features we inherit from our parents). Although this may not affect the parent, it can sometimes cause a miscarriage.
  • Weak cervix: Weakness of the cervix is known to be a cause of miscarriage from 14 to 23 weeks of pregnancy.
  • Developmental problems of the baby: Some abnormalities of the baby may lead to a miscarriage but are unlikely to be the cause of recurrent miscarriage.
  • Infection: Any infection that makes you very unwell can cause a miscarriage.
  • The shape of the uterus: It is not clear how much an abnormally shaped uterus contributes to recurrent miscarriage or late miscarriages. However, minor variations do not appear to cause miscarriage.
  • Diabetes and thyroid problems: Diabetes or thyroid disorders can be factors in miscarriages. They do not cause recurrent miscarriage, as long as they are treated and kept under control.
  • Immune factors: It has been suggested that some women miscarry because their immune system does not respond to the baby in the usual way. This is known as an alloimmune reaction. There is no clear evidence to support this theory at present. Further research is needed.

Available Tests

Blood tests:

  1. APS is diagnosed if you test positive on two occasions 12 weeks apart before you become pregnant again.

  2. For thrombophilia. If you have had a late miscarriage you should be offered blood tests for certain inherited thrombophilias.

  3. To check you and your partner’s chromosomes for abnormalities. You may be offered this test if your baby has been shown to have abnormal chromosomes.

Tests for abnormalities in the baby:

You should be offered tests to check for abnormalities in your baby’s chromosomes.

Tests for abnormalities in the shape of your uterus:

A pelvic ultrasound scan or MRI can detect the abnormal shape of the uterus.

Tests for infection:

Blood tests and vaginal swabs can detect infections that may have caused the miscarriage.

Treatment

Medical treatment:

Aspirin and heparin injections (blood thinners) are used for diagnosed cases of APS.

Genetic counseling and referral to an assisted conception unit in cases of genetically identified cause for recurrent miscarriage.

Laparoscopic cerclage before successful pregnancy can be performed for cases of recurrent 2nd trimester (12-24weeks) if there is a very short cervix and where cervical stitch inserted from vagina has failed in the past.

Hysteroscopic resection of the intrauterine septum can be performed along with surgery to correct uterine abnormal shape via laparoscopy.

For more information about recurrent miscarriage; click here: https://www.rcog.org.uk/en/patients/patient-leaflets/recurrent-and-late-miscarriage/

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