Recurrent Miscarriages
Recurrent Miscarriages in a nutshell
- Characterized by three or more failed pregnancies
- Includes miscarriages that were detected by ultrasonography or pregnancy tests.
- The cause of recurrent miscarriage will determine the course of treatment; close observation and emotional support are frequently beneficial.
- Requires prompt attention and constant professional monitoring.
Understanding Miscarriages
A miscarriage happens when a pregnancy ends before 24 weeks of gestation. This is referred to as an early miscarriage or first trimester if it occurs within the first three months of pregnancy. Before 24 weeks, other types of pregnancy loss can occur, such as ectopic pregnancy or molar pregnancy.
Recurrent miscarriages: What is it?
The term recurrent miscarriages is used to describe an early miscarriage that occurs three or more times. You may experience healthy pregnancies in between these miscarriages; they don’t have to occur one after the other. One in 100 women (1%) experience recurrent miscarriages.
Why do recurrent miscarriages happen?
There can be several reasons as to why recurrent miscarriages happen. The majority of miscarriages are sporadic and caused by chromosomal or genetic abnormalities.
The most common reason for a single miscarriage or multiple miscarriages is that the pregnancy had abnormal chromosomes from the beginning. This accounts for half of all miscarriages (50%) and is more common as parents age.
This occurs most of the time despite the parents having normal chromosomes. However, one parent may have an unusual arrangement of their chromosomes in 6 out of 100 (6%) couples who have had three miscarriages. This does not harm the parent, but it may result in miscarriage if it is transferred to the embryo.
Your chances of experiencing a single loss or multiple miscarriages increase with age. This is because your eggs become less quality as you age. Age-related risk of recurrent miscarriages:
In addition, miscarriages may occur more frequently in mothers and fathers older than forty.
A body mass index (BMI) of more than 25 indicates overweight, while a BMI of less than 19 indicates underweight, and both increase the risk of miscarriage. Smoking cigarettes and consuming more alcohol or caffeine than is advised might also raise your risk of miscarriage.
Antiphospholipid syndrome (APS): this illness may result in subsequent pregnancy problems or repeated miscarriages. You run the danger of getting blood clots as well.
Blood clotting issues (thrombophilia)
Congenital uterine anomalies are uncommon shapes of the uterus that affect about five out of every 100 women at birth. A uterus with an irregular shape is more common in women who experience recurrent miscarriages (around 13 out of 100 women). E.g. septate & bicornuate uterus
Some women develop scar tissue inside their uterus or fibroids, which are muscle knots in the uterine wall. Depending on their size and position, they may have different effects on you and might impact your risk of miscarriage.
Numerous hormonal disorders may be related to miscarriages, if there are not well controlled such as:
- Diabetes
- Thyroid issues
- Also PCOS: Women who have PCOS (polycystic ovarian syndrome) are more likely to miscarry. The reason behind this remains unclear. However, it might be because this illness occasionally results in elevated levels of the hormones testosterone and insulin.
- Prolactin imbalance: You may be more likely to miscarry if your levels of the prolactin hormone are abnormal.
Your spouse may be more likely to experience recurrent miscarriages if their sperm contains abnormal DNA. Since there is now little solid evidence to support the idea that altering sperm health can lower the chance of miscarriage, sperm testing is typically not recommended.
It’s been proposed that some women miscarry due to abnormal immune system responses during pregnancy. More investigation is required as there is currently insufficient medical evidence to substantiate this notion, which is still under ongoing clinical research experimental.
Evaluating Recurrent Miscarriages
It’s critical to determine whether there is a cause or manageable treatment for your recurrent miscarriages so that you can receive the best possible support and care. for recurrent miscarriages, you and your partner can seek help from Dr Salem.
APS, Thyroid examinations, such as thyroid antibody testing. If your medical history indicates diabetes may be a factor, get tested. You will be advised to get blood tests to look for further hormonal issues, such as prolactin imbalance or PCOS.
could be made available to you and your partner
To examine the shape of your uterus, a pelvic ultrasound scan or other imaging techniques such as HSG or HyCoSy can be offered, sometimes, hysteroscopy (camera of the womb) may be required.
Treating recurrent miscarriages
Now that we have understood why recurrent miscarriages happen, let us know the treatment options:
Maintaining a healthy weight, avoiding smoking and refraining from frequently consuming large amounts of alcohol are crucial to raising chances of successful pregnancy. Limit daily caffeine intake to less than 200 mg (or around two cups of tea or instant coffee).
Treatment with low-dose aspirin tablets and blood-thinning injections (heparin) during pregnancy can improve your chances of becoming pregnant if you have APS and have experienced repeated miscarriages. As there reduce the risk of blood clotting.
You can be given the option to take heparin if it is determined that you have a blood clotting disorder. This will be contingent upon your unique situation and any elevated risks of blood clots during pregnancy.
You may be advised to get genetic counseling if it is discovered that you or your spouse have a genetic issue. Depending on your unique situation, they will explain your alternatives such as pre implantation genetic testing during assisted reproductive technology treatment and talk about your possibility of having another miscarriage in the future.
Surgery to remove your uterine septum may be recommended to you. It is unknown if having surgery to treat fibroids or other disorders that change the interior structure of the womb lowers the chance of miscarriage. Depending on your unique circumstances, Dr Salem will consider the possible advantages and disadvantages of uterine surgery with you (for example, the size and position of a fibroid) and advice you accordingaly.
We will help you manage your diabetes and thyroid condition as much as possible before your subsequent pregnancy. Progesterone therapy does not appear to prevent recurrent miscarriages unless bleeding occurs during the first trimester of pregnancy. Progesterone should be administered to you if you are bleeding during pregnancy and have experienced a past miscarriage to try to prevent another one.
Assisted reproductive technology (IVF-ICSI) with pre- implantation genetic testing of embryos
What if no cause of recurrent miscarriage is found?
If no cause is identified for your recurrent miscarriage, it is a common scenario known as unexplained recurrent miscarriage. In such cases, current evidence suggests that no specific medical treatment can definitively lower the risk of another miscarriage.
However, your chances of having a successful pregnancy remain good and promising, depending on your circumstances, even without any changes. In future pregnancies, receiving supportive care from Dr Salem EL Shawarby – a reproductive medicine consultant experienced in managing recurrent miscarriage, can be beneficial. This may involve regular ultrasound scans for reassurance and monitoring.
Mental well-being following repeated miscarriages
Recurrent miscarriages can be a painful experience that can affect your physical and mental health.
Some people develop severe symptoms of anxiety, despair, and/or post-traumatic stress disorder. You may wish to discuss your mental health with Dr Salem, as he can help you with further support and compassionate care, and refer you if necessary
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