A recurrent miscarriage is identified when there have been more than two and consecutive miscarriages or pregnancy losses. Often a spontaneous loss before the completion of 20 weeks is termed as a miscarriage. Miscarriages can arise due to several reasons and are relatively common with approx., 15% of all pregnancies ending in miscarriages. However, loss of pregnancies can occur in any trimester of the pregnancy.
Recurrent miscarriages are defined when three consecutive losses occur within the first 12 weeks or the first trimester, or two in one and the one in the 20 weeks or the second trimester.
The consecutive or recurrent miscarriages are also known as “habitual pregnancy loss” often suggest an underlying medical condition for which a specialist should be consulted. The underlying causes could be a genetic defect, an abnormally shaped uterus, uterine fibroids, and scar tissue in the uterus that may hinder implantation or growth of the foetus. Hormonal imbalances can also aid or increase the chance of miscarriage. Medical treatment for recurrent miscarriages would include careful monitoring which may include hormone therapy, IVF with PGS, prenatal care or sometimes even surgery. Depending on the cause that has been determined for the recurrent miscarriages appropriate treatment has proved to be both safe and effective for most couples.
Some of the reasons that may be responsible for recurrent miscarriages are:
- A genetic-chromosomal abnormality that could be carried over from either of the parents and affects the development of the embryo. Preimplantation Genetic Screening (PGS) is a technology that can be used to identify chromosomal defects in embryos created through in vitro fertilization (IVF) before pregnancy. Read our blog for more information: “What is Preimplantation Genetic Screening (PGS)?”
- Conditions affecting the uterus making the implantation of the embryo difficult. There are many reasons that could affect how a uterus behaves, for example, polyps, fibroids, or congenital defects, can result in miscarriage or complications later in pregnancy. A simple ultrasound or an x-ray can help us in determining if the uterus has any abnormalities and needs correction. Sometimes a surgery may be advised to correct the uterus (septate uterus).
- Some prior diseases that may affect the immune system could be a reason for causing recurrent miscarriages. Researchers believe antibodies such as lupus anticoagulant (LAC) and anticardiolipin antibodies (ACA) can cause foetal death by causing clotting in the early placental circulation. There are other diseases that could be a cause such as Thrombophilia – the tendency to form blood clots. Identification and testing for the presence of these antibodies could lead to simple medicines to control its impact.
- Though extremely unusual an infection can cause a miscarriage, though it may be unlikely for it to a to cause multiple pregnancy losses. Some infections that may or may not be the cause but should be brought into the notice of one’s specialist include the bacteria mycoplasma, ureaplasma, and Chlamydia. Screening is done through cultures and we are typically able to eliminate those problems during the evaluation.
- Hormonal Disorders from diseases affecting the endocrine system, especially those that are relatively mild, do not appear to increase the risk of miscarriage, such uncontrolled diabetes or thyroid disease are known to increase a woman’s risk of miscarriage. Furthermore, women with Polycystic ovary syndrome (PCOS) are at increased risk for sporadic or a random loss. These conditions can easily be managed with medication and should be corrected prior to further attempts at conception.
- Environmental or lifestyle factors, such as smoking, excessive caffeine intake (more than two cups of coffee a day) and alcohol use could lead to miscarriages. It is generally advised to pregnant women especially those with a history of recurrent loss, to make the requisite lifestyle and health changes.
It can be said, that a miscarriage is a natural process to protect the woman from a pregnancy that could be abnormal and turn dangerous, however, with recurrent miscarriages there are many reasons that could contribute to continued failure to carry a pregnancy. In such cases, it is advisable that a specialist is sought out immediately. We hope this information is helpful.
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