Recurrent Pregnancy Loss – Reasons & Treatment

Recurrent pregnancy loss is not uncommon, and the person who deals with it goes through a lot of emotional trauma. However, in many cases, there has been no known cause to explain why recurrent miscarriages take place.

Having one miscarriage after another can drain a person emotionally. Often, the person has no hope of becoming a mother in the future. However, it has been seen that most women go on and have babies even after experiencing recurrent miscarriages. This is most likely when there is no identifiable cause for the miscarriage.

One in every 100 women is likely to experience recurrent miscarriage. The chances of another miscarriage increase a little as you grow in age. In general, a person who has experienced three miscarriages one after the other has a 40% chance of having another miscarriage. This means that six out of ten women will have a successful pregnancy after recurrent miscarriages.

What Is Recurrent Pregnancy Loss?

When someone experiences three or more miscarriages in a row, it is termed as recurrent miscarriage or recurrent pregnancy loss. If you have experienced this, it is important that you visit a gynaecologist immediately. The doctor will be able to find out the probable cause/s behind it.

Causes of Recurrent Miscarriage

Studies have not been able to identify a direct cause for spontaneous abortion. While certain health conditions are thought to be responsible for miscarriages, the exact relation between these conditions and the miscarriage is still under research.

Some of the probable causes that lead to recurrent miscarriages could be:

• Antiphospholipid syndrome or APS: This is a condition when your blood clots easily and without outside stimuli. This is also known as Hughes syndrome or sticky blood syndrome. This cause has been found to be responsible for 15-20% of the recurrent miscarriage cases. Other risks include premature delivery or stillbirth.
• Genes: Your genes can also be responsible for the series of miscarriages. If there is an abnormality in your or your partner’s chromosomes, it can lead to miscarriages. In most of the cases, this abnormality is diagnosed once the baby is born and he/she inherits it. About 5% of the couples experiencing recurrent miscarriages have a chromosomal abnormality.
• Thrombophilia: This can also be one of the causes of recurrent miscarriages. This is a genetic blood-clotting disorder that leads to clotting of blood in the blood vessels.
• Physical anomalies: If you have cervical weakness or the shape of your uterus is abnormal or it has fibroids, this can lead to recurrent miscarriages. A malformed uterus is responsible for 15% of the recurrent miscarriages.
• Septate uterus: This is a condition where your uterus has a septum that divides the uterus into two cavities. This can also be a probable cause for miscarriage.

• Vaginal infection: Infections like bacterial vaginosis can also increase the risk of miscarriages. They can also lead to premature birth. Unfortunately, the exact role of the bacteria is still not clear in the case of miscarriages. Other infections like listeriosis, toxoplasmosis, herpes, measles, etc., can also be responsible for miscarriages.
• Hormonal problems: These can be one of the causes of recurrent miscarriages. Problems like polycystic ovaries are linked to miscarriages though the reason behind it is not clearly understood.
• Endocrine disorders: Disorders like hypothyroidism can lead to untimely loss of the foetus. Diabetes mellitus, if untreated, can cause miscarriages too.
• Luteal phase defect: This is when there is an insufficient release of the hormone progesterone. It can also lead to miscarriages.

Your age can also be the reason behind this occurrence. The older you are, the higher is the risk for miscarriages. Your partner’s age also has an important role to play when it comes to recurrent miscarriages.

As you turn 35, the number of eggs and their quality will start to decline, and this intensity will increase with your age. There is a chance of the genetic material going wrong at the time of fertilisation. This can lead to a chromosomal abnormality in your baby and increase the chance of a miscarriage. Lifestyle factors like smoking, consuming alcohol, or exposure to toxins can also lead to recurrent miscarriages.

While there are many causes that are linked to recurrent miscarriages, in most cases, no verifiable cause can explain why recurrent miscarriages take place.

Diagnosis

Thorough and proper clinical examinations are conducted to find out the actual cause of recurrent miscarriages. An ultrasound scan will be recommended to you to assess your ovaries and uterus. Blood tests for recurrent miscarriage can also be recommended to see if you or your partner have any chromosomal abnormalities. Genetic counselling will be prescribed if the above-mentioned test reveals any abnormality.

TORCH is a specialised test that reveals viral or bacterial infections. It can be recommended by your doctor to diagnose the cause of miscarriage. Tissues from the placenta can also be tested to find out the probable cause.

If none of these tests yield any result, chances are high that the next pregnancy will be successful, and you will become a mother.

What Treatment is Available for Recurrent Pregnancy Loss?

The treatment depends on the causes that have been diagnosed. There is, of course, no treatment in the cases of unexplained recurrent miscarriages. Let’s look at some of the treatments available for the known causes:

Genetic Counselling: The primary objective of abortion counselling is to empower you and make you feel positive. It involves encouraging the couple to take a mutual decision about conception. Rigorous activities and too much of exercise are restricted. Sexual intercourse is also not recommended when you are expecting and more so during the first and third trimester.

Medicines and Injections: Many gynaecologists prescribe progesterone injections, though there is a lot of doubt as far as this line of treatment is concerned. Progesterone is known to relax the muscles and increase the risk of an abnormal pregnancy. It can also lead to incomplete abortion.

If you have APS, your doctor might recommend heparin administration as this is known to increase the chances of birth by more than 70 percent. The administration of metformin can also be helpful, according to some experts, and more so if the woman has polycystic ovaries.

Surgical Treatment: Cervical cerclage or McDonald’s stitches is a common recurrent miscarriage treatment option for patients who have cervical problems. In this procedure, stitches are given to close your cervix. This prevents premature birth or miscarriage. This involves a risk and can induce uterine contractions. This can help only those women who have less than 25 mm cervix.

Chances of Having a Healthy Baby after Recurrent Miscarriage

Doctors have observed that the chance of a successful pregnancy right after a recurrent miscarriage is at its peak. Your pregnancy will be closely monitored, and the fact that you will get close attention and care will reduce the risk of anything going wrong. If there are chromosomal defects involved, then it is hard to predict the chances of you conceiving a healthy baby. If there is a treatment for the genetic disorder, then you should ideally be able to conceive.

Conclusion: There is no single explanation behind why recurrent miscarriages take place. There are some strict rules such as not smoking during pregnancy. However, there are many women who have not touched a cigarette and still have a miscarriage. It is natural for recurrent miscarriage to make you feel emotionally drained out. Bearing the pain of losing another baby can be very tough. Make sure to seek support from your friends and family. Support groups and counsellors are also great options that you can try out. It is important that you stay optimistic and have a positive mind. Both of these will be essential to help you have a normal pregnancy and give birth to a healthy baby.