All You Need To Know About Recurrent Miscarriages

Miscarriages frequently happen, accounting for 15–25% of pregnancies and typically happening in the first trimester (up to 13 weeks). A single miscarriage or even two is not a sign of future infertility. Nevertheless, they could make patients anxious and wonder if they can actually deliver a live baby. After losing two pregnancies, more than half of families go on to have healthy children naturally.

Unexpected miscarriage is shockingly frequent. There are far more pregnancies that fail before being clinically identified, compared to the 15% of clinically documented pregnancies that end in spontaneous loss. Only one in every thirty conceptions ends in a live baby. Couples who experience spontaneous miscarriage frequently may find it to be physically and emotionally demanding.

What are Recurrent Miscarriages?

The term "recurrent miscarriage", or "habitual abortion", refers to three successive pregnancies lost prior to 20 weeks after the last menstrual period. According to the frequency of random pregnancy loss, 1 in 300 pregnancies should have recurrent miscarriages. However, epidemiologic research has shown that 1% to 2% of women do endure repeated miscarriages.

Depending on whether a live birth has ever taken place, recurrent miscarriage may be regarded as a primary or secondary process. The phrase "women with non-consecutive pregnancy losses interspersed with normal pregnancies" has not been coined. The main questions that recurrent miscarriage-suffering couples have concerned the aetiology and likelihood of future recurrence. Genetic, endocrine, anatomical, immunological, thrombophilic, and environmental variables are among the general aetiological categories of recurrent miscarriage.

At Manipal Hospitals, the obstetrician and gynaecologist in Bangalore take a comprehensive approach towards gathering information on the patient's current classification, ascertaining the type of prior miscarriages, and compiling all potential risk factors before examining the patient, in order to proceed with the recurrent miscarriage treatment. However, in up to 50% of instances, despite comprehensive inquiry, no cause is discovered. The likelihood of a future pregnancy succeeding is, however, generally good, the overall live birth rates following normal and abnormal diagnostic evaluations for recurrent miscarriage are, respectively, 77% and 71%.

Cause of Recurrent Miscarriages

Many people go on to have a successful third pregnancy, even though the causes of miscarriages are sometimes not clear. There is still a 65% probability that any third pregnancy will result in a live delivery, even after two miscarriages.

Finding the cause at this time may save future losses and emotional stress, but if one is found, it might be simple to remedy. One may suffer from recurrent miscarriage if they have had two losses, and diagnostic testing may be helpful to determine whether there is a cause for repeated miscarriages.

The goal of the aforementioned examinations is to identify the reason for miscarriages, but in up to 50–75% of cases, the testing is normal with no clear solution. Some of the causes are discussed below:

• Blood Clotting Disorders

Sticky blood and recurrent miscarriages can be brought on by some blood clotting conditions, including antiphospholipid syndrome and systemic lupus erythematosus. These uncommon immune system illnesses can damage the placenta's blood supply and lead to blood clots that impair the placenta's ability to function. This may deprive the developing child of vital nutrients and oxygen, which could result in miscarriage. Before becoming pregnant, antiphospholipid antibodies should be checked on all women who have experienced recurrent miscarriages. Aspirin and heparin therapy, which both work to thin the blood, may be used as treatments. According to research, women who frequently miscarry have a higher propensity for blood clots, which might obstruct the baby's access to nutrition.

• Thyroid Problems

Problems with the thyroid have been linked to a higher risk of miscarriage and other pregnancy issues. They are frequently simple to diagnose with a blood test, and they are also simple to cure. Prior to becoming pregnant, a healthy thyroid function is crucial.

• Thyroid Antibodies

Thyroid antibodies are tiny bloodstream molecules that can assault the thyroid and impair its function. High thyroid antibody levels can raise the chance of miscarriage. In particular, when they become pregnant, people with antibodies should have their thyroid function checked.

• Uterine Issues

Women run a higher chance of recurrent miscarriage and early birth if their womb is irregularly formed. In most cases, an ultrasound scan is used to diagnose this. Several methods for examining the uterus' shape exist, and depending on the results, surgery can be advised.

• Genetic Cause

One or both partners may occasionally pass on a defective chromosome, leading to recurrent miscarriages. You and your spouse might be offered a blood test to look for chromosomal abnormalities based on your history of miscarriages (known as karyotyping). You should be sent to a clinical geneticist for additional testing if the tests reveal an issue.

• Cervical Weakness

Women might be given the option to get a scan starting at 14 weeks to measure the length of their cervix if they have a history of late miscarriages and are thought to be at risk of cervical incompetence or cervical weakening. They may be advised to get a cervical cerclage (cervical stitch) either before or during a pregnancy, depending on their pregnancy, medical history, and/or scan results.

• Natural Killer Cells

Some medical professionals think that the uterus' natural killer cells contribute to infertility and miscarriage. Women can undergo testing to determine their NK cell count. However, the NHS does not offer it. Tests are available at certain fertility clinics, but not all.

Other risk factors are the following:

• Age

Couples with a woman who is over 35 and a man who is over 40 had the highest miscarriage risk.

• Increased Number of Previous Miscarriages

After each subsequent loss, the chance of miscarriage rises (losses one after another). A woman's likelihood of experiencing another miscarriage is 4 in 10 after three consecutive ones. This indicates that six out of ten (60%) of the women in this scenario will go on to have a child the following time. 

Diagnosing Recurrent Miscarriage

• A fertility specialist or ob/gyn will analyse a patient's medical history and prior pregnancies to identify the reason for recurrent miscarriages. A comprehensive physical examination, which includes a pelvic exam, is typically advised by a doctor.

• A karyotype test, which identifies and assesses the size, shape, and number of chromosomes in a sample of body cells, may be carried out by the physician if it is thought that the patient's repeated miscarriages are caused by a genetic defect.

• A doctor may suggest imaging tests, such as an MRI or sonogram/ultrasound if the doctor feels a uterine issue is at the root of recurrent miscarriage. If a woman has a problem with the shape of her uterus, it can be detected with an ultrasound or a hysterosalpingogram (HSG), which is an X-ray of the fallopian tubes and uterine cavity. Blood testing can be used by doctors to identify immune system issues like APS.

• A definite diagnosis can be made in about 50% of individuals who are assessed for recurrent miscarriage. The remaining individuals' diagnosis of recurrent miscarriage is not known to have a specific aetiology. Depending on the patient's age, the likelihood of a successful future outcome in the group of patients who do not know the origin of their illness can reach 70%.

Treatment for Recurrent Miscarriage

If you are seeking knowledge on recurrent miscarriage treatment in Bangalore, an obstetrician and gynaecologist would be the right specialist to consult. The treatment procedures are as follows:

• Recurrent miscarriages can be treated with lifestyle modifications, drugs, surgery, or genetic testing to improve the likelihood of a healthy pregnancy. In certain circumstances, including recurrent miscarriages, medical or surgical therapies can reduce a woman's risk of subsequent miscarriages.

• A woman still has a 60 to 80% probability of conceiving and carrying a full-term pregnancy even after three miscarriages. The majority of the time, women choose to continue their natural pregnancy attempts, but in some cases, a doctor may recommend medication to help lower the risk of suffering another loss.

• Surgery can correct issues with a septate uterus and remove certain fibroids or anomalies caused by scar tissue. Since surgical correction increases the live birth rate, it is frequently the preferred treatment for anatomical problems.

• A doctor may recommend blood-thinning drugs like heparin or low-dose aspirin if the patient has an autoimmune condition like APS. Although a patient can use blood-thinning drugs to reduce the risk of miscarriage while pregnant, she should consult a doctor before doing so due to the increased risk of life-threatening bleeding issues.

• Treatment for physical conditions like hypothyroidism, hormone abnormalities, and abnormal blood sugar levels might increase the likelihood of a healthy, full-term pregnancy. Progesterone supplements or drugs that stimulate the brain's dopamine receptors can help with this process.

• A doctor might recommend genetic counselling if a chromosomal issue like a translocation is discovered. Even though many couples with translocations are able to conceive normally, a doctor may advise fertility treatments such as in vitro fertilisation (IVF), which is a procedure in which a reproductive specialist combines eggs and sperm in a lab. Preimplantation genetic diagnosis (PGD) allows for the genetic testing of the embryos after which only healthy ones are delivered to the uterus. This enhances pregnancy results.

• Making healthy lifestyle decisions like giving up smoking or using illegal drugs, consuming less alcohol and caffeine, and maintaining a healthy weight may reduce the risk of recurrent miscarriage. There is no evidence that mild depression, worry, or stress contribute to recurrent miscarriages.

Effective Care Plan after Recurrent Miscarriages

The patient will typically be offered blood tests and a scan after recurrent miscarriages to see whether there is anything wrong. She will be directed, if at all feasible, to a specialised department that deals with managing recurrent miscarriages. In these situations, competent supportive prenatal care frequently has a significant impact. Attending an early pregnancy unit may lower the chance of further miscarriages, according to some data.

• Blood Tests

Complications can be checked for using blood tests. Impaired blood coagulation, polycystic ovarian syndrome, and high levels of certain antibodies can damage the placental blood supply or result in improper placental attachment in the womb, both of which can disrupt the pregnancy.

• Uterine Examination

Women experience a higher chance of recurrent miscarriage and early birth if their womb is irregularly formed. Several methods for examining the uterus' shape exist, and depending on the results, surgery can be advised.

• Progesterone and Recurrent Miscarriages

Recent research suggests that progesterone may be beneficial if a woman experiences bleeding during her current pregnancy after one or more previous miscarriages. This study (known as the PRISM trial) was released in 2019 and demonstrated that the more prior miscarriages a woman has experienced, the greater the benefit from progesterone therapy. Progesterone is a hormone that aids in uterine lining thickening and aids the mother's body in absorbing the developing child. It is delivered as tablets and administered intra-vaginally twice daily.

More Facts regarding Recurrent Miscarriages

• Recurrent miscarriages are not common. Women over the age of 35 or those who have previously had a miscarriage are more likely to experience recurrent miscarriages.

• As many women undergo miscarriages without even being aware that they are pregnant and without showing any signs or symptoms of the miscarriage, the incidence of miscarriage is probably underreported. Most of the time, an ultrasound can help a medical professional identify and diagnose a miscarriage (a diagnostic imaging technique that uses sound waves).

• Vaginal bleeding, a decrease in tenderness or fullness in the breasts, and a lack of fetal movement or sound can all occur in women who suffer miscarriages or recurrent miscarriages. Women should inform their doctor or midwife of such symptoms and monitor their bleeding frequency.