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Recurrent Miscarriages Can Be Devastating: A Doctor Explains the Causes

To understand why a pregnancy results in a miscarriage, it is vital to perform several tests.

A woman announces to her family that she is pregnant and the excitement of a new arrival is palpable! The happiness of grandparents is visible and there is joy in the air!

Unfortunately, one out of every five to six pregnancies end in a miscarriage, i.e. the pregnancy is lost! And if it happens not once, not twice but three times in a row to a couple, then it can be disastrous! Recurrent losses in pregnancy cause immense emotional stress for the couple.

Due to lack of information about this occurrence, various forms of therapies have come to be associated with it. They include taking herbal treatments, sleeping in a particular manner, tying some religious threads on the body, avoiding certain foods, etc. These “therapies” have neither been proven useful nor are they recommended by credible practitioners of medicine.

To understand why a pregnancy results in a miscarriage, it is vital to perform tests. Various tests are carried out to determine if there were hormonal, infective, or genetic issues. The treatments vary according to the causes. Hence, it is not possible to prevent a reoccurrence, unless all the necessary tests are done.

Chromosomal causes:

Chromosomal abnormalities are a primary cause of miscarriages

At least 50% of the pregnancies that are lost in the first three months show a major chromosomal or genetic abnormality when the tissues are examined.


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In pregnancies lost later in the gestation period, there is a high rate of chromosomal abnormality, roughly 30% in the six months of pregnancy and 5% in the last three months.

The chance of chromosomal abnormality being the cause of recurrent pregnancy loss (RPL) is low (< 5% of couples with RPL). Women older than 35 years have a greater tendency to produce eggs with chromosomal abnormalities. Whenever a couple has suffered two or more miscarriages, an investigation of the chromosomes for the female and the male is indicated.

In rare cases, if an abnormality is identified, prompt consultation with an experienced human geneticist is recommended, since the research in this field is complex and dynamic.

Immunological causes:

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Immunological causes of recurrent pregnancy loss are poorly understood. Two major categories of immunological causes of recurrent pregnancy loss are autoimmune (in which the woman’s immune system attacks her own organs and tissues) and alloimmune (in which the immune system attacks tissues considered foreign).

Autoimmune disease or dysfunction may play a role in up to 10% of recurrent pregnancy loss. Antiphospholipid (APS) is the autoimmune dysfunction that is classically associated with recurrent pregnancy loss. Small blood clots develop in the circulation of the fetus which interrupt the passage of oxygenated blood to the fetus. This is a possible reason for the fetal losses.

Low dose aspirin and heparin (blood thinners) are the preferred treatment options for women with APS. In a situation where there are alloimmune causes, i.e. the fetus is being treated as foreign tissue by the mother’s body, other therapies such as leukocyte immunisation with the father’s blood and immunoglobulin therapy are used.

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Hormonal causes:

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The most common hormonal cause of recurrent pregnancy loss is “luteal phase defect” which is associated with a low progesterone secretion.

Progesterone is necessary for the development of the lining of the uterus to sustain a pregnancy. Progesterone appears to have a critical role in implantation and the development of a normal pregnancy. Its deficiency can lead to infertility in severe cases and recurrent pregnancy loss in milder cases.


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A common treatment for a luteal phase defect is progesterone supplementation in the form of vaginal suppositories, injections, oral tablets or a combination of the above. Controlled diabetes mellitus and controlled thyroid disorders are not considered to be causes of pregnancy loss today.

Infections:

Certain chronic infections such as Toxoplasmosis which a woman may suffer from, can be passed to the fetus and harm it. If the infection is not detected, it may continue to play havoc with future pregnancies. Hence it is important to do the necessary tests and treat the infections if present, to ensure successful pregnancies in future.

Uterine Abnormalities:

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Abnormalities of the uterus such as defects in the structure of the uterus since birth, or presence of fibroids in the cavity, or a septum (partition) in the cavity, or an incompetent OS (mouth of the uterus) can also lead to miscarriages. Correcting these problems before the next pregnancy can help prevent miscarriages.

Lifestyle factors:

Lifestyle factors such as smoking, heavy drinking and drug abuse can also increase the risk of recurrent miscarriages.

Unknown causes:

Even after thorough investigations, the exact cause of recurrent miscarriages may not be found. Studies point that couples with recurrent miscarriages due to unknown causes have a 70% chance of eventually having a normal pregnancy.

In conclusion:

There is no experience more difficult than having to go through a miscarriage. It is not only physically taxing but emotionally challenging as well. The loss of a pregnancy can be even harder to deal with, especially when it occurs time and again.

As doctors, we empathise with our patients and do whatever is possible to ensure successful pregnancies. The joy and pleasure of a healthy pregnancy and childbirth cannot be described–both for the couple and the treating doctors!

(Written by Dr. Duru Shah and edited by Shruti Singhal)

About the author: Dr. Shah is the Director, Gynaecworld Center for Assisted Reproduction and Women’s health Panel Consultant – Breach Candy Hospital, Jaslok Hospital, Global Hospital and Hinduja Healthcare

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