Are repeated miscarriages common?
Miscarriages are frequent, happening in 15-20% of all pregnancies, most often during the first trimester (up to 13 weeks). A single or even two losses are not suggestive of future infertility. Nonetheless, they may cause patients to be apprehensive and doubt their capacity to give live birth. After losing two pregnancies, more than half of couples will go on to have healthy children on their own. If you have not had a live delivery and have had two or more miscarriages, you may want to look more thoroughly at probable causes.
There are several reasons for miscarriage, however, they are often classified as early or late.
- Recurrent early miscarriages (during the first trimester) are most usually caused by genetic or chromosomal disorders in the embryo, with aberrant chromosomal numbers accounting for 50-80 percent of spontaneous losses. Early miscarriage can also be caused by uterine structural issues.
- Recurrent late miscarriage may be caused by uterine abnormalities, autoimmune issues, an incompetent cervix, or early labor.
Here are some of the most prevalent reasons of repeated miscarriages:
- Genetic issues that result in an anomaly of the growing fetus can be a primary cause of miscarriage. Either couple, or both, may be genetically susceptible to passing on a defect to the fetus. According to one research, chromosomal disorders cause 50-60% of all losses in the first three months of pregnancy.
- Miscarriage can also occur when the uterine lining does not grow properly due to abnormal hormone levels. As a result, the fertilized egg may not have the ideal environment for implantation and nutrition. This is caused by aberrant hormone levels. Those with thyroid and adrenal gland issues, as well as women with diabetes, are more likely to miscarry owing to hormonal abnormalities. Furthermore, an increased prolactin level might interfere with normal uterine lining formation.
- Miscarriage can be caused by structural abnormalities or the form of the uterus, which generally interfere with the implantation of the fertilized egg. Uterine fibroids are benign growths on the uterine wall. Fibroids can cause infertility if they obstruct the entrance of the Fallopian tube(s) or interfere with the regular functioning of the uterine lining. A septum (a fibrous wall that separates the uterine cavity) can lead to poor implantation and pregnancy loss. Another source of structural issues is DES exposure, which results in a T-shaped uterus and contributes to pregnancy loss.
- Cervical Issues: An “incompetent cervix” is another reason of miscarriage, which means the cervical muscle is weakening and cannot remain closed as the growing fetus grows and reaches a particular weight, putting pressure on the cervical opening.
- Infections: German measles (rubella), herpes simplex, ureaplasma, CMV, and chlamydia can all have an impact on fetal development and, in some situations, end in miscarriage.
- Environmental Toxins: Environmental toxins in the air surrounding you might cause fetal harm or miscarriage, especially if you are exposed on a regular basis after 20 weeks of pregnancy. According to research, marijuana, cigarette, caffeine, and alcohol usage can all have an impact on embryonic development and result in miscarriage. Most doctors advise pregnant women to minimize or avoid using them.
- Antiphospholipid antibodies are one type of immunologic issue that might result in a miscarriage. To identify the existence of these antibodies, blood tests are employed. If present, blood-thinning medicines may be utilized. Baby aspirin (81 mg) daily, frequently starting at ovulation and continuing throughout the pregnancy, and/or Heparin, an injection-based blood-thinning medication. Another type of immunologic cause of miscarriage is when the woman’s natural protective reaction to the embryo is disrupted.
- Some women suffer signs and symptoms prior to miscarriage, while others do not. Some symptoms of an impending miscarriage include: vaginal spotting, which is generally dark brown and changes to pink or red; a reduction in breast tenderness or fullness; and the lack of fetal movement or heart sounds. Cramping and vaginal bleeding are symptoms of a miscarriage. Take the initiative and contact your doctor right away.
- If you’ve had more than two miscarriages, don’t walk; instead, call your OB/GYN or get a referral to a reproductive expert to help narrow down probable causes and assess what may be done to avoid future losses. They can do a battery of tests to see whether there is an underlying explanation for the recurring miscarriage.
Here are some of the tests your doctor may recommend:
- Hormone testing If you haven’t already, request a prolactin, thyroid, and progesterone level. If they are abnormal and you are given therapy, make sure you are re-tested to monitor your levels.
- Structural evaluations. A hysterosalpingogram is performed to assess the shape and size of your uterus and to rule out any scarring, polyps, fibroids, or a septal wall that might interfere with implantation. If the uterine cavity is causing concern, a hysteroscopy (examination performed in conjunction with laparoscopy or as an office procedure) can be performed. The cervical muscle is overly lax in certain women, resulting in pregnancy loss after the first trimester. When a woman is not pregnant, a particular exam is performed to screen for an incompetent cervix.
- Uterine Lining Examinations An endometrial biopsy is performed on cycle day 21 or later to determine whether your lining is thick enough for the fertilized egg to implant. If there is a two-day or longer delay in the creation of the lining, you will be treated with several hormones (Clomiphene, hCG, Progesterone). It is critical to repeat the biopsy after multiple cycles to ensure that the medication is effective. If you are taking Progesterone, talk to your doctor about the benefits of oral, vaginal gel creams or pills, or injections.
- Genetic Analysis. Because it is difficult to retain miscarriage tissue for proper investigations, chromosomal testing are seldom performed on it. If chromosomal testing is required, you and your partner will have blood tests to ensure that there is no gene translocation (a condition in which the number of genes is the normal 46, but they are joined together abnormally). This disease can lead to miscarriage.
- Immunological examinations. Antithyroid antibodies (antibodies to thyroglobulin and thyroid peroxidase), the lupus anticoagulant factor, and anticardiolipin antibodies are all blood tests to look for immunologic reactions that might induce pregnancy loss. Lupus and anticardiolipin antibodies appear to affect blood clotting systems within the developing placenta. Blood testing can also be used to look for protective blocking elements. These are necessary in order to keep the pregnancy from being rejected by the mother’s body.
Recurrent miscarriage is quite unlikely. According to ACOG, around 5% of women will have two or more consecutive miscarriages, and 1% will have three or more. Women over the age of 35 and those who have had prior losses are at a greater risk of recurrent miscarriage.
Miscarriage is likely underreported since many women miscarry before they even realize they are pregnant and have no signs or symptoms of the miscarriage. In most circumstances, an ultrasound may be used to identify and diagnose a miscarriage (a diagnostic imaging technique that uses sound waves).
The vast majority of miscarriages are caused by genetic defects in the embryo or fetus, such as an extra or missing chromosome. These are usually random mutations that are unlikely to occur again. However, in the case of recurrent miscarriage, the situation is different, and the doctor will check for a specific sort of mutation known as a balanced translocation. While it is linked to recurrent miscarriage, it is still an extremely rare event.
Some women who suffer miscarriages or recurrent losses feel vaginal bleeding, breast discomfort or fullness, and fetal movement or sound loss. Women should report such symptoms to their doctor or midwife and maintain a record of how much bleeding happens.
If a miscarriage patient passes tissue, she should keep it. It can subsequently be used by a doctor to assist pinpoint the reason for the miscarriage. A miscarriage can result in strong sentiments of loss and sadness. Some doctors advise patients to attend a support group to discuss their experience and grief over the loss of the pregnancy and baby.