Understanding Miscarriages

Miscarriage refers to the spontaneous loss of the fetus before one completes the 20th week of pregnancy, taking into account the period from the conception to gestation. It usually happens in the first trimester of the pregnancy; that is within the seventh and the twelfth week of conception. Recurrent miscarriage is when one suffers from multiple miscarriages in a row.

Possible Causes:

1. Abnormally-shaped Uterus: Some miscarriages, particularly late ones, are thought to happen because the uterus (womb) has an abnormal shape.
2. Polycystic Ovary Syndrome (PCOS): Women with this condition have many small cysts in their ovaries.They also tend to have hormonal problems, including high levels of insulin and male hormone in the blood, which can lead to recurrent miscarriage.
3. Infection: Some serious infections can cause or increase the risk of single miscarriages. These include toxoplasmosis, rubella, listeria and genital infection. But it is not clear whether infection plays a role in recurrent miscarriage.
4. Diabetes and Thyroid Problems: Uncontrolled diabetes and untreated thyroid problems can cause miscarriage. But well-controlled diabetes and treated thyroid problems do not cause recurrent miscarriage.

Risk Factors:
Your risk of recurrent miscarriage is higher if:

• You and your partner are older; the risk is highest if you are over 35 and your partner over 40; 
• You are very overweight. Being very underweight may also increase your risk.

Each new pregnancy loss increases the risk of a further miscarriage. But even after three miscarriages, most couples will have a live baby next time.

Testing After Recurrent Miscarriage:

If you have had three miscarriages in a row, you should be offered tests to try to find the cause. This should happen whether or not you already have one or more children. Testing is not usually offered after one or two early miscarriages (up to 14 weeks) because these are often due to chance. But you might be offered tests after two early miscarriages if you are in your late 30s or 40s or if it has taken you a long time to conceive.
If you had a late (second trimester) miscarriage, where your baby died after 14 weeks of pregnancy, you should be offered tests after this loss.

1. You can opt for blood tests to check for sticky blood syndrome or APS. Tests would look for antibodies that would help treat the condition. Antibodies are chemicals produced by the body to combat infections.
2. Get an examination done should the doctor suspect chromosomal abnormalities and in case it is diagnosed, both of you can consult a clinical genetics specialist for genetics counseling.
3. Your doctor will recommend an ultrasound scan to trace any type of abnormality that may make a pregnancy futile, for instance, a short or a fragile cervix.

Your hopes:

It is natural to pin your hopes on testing as the answer to your problems. But there are three reasons why it may not be the answer you’re looking for:

• A cause may not be found; when this happens your miscarriages are called ‘unexplained’ 
• Even if a cause is found, it may not be treatable;
• Treatment may not lead to a successful pregnancy. This can happen if a pregnancy miscarriages for a different reason than the one being treated. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.