Repeated Miscarriages

What is recurrent spontaneous pregnancy loss?

Miscarriage means that pregnancy is lost before the end of the 22nd week of pregnancy. When three or more miscarriages in a row is called the recurrent spontaneous loss or habitual loss.

Miscarriage – also called spontaneous pregnancy loss – unfortunately happens quite often. Between 25 and 30% of couples find that one or more pregnancies end in a miscarriage. Although 15% of pregnancies in which the woman is aware that she is pregnant, becomes a miscarriage, then the total number nearer 50%.

Most miscarriages are done fr so early in the pregnancy that the woman has not yet reached to discover that she is pregnant.

In 10-12% of all pregnancies miscarriages occurs so late that an embryo can be seen by an ultrasound scan.

How frequently repeated miscarriages?

Barely 1% of all women miscarry three or more times in a row. In these cases we speak of  repeated miscarriage. Fortunately successful for most women with repeated miscarriage to have a baby in a subsequent pregnancy.

What causes repeated miscarriages?

There can be many explanations why a pregnancy develops into a miscarriage, but in over half the cases there is a fault in the fetal genes (chromosomes).

The process of making a child is complicated and error-prone to the genetic material. One can say that a miscarriage is often nature’s way to discard embryos that would not be a viable child.

The risk of chromosome abnormalities in the fetus increases in older women, while the risk will be greater of miscarriage.

When miscarriages are so frequent, there are also some who just randomly has three miscarriages in a row. The older the woman is, the greater the risk of miscarriage, the risk of recurrent spontaneous miscarriages increases with age. The man’s age has little or no meaning.

The woman’s age and the risk of miscarriage:

• Under 19 13%
• 20-24 years 11%
• 25-29 years 12%
• 30-34 years 15%
• 35-39 years 25%
• 40-44 years 50%
• over 45 years 93%

The chance of a successful pregnancy depends on the number of previous miscarriages.

For a young woman who has not previously had a child, the risk of a new abortion:

• After no abortions 11%
• After 1 miscarriage 15%
• After two miscarriages 25%
• After three miscarriages 45%
• After 4 spontaneous abortions 55%

A woman with three previous miscarriages and no child has 50-60% chance of having a child in the next pregnancy. If the woman has previously given birth to a child, the chance of another child in the next pregnancy 80%.

In general, the more abortions previously set, the older you are and the fewer normal pregnancies has been implemented, the greater the risk of a miscarriage.

What are the symptoms of recurrent spontaneous miscarriages?

Bleeding and pain of miscarriage.

What symptoms should you pay particular attention to?

Bleeding and pain.

Why are there some who have repeated miscarriages?

One can only find an explanation in approximately half of all women with recurrent spontaneous miscarriages. And even if we find the cause, it is not certain that there is a treatment that works.

Malformation of the uterus

About 5% have malformations of the uterus, which can increase the risk of miscarriage. It can be about a partition wall of the uterus or fibroids (fibroids) in the womb lining.

The uterus may be examined with ultrasound, and the examination may be supplemented by water scan, where there is introduced a little sterile saline into the uterine cavity – or a keyhole.

chromosomal aberrations

For more than three miscarriages can examine fetal chromosomes. If the fetal chromosomes are abnormal, it is a good sign. This indicates that the abortion is a coincidence. Is that normal chromosomes in the fetus, there is greater risk of another cause abortion.

At four or more consecutive abortions examines parental chromosomes. It may also be relevant by spontaneous abortion after 12 weeks, and if there are several in the immediate family (mother, siblings) who have experienced spontaneous abortions. The chromosomes examined by a blood test.

At about 5% of men / women with recurrent spontaneous miscarriages has two chromosomes switched places (called translocation), and this can cause miscarriage in up to 50% of the couple’s pregnancies.

Hormone disorders

Poorly controlled diabetes increases the risk of miscarriage.

Polycystic ovary syndrome  (PCOS) does not give an increased risk of miscarriage, unless they are overweight or have diabetes beginning.

The hormone progesterone made in the ovaries after ovulation and during early pregnancy is necessary to maintain a pregnancy. For many years it was thought that too little of this hormone could be a cause of spontaneous miscarriage. Now we know that in most cases, where there is a low progesterone in a woman who later miscarry, it is because the fetus for other reasons is not viable. So there is no need for treatment with progesterone in repeated miscarriages.

Immunological relationship

In a pregnancy, a woman’s immune system accept the fetus, which of course has a different tissue type than her. It is a complex and only partially understood process. If it does not work, it can cause miscarriage.

Women with recurrent miscarriages are often specific antibodies in their blood than women who have had children without problems. Some believe that these antibodies can cause miscarriage by damaging the placenta. Others believe that the antibodies are merely a symptom of these women have a poorly regulated and aggressive immune system. It is difficult to measure the immune system, but the detection of autoantibodies may be followed by other studies.

Blood clotting

Changes in blood clotting factors may impact on recurrent spontaneous miscarriages. Some of these changes are heritable and associated with increased risk of blood clots in the placenta. It can lead to miscarriage.

Lifestyle

Smoking, alcohol, coffee (more than three cups a day) and obesity are thought to increase the risk of miscarriage, but the relationship is uncertain and in any case not pronounced.

Many women who miscarry are worried that stress may have triggered abortion, and it can not be ruled out that severe emotional stress can lead to miscarriage.

How inspects for repeated miscarriages?

• At the first consultation the doctor with you and using previous records trying to get an overview of how the previous pregnancies progressed. This can be a very complicated affair. Therefore it is a good idea that you previously tried to write about previous pregnancies down (date, how far were you, what were reading.) The doctor will also collect information about your state of health and ask for hereditary diseases in your immediate family
• By three miscarriages or more you will be referred to the gynecologist who will examine the uterus by ultrasound scan
• Apart from scanning, prehistory and your age, your doctor may give a reasonable estimate for the next pregnancy is going well without treatment. This can be a great help when I need to consider if you dare try new pregnancy, and whether you should receive evaluation and possible treatment, which costs time and effort and may have side effects

How is it diagnosed?

Three or more miscarriages in a row where the pregnancy is confirmed with positive pregnancy test, ultrasound or tissue examination.

What treatment is there?

Generally, one must unfortunately say that it is rarely possible to find a treatment for recurrent spontaneous miscarriages that have proven their value in scientific experiments.

Since the probability of a successful pregnancy is fairly large – even after three or four miscarriages, any treatment result in many successful pregnancies – even if the treatment itself is ineffective. Therefore, all treatments for recurrent spontaneous miscarriages tested in clinical studies in centers that are specially qualified. When considering medical treatment is of course also important to use medications that are known to not give birth defects.

After three miscarriages

Even if you have three miscarriages in a row, there is still a high probability that this happened by pure chance, and there is good possibility that the next pregnancy is progressing normally. Chances are even better if you have previously performed a normal pregnancy.

Miscarriages can cause anxiety and depression, and such problems in pregnancy may increase the risk of another miscarriage. It is currently being investigated whether psychological support in early pregnancy reduces the risk of a new miscarriages in those with unexplained miscarriages.

A form of psychological support that is often used in a new pregnancy after several miscarriages, the ultrasound scan every week until you reach 12 weeks.

After four or more miscarriages

For more than three miscarriages, or if you have previously had a miscarriage after the 12th week, your mother or sister has aborted several times, or you have a so-called autoimmune disease that can be offered further investigation.

This may consist of blood, where your immune system, blood clotting or your chromosomes examined.

If any one chromosome errors in either father or mother refer to genetic counseling, trying to find out if the defect can cause risks to the fetus, or whether to carry out special studies in pregnant again.

In some cases, a blood-thinning medication in the next pregnancy be current.

More special treatments take place only on a trial plan.

How is long-term prospects?

They will depend on the number of miscarriages and births you have had a number of other factors when your age is the most significant. Other factors are smoking, alcohol, obesity and any chronic diseases.

How do I avoid or exacerbate recurrent spontaneous miscarriages?

By avoiding harmful influences such as smoking, alcohol and obesity and make sure that any medical conditions are well treated.