Everything You Need to Know About Recurrent Miscarriages

Recurrent miscarriage is medically defined as 3 or more spontaneous pregnancy losses that occur before 20 weeks of pregnancy.

Recurrent miscarriage is quite different from infertility, because infertility is the inability to get pregnant rather than the inability to sustain the pregnancy.
There are many known disorders that are responsible for recurrent miscarriage and whenever we pinpoint the cause, management is tailored accordingly to ensure a successful pregnancy.

Among the main causes are the following:

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The most common sign of miscarriage is the bleeding (whether minimal spotting or heavy bleeding) which might be associated with lower abdominal cramps. Sometimes sudden cessation of the morning sickness might be a clue to miscarriage.

In most cases we have missed abortion where there are no symptoms of miscarriage and it is discovered during routine antenatal visit on the antenatal ultrasonography.
In general, one spontaneous miscarriage is not alarming to the obstetrician and the rate of successful pregnancy and delivery is not affected after 1 miscarriage. Hence, we reassure the patient after 1 miscarriage, advise her to try to get pregnant after 3 months.

On the other hand, 2 consecutive miscarriages should alert the patient for thorough examination by her obstetrician before the next pregnancy. However, 3 or more consecutive miscarriages require full investigation in order to diagnose the underlying cause and give the proper treatment.

Blood tests are done to check for autoimmune antibodies, thyroid dysfunction with antibodies formation, clotting factors disorders, as well as for uncontrolled blood sugar level.

Ultrasound scanning is done to check for fibroid, polyp. Karyotyping for the parents is requested to check for genetic disorders. In addition genetic testing for the abortus is also indicated at the time of miscarriage.

Management is planned according to the result of the investigation findings. Anatomical abnormalities could be corrected by surgical procedures.

Endometrial polyp/sub mucous fibroid could be removed by a simple procedure known as hysteroscopy for cases of Diabetes; blood sugar should be controlled at least 3 months before the next pregnancy.

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Low dose Aspirin with/without low molecular weight heparin is indicated in cases of thrombotic disorders and autoimmune antibodies. For cases of genetic disorders, genetic counselling is done and preimplantation genetic diagnosis (referred to as PGD) is done before embryo transfer in specific cases.

Once the patient is pregnant, close follow up is done; progesterone medications are given to support the pregnancy. Cervical incompetence is treated by stitching the cervix around week 12 – 13 of pregnancy (procedure known as Cerclage) with proper monitoring of the cervical length.

To summarize, recurrent miscarriage is a frustrating medical condition, but with proper medical counselling, proper investigation work up, and proper management, subsequent successful pregnancy is achieved.

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