Recurrent loss of pregnancy

The death of an unborn child can have devastating traumatic, emotional and psychological impact on a woman. In some cases it also comes with intense physical pain, bleeding. And for some women this may not be a one-time thing, as they may experience recurring pregnancy loss – when three or more consecutive pregnancies end in miscarriages.

Between two to five per cent of couples are affected by recurrent miscarriages. Fifteen to 25 per cent of pregnancies end in miscarriage even before the pregnancy test. Early pregnancy loss occurs during the first 90 days, or first three months of pregnancy and is considered a spontaneous abortion or miscarriage. At that time, the weight of the baby is approximately 500 grammes, unable to support independent life. Several conditions can cause early pregnancy loss, among them hormone imbalance, embryo deformity and immune reactions to the growing baby. Late pregnancy loss can happen between 20 to 36 weeks. This is called pre-term birth.

Recurrent abortions can either be spontaneous (occurring by itself) or threatened or incomplete, with just pains which subside after complete bed rest. Complete miscarriage has several signs, such as incapacitating abdominal pain with bleeding from the womb and portions of the developing baby.

Causes of recurrent pregnancy loss

Anatomical or iatrogenic causes: The structure of the womb has an effect on the ability to carry a child to term. For example polyps, fibroids in the cavity of the womb, a weak cervix, or adhesions within the womb from previous surgical interventions can cause recurrent pregnancy loss.

Endocrine disorders: Adult onset diabetes, polycystic ovarian syndrome, decreased or increased activity of the thyroid gland, and ovarian hormones imbalances are some endocrine causes of recurrent miscarriages.

Diabetes is a frequent cause of recurrent pregnancy loss. It is the cause of 20-25 per cent of miscarriages that happen even before the pregnancy test. Diabetes that develops after the pregnancy is called gestational diabetes, and should disappear or resolve after the delivery of the baby. It occurs in two to three per cent of all pregnancies and must be considered as a possibility and checked for at each antenatal visit.

Thrombotic causes: Thrombophilia is another common cause of early recurrent pregnancy loss. This blood-clotting disorder can be either an inherited or acquired condition. The risk of blood clots forming inside of the blood vessels is increased in obesity, and in people with a family history of thrombophilia during pregnancy. Fortunately, this is one of the frequent causes of pregnancy losses that can be treated.

Immunologic causes: High levels of immunoglobin blood levels, that is IgG and IgM can lead to recurrent pregnancy loss. These are responsible mainly for early pregnancy losses – before ten weeks of pregnancy. This may be due decreased maternal tolerance of the foetus.

Ovarian factor: This is also referred to as luteal phase defect and is seen in women with insufficient production of progesterone to maintain the early pregnancy.

Infections: A number of maternal infections can lead to pregnancy loss including toxoplasmosis listeriosis, and certain viral infections such as rubella, Herpes simplex, measles, cytomegalovirus and coxsackie virus, malaria, syphilis and brucellosis.

Chronic endometritis, which is a bacterial infection of the womb, has been found to be prevalent in some women with recurrent miscarriage.

Risky lifestyle behaviour: Consuming large quantities of alcohol during pregnancy have been confirmed by case reports studies to be a cause of recurrent pregnancy loss. The quantity of alcohol consumed is directly proportional to the incidence of repeated pregnancy loss. Cigarette smoking, with its strong nicotine component, also introduces the developing baby to its poisons and causes reduction of blood supply to the womb and placenta

Trauma: Falls or domestic abuse associated with abdominal trauma may trigger pregnancy loss

Unexplained causes: There is also a large percentage (25 per cent) of unexplained pregnancy losses. Fortunately, fertility can be regained in many cases with good diagnosis and proper management by a specialist.

Management of recurrent pregnancy loss

Management of recurrent pregnancy loss is individualised by the cause and tailored to each case. Once the cause is ascertained, your physician will advise you on the best course of treatment.

Close monitoring of your pregnancy by your specialist is important. The treatment of either early or late miscarriage differs. It is crucial that a thorough checkup is done to help pinpoint the exact nature of the recurrent loss. Among the best line of management are laboratory investigations such as:

Ultrasound scan of the reproductive organs, which are essential for assessment of an abnormal medical condition.

Blood tests to diagnose or confirm diabetes, thyroid function test, blood clot formations test.

Pre-implementation genetic resting for chromosomal testing for confirming foetal viability.

Contact Dr Maxwell on 363-1807 or 757-5411