If you lose a baby before 24 weeks of pregnancy, it is called a miscarriage. If this happens in the first 3 months of pregnancy, it is known as an early miscarriage. Unfortunately, early miscarriages are common, with 10 20 in 100 (10 20%) pregnancies ending this way. Late miscarriages, after 3 months of pregnancy but before 24 weeks, are less common: 1 2 in 100 (1 2%) pregnancies end in a late miscarriage. When a miscarriage happens three or more times in a row, it is called recurrent miscarriage. Recurrent miscarriage affects 1 in 100 (1%) couples trying to have a baby.

Why does recurrent miscarriage and late miscarriage happen?

Sometimes there is a reason found for recurrent and late miscarriage. In other cases, no underlying problem can be found. Most couples are likely to have a successful pregnancy in the future, particularly if test results are normal.

There are a number of factors that may play a part in causing recurrent and late miscarriage:

Age, the older you are, the greater your risk of having a miscarriage. If the woman is aged over 40, more than 1 in 2 pregnancies end in a miscarriage. Miscarriages may also be more common if the father is older.
Antiphospholipid syndrome (APS- a syndrome that makes your blood more likely to clot) is uncommon but is a cause of recurrent miscarriage and late miscarriage.
Thrombophilia (an inherited condition that means that your blood may be more likely to clot) may cause recurrent miscarriage and in particular late miscarriages.
Genetic factors, about 2 5 in 100 couples (2 5%) with recurrent miscarriage, one partner will have an abnormality on one of their chromosomes (the genetic structures within our cells that contain our DNA and the features we inherit from our parents). Although this may not affect the parent, it can sometimes cause a miscarriage
Weak cervix is known to be a cause of miscarriage from 14 to 23 weeks of pregnancy. This can be difficult to diagnose when you are not pregnant. It may be suspected if in a previous pregnancy your waters broke early, or if the neck of the womb opened without any pain.
Developmental problems of the baby may lead to a miscarriage but are unlikely to be the cause of recurrent miscarriage.
Infection that makes you very unwell can cause a miscarriage. Milder infections that affect the baby can also cause a miscarriage. The role of infections in recurrent miscarriage is unclear.
An abnormally shaped uterus may contributes to recurrent miscarriage or late miscarriages. However, minor variations do not appear to cause miscarriage.
Diabetes and thyroid problems can be factors in miscarriages. They do not cause recurrent miscarriage, as long as they are treated and kept under control.
It has been suggested that some women miscarry because their immune system does not respond to the baby in the usual way. This is known as an alloimmune reaction. There is no clear evidence to support this theory at present. Further research is needed.
Are there any other risk factors?

Being overweight increases the risk of miscarriage. Smoking and too much caffeine may also increase the risk. Excessive alcohol is known to be harmful to a developing baby and drinking five or more units a week may increase the risk of miscarriage.

The chance of a further miscarriage increases slightly with each miscarriage. Women with three miscarriages in a row have a 4 in 10 chance of having another one. This means that 6 out of 10 women (60%) in this situation will go on to have a baby next time. 

Why are investigations helpful?

Finding out whether there is a cause for your recurrent miscarriage or late miscarriage is important as your doctor will be able to give you an idea about your likelihood of having a successful pregnancy. In a small number of cases there may be treatment available to help you.

What investigations might be offered?

Blood tests:

For APS- APS is diagnosed if you test positive on two occasions 12 weeks apart, before you become pregnant again.
For thrombophilia- If you have had a late miscarriage you should be offered blood tests for certain inherited thrombophilias.
To check you and your partner s chromosomes for abnormalities. You may be offered this test if your baby has been shown to have abnormal chromosome
Tests for abnormalities in the baby You should be offered tests to check for abnormalities in your baby s chromosomes. This is not always possible but may help to determine your chance of miscarrying again. If you have had a late miscarriage you may also be offered a postmortem examination of your baby. This will not happen without your consent and you will have the opportunity to discuss this with your health team beforehand.

Tests for abnormalities in the shape of your uterus. You should be offered a pelvic ultrasound scan to check for any abnormalities in the shape of your uterus. If an abnormality is suspected, further investigations may include a hysteroscopy (a procedure to examine the uterus through a small telescope which is passed through the vagina and cervix) or a laparoscopy (a procedure in which a surgeon uses a fine telescope to look inside the abdomen and pelvis).

Tests for infection. If you have had a late miscarriage, tests such as blood samples and vaginal swabs may be taken at the time to look for any source of infection.




What are my treatment options?

Treatment for APS

If you have APS and have had recurrent miscarriage or a late miscarriage, treatment with low-dose aspirin tablets and heparin injections in pregnancy increases your chance of having a baby. Aspirin and heparin make your blood less likely to clot and are safe to take in pregnancy.

Having APS means you are at increased risk of complications during pregnancy such as pre-eclampsia, problems with your baby s growth and premature birth. You should be carefully monitored so that you can be offered treatment for any problems that arise.

Treatment for thrombophilia

If you have an inherited tendency to blood clotting (thrombophilia) and have had a miscarriage between 12 and 24 weeks of pregnancy, you should be offered treatment with heparin. At present there is not enough evidence to say whether heparin will reduce your chance of miscarriage if you have had early miscarriages (up to 12 weeks of pregnancy). However, you may be still offered the treatment to reduce the risk of a blood clot during pregnancy.

Your doctor will discuss what would be recommended in your particular case.

Referral for genetic counselling

If either you or your partner has a chromosome abnormality, you should be offered the chance to see a specialist called a clinical geneticist. They will discuss with you what your chances are for future pregnancies and will explain what your choices are. This is known as genetic counselling.

Monitoring and treatment for a weak cervix

If you have had a miscarriage between 14 and 24 weeks and have a diagnosis of a weak cervix, you may be offered an operation to put a stitch in your cervix. This is usually done through the vagina at 13 or 14 weeks of pregnancy under a general or spinal anaesthetic. Your doctor should discuss the surgery with you.

If it is unclear whether your late miscarriage was caused by a weak cervix, you may be offered vaginal ultrasound scans during your pregnancy to measure the length of your cervix. This may give information on how likely you are to miscarry. If your cervix is shorter than it should be before 24 weeks of pregnancy, you may be offered an operation to put a stitch in your cervix.

Surgery to the uterus

If an abnormality is found in your uterus, you may be offered an operation to correct this.

Hormone treatment

Taking progesterone or human chorionic gonadotrophin hormones early in pregnancy has been tried to prevent recurrent miscarriage. More evidence is needed to show whether this works.

Immunotherapy

Treatment to prevent or change the response of the immune system (known as immunotherapy) is not recommended for women with recurrent miscarriage. It has not been proven to work, does not improve the chances of a live birth and may carry serious risks (including transfusion reaction, allergic shock and hepatitis).

What if no cause is found?

Where there does not appear to be a cause for recurrent miscarriage or late miscarriage, there is currently no evidence that heparin and aspirin treatment reduces the chance of a further miscarriage. For that reason this treatment is not recommended in these circumstances.

What does this mean for us in the future?

You and your partner should be seen together by a specialist health professional. Your doctor will talk to you both about your particular situation and your likelihood of having a further miscarriage and a successful pregnancy. If a cause has been found, possible treatment options will be offered to you to improve your chance of a successful pregnancy.

For couples where no cause for recurrent miscarriage has been found, 75 in 100 (75%) will have a successful pregnancy with this care. It is worth remembering that the majority of couples will have a successful pregnancy the next time even after three miscarriages in a row.

Recurrent And Late Miscarriage - Tests & Treatment For Couples!

Recurrent pregnancy loss is termed as the occurrence of three or more miscarriages. Recently, the American Society for Reproductive Medicine has altered the definition and limited the number of miscarriages to two. A pregnancy loss can only be termed so if the pregnancy is clinically recognized and is ends involuntarily before 20 weeks. The pregnancy loss must be identified by a registered doctor to term it as pregnancy loss.

What are the major causes of Recurrent Pregnancy Loss?
There could be a lot of reasons behind recurrent pregnancy loss. Most of the pregnancy failure happens from reasons such as abnormalities of the genes, chromosomes and other random events. It is estimated that close to 15 percent of the pregnancies end up in miscarriages. While 30-60 percent of the pregnancies expire within the first 12 weeks, fifty percent of the women are believed to be not aware of the pregnancy in the first place. The risk of miscarriage, however, is less than 50 percent.

An advanced maternity age is another crucial factor towards recurrent 2pregnancy loss. The risk of miscarriage dramatically increases among these women owing to their poor quality of egg, abnormalities in the chromosome etc. At a time, it has been observed that either the father or the mother might have irregularities in the gene leading to early miscarriage.

An abnormality in the uterus might also be a reason for a miscarriage. Poor blood supply and inflammation of the uterus are two of the topmost reason for miscarriages among many women. While some women born with a defective uterus, some develop uterus anomalies due to lifestyle and unhealthy life practices.

Last but not the least, a woman s immune system might also play a pivotal role towards a miscarriage. Certain hormonal irregularities, diabetes and thyroid diseases might lead to a miscarriage. Then there are the environmental factors such as stress, occupational factors, lifestyle practices etc that contributes towards a miscarriage.

What are the tests conducted?
To evaluate the exact reason for repeated miscarriages, a doctor performs a detailed physical and surgical examination. Some other areas where a doctor sneaks into include family history, genetic history etc. A karyotype test might also be prescribed in case a doctor feels the need of doing so. The uterus cavity and the uterus are closely monitored to understand any potential lack in the anatomy. This is followed by a list of imaging tests that a doctor might prescribe. These include MRI, X-ray, hysteroscopy etc.

What are the treatment options?
The treatment options are decided based on the finding of the tests. Sometimes plain medicines along with antibiotics can cure the condition, while sometimes surgery might be required to fix any potential threat within the uterus. In any case, the probability of future pregnancy after treatment goes as high as 77 percent.


Recurrent Pregnancy Loss - Things You Should Avoid!

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:

Abnormally-shaped Uterus: Some miscarriages, particularly late ones, are thought to happen because the uterus (womb) has an abnormal shape.
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.
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.
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.

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.
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.
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 miscarries for a different reason than the one being treated.

Understanding Miscarriages

Recurrent miscarriage is a condition when there has been three or more successive pregnancy losses. It is different from infertility as, infertility is the inability to conceive. For many cases, the cause of a recurrent miscarriage has not always been found. A number of factors can cause recurrent miscarriages of which some are treatable.It may not always be possible to identify a cause for recurrent miscarriage in a couple, even after extensive research and treatment procedures. Some of the common causes of recurrent miscarriage are described below:
1. Chromosomal abnormalities: Incompatible chromosomes can result into pregnancy losses. When an egg and a sperm meet, of which one of them is faulty, they can't line up properly resulting into chromosomal abnormality. Such conditions lead to miscarriages.
2. Uterine abnormalities or Incompetent cervixes: Miscarriages occur if the uterus is abnormally shaped since the embryo is not properly implanted or even if it gets implanted, it may not get sufficient nourishment to survive. If the woman has a weak cervix, it cannot hold the developing embryo, leading to miscarriage.
3.  Immunologic disorders: Under rare cases, the embryo itself is not accepted by the body. Antiphospholipid antibodies are those, which attack self tissues, such as embryos and prevent them from building up. This leads to recurrent miscarriage.
4. Untreated thyroid problems: Conditions such as thyroid or uncontrolled diabetes result in uterine conditions which make it tough for the embryos to survive.
5. Polycystic ovary syndrome: Women with polycystic ovary syndrome tend to have high levels of male hormones which, result in irregular menstruation and ovulation. This can prevent the lining of the endometrium from maturing that is required for holding the embryo.
6. Bacterial infections: There may be presence of a number of microorganisms inside the reproductive tract that may be harmless for the person. But there may be certain bacteria lined up in the reproductive tract, which can prevent development of embryo, thus leading to miscarriages.
7.  Lifestyle: Smoking and drinking are harmful lifestyle habits, which may increase the chance of miscarriage to a great extent. It is always advised to avoid smoking or drinking when you wish to conceive. Other lifestyle conditions, such as working in certain environments like hospital environments, farms, laboratories, etc, may lead to miscarriages; however, the exact reason has not been identified yet.

Reasons For Recurrent Miscarriage

Natural therapies are a great option to support your body and prepare it for pregnancy. As with any approach trying to decrease the chance of miscarriage, these steps will help to nourish and support the body, inviting a healthy pregnancy to occur.

Preparing ahead of time for your pregnancy is also important for decreasing the chance of a miscarriage, these steps must be practiced for at least 3 months before you become pregnant again. If you are currently experiencing a miscarriage contact your doctor or midwife right away.

Prepare for conception: The first step is to prepare your body with fertility cleansing. Fertility cleansing helps you to support the liver in cleansing the body of old toxins and excess hormones while encouraging the uterus to cleanse itself of  old  contents, increasing uterine circulation and tone.

Eat a nutrient dense fertility diet: The next step is to nourish and build up your body to be a healthy, baby friendly body. This can be done through eating a well balanced and nutritious diet. What you eat has a strong impact on:

The health of your eggs
Your hormonal balance
Creating a healthy placenta
Decreases chance of a miscarriage
Building nutrient storage for baby
Creating a healthy reproductive system
Build a healthy foundation: One of the major foundational steps to increase your chance of having a healthy pregnancy is to take some basic vitamins, minerals, and EFA s. There are specific vitamins and minerals that are necessary for a healthy reproductive system, hormonal balance, and ovulation. Essential fatty acids are also extremely important for miscarriage prevention.

Apply fertility or abdominal massage: Another important element of promoting a healthy conception is to increase circulation to the uterus. Through applying a simple massage method called self fertility massage you are able to increase the circulation to the uterus, clear adhesions and congestion.

4 Steps to Decrease the Chance of Recurrent Miscarriage

A miscarriage is generally characterized by the loss of a fetus before the passage of around one forty days of pregnancy. In medical terminology, a miscarriage is usually referred to as a spontaneous abortion, precisely because it happens spontaneously. According to studies, about 50% of all pregnancies end up in miscarriages and around 80% of miscarriages occur within the first three months of pregnancy. If they happen to occur after the passage of twenty weeks of gestation, they are normally termed as late miscarriages.


Causes
The most common cause of miscarriages is primarily due to the presence of some fatal or critical genetic problem in the unborn baby, which may or may not be in any way related to the mother. Apart from this, there is a host of other causes which are held responsible for miscarriages. These may include:
1. Cervical insufficiency (weakness of the cervix)
2. Infection
3. Hormonal imbalances
4.  Physical problems in the mother
5. Medical problems in the mother
6. Immune system responses
7. Uterine abnormalities


Symptoms
Here are a few indicators of a miscarriage:
1. Bleeding (which can vary from light to heavy bleeding)
2. Abdominal pain
3. Weakness
4. Severe cramps
5. Fever
6. Back pain


Treatment
1. Treatment of miscarriages normally involves three steps - a pelvic exam, an ultrasound test and blood tests to confirm whether or not it is a miscarriage.
2. If the miscarriage is complete and yet the uterus is still not emptied of its contents, then it may be necessary for you to undergo a dilation and curettage operation.
3. If you have gone through multiple miscarriages in the past, then the treatment will probably involve a pelvic ultrasound, a hysterosalpingogram or a hysteroscopy.


Causes, Symptoms and Treatment of Miscarriage

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