For a mother, a miscarriage is the last thing she would want to hear. It can pin her down psychologically, leading to trauma and stress in unfathomable measures. To understand miscarriage better: it is a condition wherein there is a loss of pregnancy within the first 22 weeks of getting pregnant. The primary symptom of a miscarriage is bleeding from the vagina. So if you experience vaginal bleeding during this phase, then consult a doctor for further guidance.

Why do they occur?
There are many reasons as to why a miscarriage may occur and no study has been able to put a finger on any one specific cause. Having said that, miscarriages are mainly caused due to the presence of unusual chromosomes in the baby. Chromosomes are genetic material that directs the growth and development of a baby. Chromosomes present in either excess numbers or less can hinder the development of the baby. If the miscarriage occurs during the second trimester (14th to 26th week), then it can be accrued to a health anomaly in the mother. A miscarriage may also occur because of a weak cervix as a weak cervix will not be able to hold a pregnancy. This condition is called cervical insufficiency and occurs when the woman is in her second trimester.

Is it possible to prevent them?
In most cases, miscarriages cannot be prevented. For women who have suffered multiple miscarriages, multiple medications might be required to help with their subsequent pregnancies. Following a healthy lifestyle is recommended as it can minimize the risk of a miscarriage. One must abstain from smoking and substance abuse and limit consumption of alcohol in order to keep the body in optimal condition. It is advised to maintain optimal weight levels and eat a well-balanced diet.

Post miscarriage
A miscarriage is a very traumatic experience for a mother to be; it can be emotionally debilitating. That is the reason counseling can help in times such as these. Start planning for a baby only once the symptoms have subsided and you have also had a period post the miscarriage. It is important to make sure that you are physically and emotionally ready to have a baby. Remember, a miscarriage doesn t mean the end of the world. One can enjoy a fully healthy and a successful pregnancy even after a miscarriage.

Miscarriage - Why it Happens?

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

It's normal to be concerned with your fertility after early miscarriage. Many couples want to try to conceive again right away, while others need time to heal. Ultimately, though, fertility following a miscarriage is an issue of concern for most couples.

Once you are ready to start trying for a child again, there are a number of things you can do to increase your chances of having a successful pregnancy.

Rest and Recuperate- Many women want to hurry and start trying to get pregnant again right away after their miscarriage. This is a perfectly normal response, but may not be the best way to guarantee a healthy pregnancy. Give your body a chance to rest so your menstrual cycle can get back to normal. You also want to give yourself plenty of time for your mental balance to return so you are ready to take on the trials of trying to become pregnant. Be gentle and give yourself time to rest and focus on taking care of your physical and emotional needs until you are ready to try again.
Change Lifestyle- Eliminating unhealthy habits can help increase your chances of conceiving later. Eliminate drug or alcohol use and quit smoking before you start trying for pregnancy. Cutting down or eliminating caffeine can also help you conceive a healthy pregnancy.
Eliminate Stress- Eliminating stress can also make conceiving easier. Stress can reduce fertility levels, making it harder to get pregnant. Practicing meditation, yoga or taking time to relax after dealing with tough issues in your life can make it much easier to conceive.
Eat Healthy- Eating a healthy diet is also essential to having a healthy pregnancy. This can also help women manage the depression caused by their miscarriage. Getting a variety of vitamins and minerals and cutting down on saturated fats and processed foods can help you get pregnant and maintain a healthy pregnancy.
Take Fertility Drugs or Therapies- There are various fertility drugs and therapies on the market today. Your doctor will prescribe different medications based on your overall health and age.
Use an Ovulation Predictor- An ovulation predictor can help you map out your cycle. This will allow you to determine which days in your cycle will be the most likely for you to conceive. 
Support the Uterus and Liver- Performing a fertility cleanse after your period has stopped can help support the uterus and liver, promoting overall fertility health. Sometimes stagnant blood can get left behind after your period which can cause discomfort or health issues. Following a fertility diet to help rid your body of the excess blood and hormones in your system can help your conceive more easily.
Massage the Uterus- When you have stopped bleeding after your miscarriage, performing a uterus massage can help your body relax. This massage will help bring fresh blood to the area and soothe the body so you can relax. 
If you have been having trouble conceiving it may be time to talk to a fertility expert. Your doctor can perform fertility tests on you and your partner to determine if there are any underlying issues present. Then you can work together to determine if any additional medical treatment is necessary to help you get pregnant.

Ways to Increase Fertility after Miscarriage

Miscarriage is the early loss of foetus within 20 weeks of pregnancy. It is also known as  spontaneous abortion . According to research, about 8-20% of the pregnancies end in miscarriage. Out of the total number of miscarriages, 80% of them end within 12 weeks of pregnancy.

Types of Miscarriages and their Symptoms 

Threatened Miscarriage   As the term suggests, in this condition the process of miscarriage might have begun. This is the initial stage of the process. In threatened miscarriage, there is slight bleeding accompanied by cramps and pain in the lower back, which is usually mild. The cervix (the lower part of the uterus) remains closed. 
Inevitable and Incomplete Miscarriage   In these conditions, there is bleeding along with an open cervix. When there is dilatation and thinning of the cervix, miscarriage is inevitable. In incomplete miscarriage, part of the tissue comes out and a part remains inside the uterus. In inevitable and incomplete abortions, the bleeding and cramps are more severe. 
Complete Miscarriage   Complete miscarriage is when the embryo has completely emptied from the uterus. The pain and bleeding reduce once the foetus is expelled. This can be confirmed through ultrasound. 
Missed Miscarriage   In Missed miscarriage, there is no sign of the life of the embryo and there is no expulsion of the embryo. It can be detected from the absence of heartbeat of the embryo found on ultrasound. 
Recurrent Miscarriage   It happens when there are two or three miscarriages one after the other. It affects about 1% of the pregnancies. 
Risk Factors 

Increased maternal age i.e., women above 35 years. 
Excess or insufficient chromosome in embryo. 
Placenta is the organ which links mother and the baby for blood supply. Problem in the development of placenta can cause miscarriage. 
Excessive smoking and drinking during pregnancy. 
Obese women have higher risk of miscarriage. 
Long-term health conditions like high blood sugar, high blood pressure, liver disease etc.
Infections like rubella, malaria etc. 
Weakened cervix, which is the result of previous injury or surgery, can also result in miscarriage. 
What are the symptoms of a miscarriage? 

Bleeding or spotting can be one of the symptoms of miscarriage. It should be kept in mind that not all pregnant women who suffer from spotting or bleeding, end in miscarriage. 
Lower backache starts before or right after bleeding, which can be persistent or you could have cramps which may be mild or sharp and can feel like more of pelvic pressure. 
Missed miscarriages are detected through ultrasound when the doctor finds that there is no heartbeat of the embryo or when the uterus is not growing. 
What are the treatment options in miscarriage? 

Medical   In most of the cases, there are no specific drugs to stop a miscarriage from occurring. In some cases, certain hormonal preparations help. There is no point in prescribing medicines for prevention of miscarriage if there is heavy bleeding. 
Surgery   Dilatation and evacuation (D&E) is a simple operation which is done under general/local anaesthesia. In this operation, the cervical canal is dilated and contents present in the uterus are evacuated. There is no cutting involved as it happens through the vagina. The process needs only five to ten minutes, but the patient has to stay in the hospital for about 3-4 hours. 
This process is opted when: 

There is heavy bleeding. 
The patient suffers from missed miscarriage. 
What can you do to prevent miscarriage? 

Nothing much can be done to prevent miscarriage in most of the cases. However, following supportive measures may help: 

There should not be overexertion during pregnancy. Moderate amount of physical activity is permissible. 
One should have a well-balanced diet. Studies have shown that a diet loaded with fruits and veggies helps in overall well-being during pregnancy. One should limit the consumption of caffeine. 
Avoid smoking, alcohol and certain drugs to prevent miscarriage. 
Avoid stress and anxiety. 
Report to Doctor (preferably Obstetrician) as soon as any symptom related to miscarriage appears.

Miscarriage - Symptoms, Treatment and Prevention

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

What is recurrent miscarriage?

If you have three or more miscarriages in a row, doctors call it recurrent miscarriage. If you have experienced recurrent miscarriage, your GP or midwife will refer you to a gynaecologist. Your gynaecologist will try to identify the reason for your losses.

Having miscarriage after miscarriage may leave you feeling utterly drained of hope. At times, it may be hard to keep trusting in the future. This experience affects every aspect of a woman s life from her mental and emotional health to her physical health and social well-being. 

If you can, try to draw comfort from the fact that most women who experience recurrent losses do go on to have a baby. This is especially the case if tests can find no reason for the losses. Six out of 10 women who have had three miscarriages will go on to have a baby in their next pregnancy.

Treatment of Recurrent Pregnancy Loss

Treatment for anatomic abnormalities of the uterus involves surgical restoration through removal of local lesions such as fibroids, scar tissue and endometrial polyps or timely insertion of a cervical cerclage (a stitch placed around the neck of the weakened cervix) or the excision of a uterine septum when indicated.

A thin endometrial lining has been shown to correlate with compromised pregnancy outcome. Often times this will be associated with reduced resistance to blood flow to the endometrium. Such decreased blood flow to the uterus can be improved through treatment with sildenafil (Viagra), Terbutaline and possibly aspirin.

Sildenafil (Viagra) Therapy Viagra has been used successfully to increase uterine blood flow. However, to be effective it must be administered starting as soon as the period stops up until the day of ovulation and it must be administered vaginally (not orally). Viagra in the form of vaginal suppositories given in the dosage of 25 mg four times a day has been shown to increase uterine blood flow as well as thickness of the uterine lining. To date, we have seen significant improvement of the thickness of the uterine lining in about 70% of women treated. Successful pregnancy resulted in 42% of women who responded to the Viagra. It should be remembered that most of these women had previously experienced repeated IVF failures.

Terbutaline this is a medication that relaxes the muscle in the uterine wall and so permits improved hormone delivery to the endometrium. The use of Terbutaline will often cause an increase in heart rate. It should not be prescribed to women who have irregular heart beats (arrhythmias), and women who have decreased cardiac reserve.

Aspirin this is an antiprostaglandin that improves blood flow to the endometrium. It is administered at a dosage of 81mg orally, daily from the beginning of the cycle until ovulation.

Selective Immunotherapy Using Intralipid, heparin, aspirin and corticosteroid

Many causes of pregnancy loss or failure can be treated with immunotherapy comprising combinations of aspirin and heparin and corticosteroids (dexamethasone or prednisone) and Intralipid (IL) to regulate increased NKa. Achievement of optimal success with Intralipid/corticosteroid therapy requires that the treatment be initiated well before ovulation takes place (about 7-14 days prior to anticipated implantation). Given the fact that only 10-15% of natural cycles (with or without the use of insemination and/or fertility drugs) will result in a pregnancy, it follows that repeated administration of Intralipid will be required in most cases before a pregnancy will occur. IVF achieves pregnancy rates that are often 2-3 times higher. This often makes IVF a treatment of choice in cases of immunologic recurrent pregnancy loss.

Role of IVF

Preimplantation genetic diagnosis (PGD) a procedure whereby the embryo can be tested for genetic or structural chromosomal abnormalities requires the use of IVF to select the best embryo(s) for transfer to the uterus. In cases of structural chromosomal (translocations) egg or sperm donation is often another option worth considering.

In those cases where due to intractable anatomical or alloimmune dysfunction IVF repeatedly is unsuccessful or is not an option, Gestational Surrogacy might represent the only recourse other than adoption.
If a couple with Recurrent Pregnancy Loss is open to all of the diagnostic and treatment options referred to above, a live birth rate of 70%   80% is ultimately achievable.

Recurrent Miscarriage - How to Deal With It?

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