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!

Do you know about the various signs and symptoms that indicate a miscarriage? Miscarriage refers to pregnancy, which ends on its own, within 20 weeks of gestation. Miscarriage is a matter of great loss and grief for pregnant women. It accounts for being the most common form of pregnancy loss. According to studies, almost 10% to 25% of pregnancies result in a miscarriage. Chemical pregnancies are likely to be responsible for almost 50% to 70% of miscarriages.

Causes of miscarriage

The causes of miscarriage vary from one woman to another and in many cases the exact cause is not identified.
During the first trimester of pregnancy, chromosomal abnormality is the most common cause of miscarriage. It signifies some problem with your baby s chromosomes. Most cases of chromosomal abnormalities occur because of damaged eggs and sperm cells.
A certain problem which appears after the zygote goes through divisional procedures may also be responsible for a miscarriage.
Other causes for miscarriage include the following:

Hormonal imbalance, maternal health complications, and infections
Several habits such as smoking, malnutrition, excessive caffeine consumption, drug abuse, and exposure to toxic substances
Maternal age
Maternal trauma
When implantation of the egg in the uterine lining occurs improperly
Warning signs of miscarriage
There are several warning signs of miscarriage. The most important of them are as follows:

Back pain, which can vary from being mild to fatal. This pain can be even worse than menstrual cramps.
Loss of weight
Discharge of mucus that is whitish pink in color
True contractions are likely, in which pain occurs after every 5 to 20 minutes.
Bright red or brown bleeding with or without the presence of cramps may indicate a miscarriage.
Passage of tissue with a cloth material from your vagina.
Sudden reduction in the signs and symptoms of pregnancy
Chances of miscarriage
There are certain factors, which indicate whether you are likely to have a miscarriage. They are as follows:

Increase in your maternal age increases the chances of a miscarriage.
Women who are in between the age of 35 to 45 are at a higher chance of miscarriages than women who are relatively young. In women above the age of 45, the chances of miscarriage are maximized.
A woman having a miscarriage in the past has more chances of having another miscarriage.
In case you experience some or any one of these symptoms, it is important for you to seek professional health care as you need to evaluate whether you are having a miscarriage or not.


How To Know If You Are At Risk Of Having A Miscarriage?

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

An abortion is a procedure which has the potential to be quite complex and is something which does trigger a lot of thought, and with good reason. Taking this into account, a person should also consider the prospect of making use of homoeopathic treatment for the purpose of preventing an abortion.

How homeopathy can help?

Prevent miscarriage: The field of homoeopathy has a range of options when it comes to medication which can be used for this. To start with there is a medicine which is known by the name Secale. It is recommended quite widely for women who happen to be anaemic and not as strong as they should be, according to the average for a woman who is expecting a child. Secale is also used at the later stages of the pregnancy. The reason for this is the fact that it has the ability to reduce the risk of a miscarriage when the muscular tissue is developed to a fairly advanced extent.
High risk patients: Another homoeopathic medicine which is often used happens to be Aconite Nap. This is used when there is a real risk of abortion which can possibly be attributed to the pregnant woman being fearful or excited.
In case of accidents: When a woman is pregnant over the course of roughly 9 months, while it may be ideal to avoid any, in some cases, an accident may take place. While this is obviously very undesirable, to say the least, in this sort of situation, arnica Montana is the homoeopathic solution.
Treat Weak Uterus: Some women may greatly desire to be mothers but may be hindered on account of having a weak uterus. But with the kind of versatility and diversity homoeopathic has, there is a solution for this problem as well! That would be caulophyllum, which is said to be very effective.
Control Bleeding: In the case of an abortion which features heavy bleeding, the best medicine would be thlaspi, which is perfectly suited to improve the situation in an expedited manner.
While these may be medicines which are generally made use of, it is to be kept in mind that one of the main reasons that homeopathy as a way of medication happens to work is the fact that it does not only allow for but also actively encourages a great degree of customisation of the program of medication in accordance with the needs of the patient. Keeping this in mind, it is important that the homoeopathic doctor is of a quality which is very good as if there is a case of suboptimal medication, there can be trouble.

How Homeopathy Can Prevent Miscarriage?

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!

For some women, having their own children is not as easy as it seems. Suffering from more than two or more miscarriages is known as recurrent miscarriage. This experience affects every aspect of a woman s life from her mental and emotional health to her physical health and social well-being. 

It is important for a woman undergoing this experience to keep in mind that she can still give birth to a healthy baby even after recurrent miscarriages.

Look after your health: Miscarriages are not very uncommon and in many instances are a result of the woman s body not being able to take the strain if a growing fetus. Hence, pay attention to your health to prepare your body for future pregnancies. Avoid smoking, alcohol, caffeine and exposure to toxins that can cause fertility problems. Eat healthy food and start taking a multivitamin with folic acid on a daily basis. Exercise regularly, but avoid strenuous activities that involve heavy lifting or dangerous contact sports. Yoga is great for pregnant women or women planning a family as it tones your body keeps your stress levels low.
Talk to people: A miscarriage can affect your emotional health and self-image, but you must remember that you are in a way responsible for the miscarriage. Talk to other women who have had a similar experience and share your feelings with them. Men and women cope with a miscarriage in different ways and hence work on communicating your feelings with your partner. Do not suppress your feelings, but acknowledge them and work through them. You may also find it beneficial to talk to a counsellor or get involved with a support group.
Give yourself a break: It s ok to not attend your friend s baby shower when you ve recently suffered a miscarriage. Instead of surrounding yourself with your friend s babies and children, take a break and pay attention to yourself. Develop a hobby or find something to keep yourself busy. Take a holiday with your partner and find ways to reconnect with them. Find your own way of acknowledging the pregnancy. This could be in the form of writing about it, naming the baby or planting a tree in memory of the baby.
Get proactive: Don t sink into despair because of your miscarriages. Educate yourself about the various reasons you may have miscarried the baby by reading books or talking to medical professionals. This can help prevent future miscarriages.

Recurrent Miscarriage - How to Deal With It?

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