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

Once the reality of the positive pregnancy test sets in, dreaming about the yet-to-arrive begins. Curiosity about gender, options for names, ways to manage, shopping ideas, etc., begin to get discussed. And then totally out of the blue the news comes that there is a miscarriage. This is one of the most depressing phases. It is very important for the family to be around and support each other. While the entire family is upset and hurt over the news, the mother needs most care as there is just not emotional but a huge physical component also to the episode. On the other hand, remember that miscarriages are extremely common, and is no indication of a fertility issue.

The first step would be to diagnose and confirm the miscarriage. After that, depending on whether it was complete or incomplete, some medical intervention might be required. In most cases, medications like misoprostol are given to expel the uterine contents. These help by clearing out the contents in about a couple of days' time. In some cases, a D and C might be required if your doctor suspects that medication will not suffice. This also helps identify if there is any issue in the uterus that could have caused the miscarriage.

While the above take care of the physical part, the emotional component also requires cautious management. Needless to say, this is trickier than the earlier one.

Mourn to your heart's content - When you have nursed a life within you and have lost it, it is very normal to cry for its loss. There would be a mix of emotions - shock, denial, confusion, anger, grief, depression, etc. Take some solace from that fact that this is nature's way of removing unhealthy fetuses.

Get someone to talk to - Need not be your husband, but anybody whom you can talk to without having to watch words. A sibling, a good friend, a close relative - your choice. Make sure you don't pick ones who will judge and sympathize with you. More than sympathy, you need someone understanding and knowledgeable.

Socialize more - As you would have kept to yourself post your positive test, use this time to socialize more and meet friends whom you have not regularly been in touch with. Close family members, your children (if you already have), society groups, movie groups, etc., help to a great extent.

Formal medical counseling: If you are not able to cope with your regular circle of family and friends, try seeking professional advice from counseling.

Spirituality - Whether you believe in temple or churches, spend some time there. Involve in some religious activity if you would like, this helps very often.

As much as it is painful and traumatic, it is not very uncommon or unnatural. Get back on your feet, the sooner you do, the better.

Miscarriage - Ways To Recover

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!

Miscarriages are quite common these days. Couples who experience miscarriage have to go through an emotional trauma. They feel frustrated because of doubts and many unanswered questions along with the emotional trauma they face. While some women feel that they are a failure after experiencing a miscarriage, some others feel extremely guilty about it. Therefore, it is very important for couples to know about miscarriage. 

Here are the six most frequently asked questions about miscarriage that you must know:

How common is it for a miscarriage to happen?

This is definitely one of the most asked questions about miscarriage. According to most doctors, miscarriage is quite common. Unfortunately, one in four pregnancies can end in miscarriage. Therefore, everyone knows someone who has suffered a miscarriage.

What can be the symptoms of miscarriage?
This is the 2nd most common question asked about miscarriage. The symptoms of miscarriage vary from person to person. For most women, the symptoms noticed are bleeding and pain. As the pregnancy advances, more pain and more bleeding are noticed. The pains are similar to extremely bad menstrual cramps. However, doctors also agree that if a woman experiences some bleeding, it doesn t always imply that a miscarriage can happen.

What are the causes of miscarriage?
A woman s age is linked to miscarriage. If a woman is over 35, the risk of miscarriage rises. This is because cells do not divide properly as women age. The DNA of a man can also play a role in miscarriage.

How do doctors treat miscarriage?
About 75 % of miscarriages occur after the embryo gets embedded into the uterus. No treatment is required for this kind of miscarriage. Most miscarriages happen during the first 12 weeks of pregnancy. These miscarriages can be resolved through medication or surgery. The miscarriages that occur after the 12 weeks can be extremely traumatic for women.

What is the biggest misconception of miscarriage?
The most common misconception of miscarriage is that it can happen due to activities like exercise and sex.

What can be done to prevent a miscarriage?
People often ask this question to their doctors. Although there is no particular way to prevent a miscarriage, people should maintain a healthy lifestyle during pregnancy. Obesity, smoking and drug use can enhance the risk of miscarriage, and hence they should be avoided. 

Aforementioned are the six most asked questions about miscarriage. You should always talk to your doctor, if you face any complications or problems during pregnancy. It is important to clear your doubts about miscarriage. You should also try your best to maintain a healthy lifestyle.

Miscarriage - 6 Common Questions That Are Asked?

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.

Recurrent Miscarriage - How Can It Be Avoided?

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

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