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If you lose a baby before 24 weeks of 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 APS- a syndrome that makes your blood more likely to 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 neck of the womb opened without any 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.
- Smoking and too much 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 ultrasound scan to check for any abnormalities in the shape of your uterus. If an abnormality is suspected, further investigations may include a vagina and cervix) or a abdomen and 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 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 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.
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.
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 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.