Recurrent Miscarriage

Miscarriage is very common and occurs in approximately one in four recognised pregnancies. The human body is amazing but due to its complexity there are many things that could go wrong in the early days of a pregnancy, with the body detecting this and ending the pregnancy.

Most of the time there is no reason found for why a pregnancy ends in miscarriage and the majority of women will have a successful next pregnancy. For some women and their partners, they will suffer another miscarriage. Having three or more consecutive spontaneous miscarriages before 20 weeks of pregnancy defines recurrent miscarriage and it is an uncommon occurrence, with 1-3% of couples affected. If this has happened to you, Dr Budden will ask for detailed information about how far along you were and what happened at the time of each miscarriage. He will then organise for a number of investigations for you, and perhaps your partner, to look for any causes of recurrent miscarriage.

Causes of Recurrent Miscarriage

Age - One of the most important factors relating to miscarriage is the age of the woman, since we know that egg age is important to the developing baby.
Alcohol – Alcohol consumption is linked to recurrent miscarriage and should definitely be avoided if you have had this problem with early pregnancy.
Antiphospholipid Syndrome – These antibodies are found in approximately 15% of women with recurrent miscarriage. The woman’s body makes these antibodies which can affect the implanting embryo. When recognised, treatments can improve chances of successful pregnancy considerably. Dr Budden will organise a blood test to check if you have these antibodies.
Chromosomal make-up of parents – Chromosome abnormalities may be responsible for more than half of all miscarriages. In a smaller number of couples, there is a situation called a balanced chromosomal abnormality. This is where all of the genetic information is present in both the male and female partners, but may be in a mixed up pattern in one of them. This means that when an embryo is being made with half the information from each parent, proper development of a baby is not possible and this results in a miscarriage. Dr Budden will recommend you and your partner have a blood test to look at your chromosomal makeup.
Anatomy – Uterine abnormalities, including the cervix, may be a factor in recurrent miscarriage. If you have an unusual uterine shape this may contribute to recurrent miscarriage. In addition, infections, injury to the uterus or the cervix and any resulting scar tissue (Asherman’s Syndrome) could contribute to ongoing problems.
Maternal Illness – Long term health problems such as diabetes or those that affect blood clotting are also associated with recurrent miscarriage and Dr Budden will include screening for these conditions in any blood test he organises for you.

Although specific causes for recurrent miscarriage are sought, it is important to note that 50% of couples with this problem have no apparent cause for their recurrent miscarriage. While this may be frustrating, in many circumstances this may mean a better chance of future successful pregnancies, so it should not always be seen in a negative way.

Treatment Options

The treatment options for recurrent miscarriage vary, according to the cause that is diagnosed. Possible treatment options are listed below. Dr Budden will discuss specific treatments for your situation.

Medical treatments may include:
- Aspirin
- Clexane (injections used to thin the blood)
- Prednisone
- Progesterone
Surgical treatments may include:
- Laparoscopy (key hole surgery) to investigate and treat abnormalities
- Hysteroscopy (looking inside the uterus) to identify and treat abnormalities inside the uterine cavity
Assisted Reproductive Technologies (ART) and in vitro fertilization (IVF)
- Preimplantation Genetic Diagnosis (PGD) may be recommended when there is a suspected gene abnormality.

This may allow for testing and selecting genetically normal embryos and prevent miscarriage.