FACTS ABOUT RECURRENT PREGNANCY LOSS/MISCARRIAGE
RECURRENT PREGNANCY LOSS/MISCARRIAGE
Recurrent pregnancy loss is defined as having two or more miscarriages prior to age of viability . After three repeated miscarriages, a thorough physical exam and testing are recommended.
A small number of women (1%) will have repeated miscarriages.
MOST COMMON CAUSES OF RECURRENT PREGNANCY LOSS:
Most miscarriages (about 60%) occur randomly when an embryo receives an abnormal number of chromosomes during fertilization. This type of genetic problem happens by chance; there is no medical condition that causes it. However, it becomes more common in women of increased reproductive age.
Are there other genetic problems associated with repeated miscarriages?
In a small number of couples who have repeated miscarriages, one partner has a chromosome in which a piece is transferred to another chromosome. This is called a translocation. People who have a translocation usually do not have any physical signs or symptoms, but some of their eggs or sperm will have abnormal chromosomes. If an embryo gets too much or too little genetic material, it often leads to a miscarriage.
Are problems with reproductive organs associated with repeated miscarriages?
Certain congenital problems of the uterus like uterine bleeding are linked to repeated miscarriages. Although there are many such disorders, one of the most common that has been associated with miscarriage is a septate uterus. In this condition, the uterus is partially divided into two sections by a wall of tissue.
Asherman syndrome, in which adhesions and scarring form in the uterus, may be associated with repeated miscarriages that often occur before a woman even knows she is pregnant. Fibroids and polyps, which are benign (noncancer) growths of the uterus, also may play a role in recurrent pregnancy loss.
Can medical conditions increase the risk of repeated miscarriages?
Women who have certain medical conditions may have an increased risk of repeated miscarriages. Antiphospholipid syndrome (APS) is an autoimmune disorder in which a person’s immune system mistakenly makes antibodies to certain substances involved in normal blood clotting. APS is associated with repeated miscarriages and fetal deaths. Another disease that can lead to miscarriage is diabetes mellitus. In this disease, high levels of a sugar called glucose are present in the blood. Women with diabetes, especially those in whom the disease is poorly controlled, have an increased risk of pregnancy loss. Women with a condition called polycystic ovary syndrome also have an increased risk of miscarriage.
How common is it that a cause for repeated miscarriages cannot be identified?
In 50–75% of women with repeated miscarriages, no cause can be found for the pregnancy loss. There may be clues about what the problem is, but there is no sure answer.
What tests and exams are available to help find the cause of repeated miscarriages?
To help find the cause of repeated miscarriages, your health care professional will ask about your medical history and past pregnancies. A complete physical exam, including a pelvic exam, may be done. You may have blood tests to detect problems with the immune system. Testing may be done to help detect genetic causes of repeated miscarriages. Imaging tests may be considered to find out if a uterine problem is causing repeated miscarriages.
Is treatment available if the cause of my repeated miscarriages can be identified?
If a specific cause of your repeated miscarriages can be identified, your health care professional may suggest a treatment that addresses the cause.
What can be done if I have a chromosome translocation?
If you have a chromosome translocation, genetic counseling may be recommended. Results of genetic testing can help clarify your options. In vitro fertilization with special genetic testing called preimplantation genetic diagnosis may be done to select unaffected embryos.
How can problems with reproductive organs be treated?
Corrective surgery may be able to increase the chances for a successful pregnancy. For example, a septum in the uterus can be removed.
What treatment is available if I have antiphospholipid syndrome?
Use of a medication that prevents blood clots, such as heparin, sometimes combined with low-dose aspirin, may be prescribed throughout pregnancy and for a few weeks afterward. This treatment can increase the rates of successful pregnancy in women with this condition.
What are my chances of having a successful pregnancy if I have repeated miscarriages and no cause is found?
About 65% of women with unexplained recurrent pregnancy loss have a successful next pregnancy.
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