Management of Recurrent Pregnancy Loss
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Recurrent pregnancy loss, also known as repeated miscarriage, means two or more consecutive miscarriages in the first trimester or in the second trimester prior to 23 weeks. Approximately 1% of women of reproductive age will suffer from recurrent pregnancy loss for different reasons. In approximately 50% of these women, no definitive cause will be identified. In many cases, however, the cause is identified, and treatment may be implemented, which may result in a successful pregnancy. Nevertheless, a successful pregnancy may still occur in approximately 60% of women with three miscarriages.
The known causes of recurrent pregnancy loss are varied and fall into a number of categories:
Genetic
In 3-5% of couples with recurrent pregnancy loss, one of the partners may carry a balanced translocation in which there is a rearrangement in one or more of the chromosomes. This may result in an unbalanced chromosome abnormality being passed to the fetus. It is important that a couple who suffers from recurrent pregnancy loss have a blood test called karyotyping to check their chromosomes for any abnormalities.
Uterine Defects
In 3-5% of couples with recurrent pregnancy loss, one of the partners may carry a balanced translocation in which there is a rearrangement in one or more of the chromosomes. This may result in an unbalanced chromosome abnormality being passed to the fetus. It is important that a couple who suffers from recurrent pregnancy loss have a blood test called karyotyping to check their chromosomes for any abnormalities.
Cervical Incompetence
Some women who have recurrent pregnancy loss in the second trimester (after 14 weeks) may have a weak cervix that cannot hold the pregnancy. This condition is known as an incompetent cervix. A successful pregnancy can be achieved by performing an outpatient procedure known as a cerclage.
Autoimmune Disorders
Autoimmune disorders produce antibodies against your own tissues. Certain autoimmune problems may cause recurrent pregnancy loss. One example is antiphospholipid antibody syndrome (APAS). APAS results in the formation of multiple small blood clots in the blood vessels that go to the placenta and may result in pregnancy loss. Blood work to detect APAS is a routine part of the workup necessary for patients with recurrent pregnancy loss. If APAS is found, blood thinners (such as baby aspirin and Heparin) are administered very early in the pregnancy.
Genetic Thrombophilia
Thrombophilia refers to a group of genetic disorders that may result in the formation of multiple small blood clots in the blood vessels supplying the placenta, potentially leading to pregnancy loss. Depending on the disorder found, treatment with blood thinners such as Heparin, and/or baby aspirin may be needed.
Environmental Factors
Tobacco, drugs and alcohol may be contributing factors in recurrent pregnancy loss.
Other Conditions may be a cause of recurrent pregnancy loss:
- Thyroid disease
- Diabetes mellitus
- Uterine infection
- Polycystic ovary syndrome (PCOS)
- Kidney disease (especially if accompanied by high blood pressure)
Ideally, these conditions need to be evaluated and treated before pregnancy is contemplated. Our maternal-fetal medicine clinicians have wide experience in diagnosing and treating problems that may cause recurrent pregnancy loss. Our MFMs will work closely with your obstetrician to determine and implement the best treatment plan for you, whether it is medication, cerclage or another treatment modality, to help you achieve a successful pregnancy.