What is Miscarriage?
Miscarriage occurs before 20 weeks of gestation. Unfortunately, 15%–20% of clinically identifiable pregnancies miscarry. 80% of these losses occur in the first 12 weeks of pregnancy.
Couples grieve about pregnancy loss. Many couples question if they should seek treatment for miscarriage. This fact sheet lists typical miscarriage causes and recommends additional examination and treatment.
What causes Miscarriage?
Many couples never discover what caused their loss. After three miscarriages, many hospitals will perform tests. Although this is unpleasant and heartbreaking, this policy is in place since most couples who have had one or two miscarriages will have a successful pregnancy the next time and test negative for recurrent miscarriage.
Most miscarriages are caused by:
- Genetic abnormalities
- Uterine abnormalities
- Cervical abnormalities
- Hormonal abnormalities
- Infection
- The immune system
- Maternal illness
- Lifestyle and environmental factors
Genetic Abnormalities
Genetic abnormalities cause 50% of first-trimester miscarriages and 20% of second-trimester ones. A chromosomal defect causes the most miscarriages. Each cell has chromosomes. Genes make up each chromosome.
Normal human cells have 23 pairs of chromosomes, one from the mother and one from the father. Missing or additional chromosomes can occur in eggs or sperm.
This chromosome imbalance causes the embryo to fail to implant, miscarry, or have an impaired child. Maternal age increases the likelihood of chromosomal abnormalities miscarriage. 40-year-old women are almost twice as likely to miscarry as 20-year-olds.
Women are born with their lifetime supply of eggs, which degrade over time. A fetal tissue karyotype can establish if recurring pregnancy loss is hereditary. A blood sample from each parent may be karyotyped by the doctor.
Both parents have normal chromosomes in 96% of cases. These occurrences suggest a possible genetic defect in the fetus. One parent has a chromosomal abnormalities such a translocation in 4% of cases.
Translocations alter chromosomal segments between two chromosomes. These translocation carriers are “balanced” since they have all their genetic information. They may produce “unbalanced” translocated sperm or eggs.
This may cause infertility, miscarriages, or birth defects. A translocation requires genetic counseling to discuss reproductive possibilities. IVF using PGD may exclude genetically imbalanced embryos.
Uterine Abnomalities
15% of recurrent miscarriers have defective uteruses. Septate uteruses have a tissue septum that protrudes into the uterine cavity. 3% of women have this congenital defect, but only half suffer reproductive issues.
The septum’s blood supply may not support normal embryonic growth, causing a miscarriage. Fibroids can also distort the uterus. Uterine fibroids, non-cancerous uterine wall tumors, affect 20% of reproductive-age women.
Fibroids may prevent fetal implantation or growth. Hysteroscopy is the major method for inspecting the uterine cavity. The doctor views the uterine cavity through the cervix with a hysteroscope.
General anesthesia or laparoscopy is used for this daycare operation. Some uterine abnormalities can be surgically repaired, improving pregnancy chances.
Cervical Abnormalities
The cervix, the small lower end of the uterus, may be too fragile to maintain a pregnancy without surgery. Their cervix opens early. Cervical incompetence causes 16% of mid-trimester (12–20 weeks) pregnancy losses. After discovering an incompetent cervix, surgery may be performed during pregnancy. Cervical stitching, or cerclage, corrects cervical incompetence.
Hormonal Abnormalities
Undiagnosed hypothyroidism, diabetes, polycystic ovaries, and elevated prolactin can induce miscarriages. Correcting these hormonal imbalances can prevent miscarriage.
Infection
Infections may induce repeated pregnancy loss, although studies have not found a higher infection rate in recurrent miscarriers than in fertile women. Chlamydia, which causes tubal infection and infertility, has been linked to miscarriages.
Recurrent pregnancy loss has been linked to mycoplasma, however the evidence is weak. Many doctors take cultures to screen for infectious organisms in couples with repeated early pregnancy losses.
If an infection is found, both partners receive antibiotics and a re-culture. However, antibiotic treatment does not guarantee normal pregnancy.
The Immune System
The immune system protects against infection, damage, and foreign substances. Pregnancy immunology is crucial. Maternal immune system problems can cause miscarriage.
The first category of immune disorders
- Mothers produce antibodies. Antibodies attack pathogens in a normal immune response. Auto-antibodies assault tissues in some persons. Several health issues can result.
- Anticardiolipin antibody, an auto-antibody, can obstruct placental blood arteries. Antiphospholipid antibodies and other autoantibodies may cause 3-15% of recurrent miscarriages.
- To treat, blood tests evaluate antibody levels. Small doses of heparin or aspirin may be recommended for elevated antiphospholipid antibody levels. These medications help 70-75% of mothers have healthy babies.
The second category of immune disorders
- The mother's immune reaction to the fetus changes. "NK" cells defend humans from infections, viruses, and organ transplants (organ transplant recipients are given immunosuppressive medicines to prevent their bodies from rejecting the organ).
- The father's genes enter the fetus during pregnancy. The mother's immune system protects it in the uterus. Some couples lack this protective response. The maternal immune system rejects the father's foreign substance in the fetus, causing miscarriage.
- Most centers do not offer experimental therapy like vaccination to prevent the mother immune system from rejecting the fetus.
Maternal Illness
Certain maternal diseases have been linked to an increased rate of pregnancy loss. Autoimmune illnesses (for example, antiphospholipid syndrome), congenital heart disease, severe kidney disease, and uncontrolled diabetes are examples of these medical conditions.
Some of these conditions can be treated, which increases the odds of a successful pregnancy, especially before conception and during the first 12 weeks of pregnancy. Special care and monitoring are advised during the pregnancy.
Lifestyle and Environmental Factors
Smoking, alcohol, and illegal drugs increase miscarriage risk. Exercise, working, interaction, and exposure to video terminals and computers do not enhance the chance of miscarriage, nor do hair spray, color, or permanents.
Some medications can cause miscarriage and birth abnormalities, but most do not. Before having x-rays or prescriptions, pregnant women should notify their doctors and dentists.
Couples should see their doctor about dangerous chemicals in their home or workplace. PFRC hospital’s Lifestyle Program is for couples interested in lifestyle modifications.
The Lifestyle Program provides free, up-to-date information on lifestyle factors that may affect conception, pregnancy, and IVF outcomes. The Lifestyle Program’s main objective is to prepare you for IVF. Contact PFRC hospital to join the lifestyle program.
What is the chance that I will Miscarry again?
Repeated miscarriage rates vary. Despite miscarriage, women who have had at least one full-term normal birth have a higher probability of a safe pregnancy. A woman with three consecutive miscarriages and no live births has a 60% probability of miscarrying again. If she has had one live birth and three miscarriages, her following pregnancy has a 30% chance of miscarriage.
What if I have experienced more than one Miscarriage?
1% of couples experience recurrent miscarriage. Recurrent miscarriage is three or more early miscarriages (before 13 weeks gestation) or two late miscarriages (13–20 weeks). In these circumstances, testing are frequently advised to discover the cause of the miscarriages and how to reduce the chances in future pregnancies.
Tests can include:
- Parental blood tests for chromosomal abnormalities.
- Testing miscarriage tissue for chromosomal abnormalities if available.
- Mother's hormonal and immune system blood testing.
- Uterine ultrasound.
- Hysterosalphingography (uterine X-ray).
- Hysteroscopy (seeing the uterus through the cervix).
- Endometrial biopsy (suctioning a little uterine lining)
The cause of recurrent miscarriage can be treated. Couples should know that these tests do not guarantee a cause for recurrent miscarriage. Only 50% of couples find a cause for recurrent miscarriage. Couples should not give up if recurrent miscarriage has no cause. 60-70% of recurring miscarriage couples have a successful pregnancy without therapy.
The Emotional aspects of Miscarriage
Miscarriages cause shock, disbelief, guilt, rage, sadness, loneliness, and melancholy. After a miscarriage, couples grieve and question why. Miscarriages intensify these feelings.
These sensations are normal, although men and women may grieve differently. Grief is personal. Both spouses should realize this and not expect the same reactions.
Women should eat protein, veggies, fruit, and whole grains to heal. Even a daily block walk is beneficial. Resting helps heal. Some couples need to memorialize their loss by planting a tree, donating to a favorite charity, or having a service.
Preparing for another Pregnancy
It’s personal when to try again. Some people want to try again right afterwards, while others need time to grieve. There is no “right” choice; you and your partner must decide what’s best for you.
You may need to discuss your feelings about trying again. To recuperate physically and mentally, it’s best to try again after your next period. Until you’re ready to try again, utilize contraception.
Where can I get support?
Prashanth Fertility Research Centre supports miscarriage couples. Our supportive counsellors listen to your issues. Contact Prashanth Fertility Research Centre reception to schedule a counseling session. Genetic screening is offered to all couples, especially those with recurrent pregnancy loss, IVF failure, low sperm counts, and amenorrhoea.