Miscarriage is the unplanned loss of a pregnancy prior to the 6th month. Understandably, most women (and their partners) feel disappointment at the abrupt end of their hopes for that pregnancy. These women often find some solace in the fact that having a miscarriage is fairly common. Many of their friends and acquaintances have likely experienced a miscarriage first-hand because one out of four pregnancies ends in miscarriage. The rate increases to 50% in women over the age of 41.
Pregnancy loss can occur at various times in gestation. It can occur as early as a few days after the missed period. Other times a miscarriage doesn’t occur until after the pregnancy is visualized by ultrasound or even after the fetal heart beat is heard.
It is almost never the case that some inadvertent action on the part of the woman caused the pregnancy loss; however, it’s easy for a woman to falsely blame herself for the miscarriage. We’d like to dispel some of the myths around miscarriage. It is NOT true that working outside the home, carrying heavy groceries, or having sex can cause a miscarriage. We repeat, “The above activities are NOT the cause of
So what problems can cause miscarriage? Having a medical illness such as diabetes or lupus can increase a woman’s risk for miscarriage. But most miscarriages are due to a problem with the fetus itself. Studies indicate that up to 70% of pregnancy losses are due to a chromosomal imbalance in the fetus. Chromosomes are the separate packages inherited from our parents that contain our genes. Such imbalances are an unfortunate random event which can cause an abnormal pregnancy. However, if a woman has 2 miscarriages in a row and desires to have a baby, it is advised that she seek medical attention from her obstetrician or a specialist in reproductive endocrinology. A fairly simple evaluation may uncover a cause of her repeated pregnancy losses. If the pregnancy loss occurred fairly late (after the 3rd month), then an evaluation is recommended after just one such miscarriage. Abnormalities in the uterus (womb), cervix (mouth of the womb), thyroid hormone levels, blood coagulation, or egg maturation are some of the correctable causes of recurrent miscarriages.
The uterus must serve as a safe incubator for the growing fetus. However, some women have a fibroid, septum, or scar tissue inside their uterus which interferes with the proper growth of the fetus. Fortunately, these abnormalities can be removed by a surgical procedure called a hysteroscopy (similar to a D&C), thus allowing the woman to go on and have a normal pregnancy in the future. Miscarriages occurring after 14 weeks of gestation, where the delivery is fairly rapid and the “labor” is not felt until the near the end are often due to a weak cervix. This condition is called cervical incompetence. Placing a stitch in the cervix (called a cerclage) often reduces the risk of pregnancy loss in these women.
An underactive thyroid gland can cause miscarriage. A simple blood test is needed to make this diagnosis, and then supplemental thyroid hormone is prescribed to correct this matter. Another blood test that should be offered is to check for an autoimmune condition that can increase the tendency for blood clots to form near the placenta which nourishes the fetus. Fortunately, once the diagnosis of this autoimmune disorder (called Antiphospholipid Syndrome) is made, treatment with blood thinning shots can be initiated early in future pregnancies so as to reduce the chance for another miscarriage.
Checking the chromosomes of the woman and her partner is another test that is frequently offered to patients who have had recurrent miscarriages. It can detect cases where the man or woman has one chromosome that is attached to one another. In that setting there is a roughly 50% chance for the fetus to inherit an unbalanced set of chromosomes, which is a situation not compatible with continued fetal growth. If one of the prospective parents has this condition, there is a therapy which we have successfully used to dramatically lower the risk of miscarriage. This therapy is called Pre-implantation Genetic Diagnosis – or PGD for short. The process requires In Vitro Fertilization (IVF) to obtain embryos which can be tested to see if they have the correct number of chromosomes BEFORE they
are returned to the womb.
In at least half of couples who undergo an evaluation for recurrent miscarriages, there is no identifiable cause. The good news is that these couples have an excellent chance for having a normal baby with their next pregnancy. Their chance for a normal pregnancy is very similar to that of a couple who has never had a miscarriage. So our advice for such couples is to try again and not to lose hope. It is safe to try to conceive again 2 months after a miscarriage. Future pregnancies can be monitored closely with hormone assays and early sonograms. If another miscarriage occurs, we recommend that any miscarriage tissue (passed spontaneously or obtained at the time of a D & C) be sent to a diagnostic lab to test for a chromosomal imbalance. A positive finding of an imbalance will give the couple the answer to the question, “What went wrong this time?”
What else can a woman do to help avoid another miscarriage? She should follow common health guidelines such as avoiding cigarette smoke and limiting caffeine intake to no more than one beverage a day. Even before a woman wants to try to conceive she should take a daily vitamin containing folate which is critical for the early growth of the embryo. Your physician will tell you if you need other special medication like progesterone or baby aspirin. Most treatment is individualized depending on the specifics of the case.
Though miscarriage can be emotionally devastating, it is a common occurrence, and there is a very high chance that the next pregnancy will be normal. Your concerns can often be alleviated by asking your doctor. Therapy is sometimes recommended and is usually successful.For more information, please call South Jersey Fertility Center at (856) 596-2233 or visit www.sjfert.com.
As seen in Camden County Woman and Burlington County Woman