Recurrent Pregnancy Loss
A miscarriage or pregnancy loss is when a pregnancy ends on its own before 20 weeks (the first half of the pregnancy).
Recurrent pregnancy loss, repeated miscarriage or habitual abortion is a medical condition affecting 1-5% of women at reproductive age, it is when some women have 3 or more pregnancy losses (miscarriages). It’s however acceptable to start evaluation after the second pregnancy loss (miscarriage). The more the number of previous miscarriages, the more likely another miscarriage will occur.
Why do I keep losing the pregnancy?
There are many causes (or risk factors) for repeated miscarriages, it can be more than one cause (or risk factor) in some women:
1)
Genetic (Chromosomal) problems
: The fetus (baby growing inside a woman) can have abnormal genes (or chromosomes) which can lead to a miscarriage. Most of the time it can happen by chance unless the mother or father has any chromosomal problems. Risk of repeated pregnancy loss due to genetic problems is only 2-5%.
2)
Structural (anatomical) problems:
affecting the shape of uterine cavity where the pregnancy implantation occurs: Fibroids (benign tumor of the uterus muscle layer), polyp (tissue growth inside the uterus), adhesions (scar tissue inside the uterus) or born with an abnormally shaped uterus. All these conditions can negatively impact the normal pregnancy implantation.
3)
Hormonal or metabolic problems:
Thyroid disease, diabetes mellitus, insulin resistance, high prolactin hormone, high androgen hormone or polycystic ovarian syndrome, can result in hormonal imbalances and lack of normal hormonal milieu needed to support the pregnancy implantation leading to a miscarriage.
4)
Thrombophilia (High clotting tendency):
some women have high tendency to produce blood clots which can impact the blood flow to the pregnancy causing miscarriage (pregnancy loss).
5)
Immune problems:
our immune system is very important to fight infection or any foreign body. some people may develop problems within this immune system leading to an overactive immune system which can start attacking their own body including the pregnancy. Conditions including rheumatoid arthritis, systemic lupus erythematosus, autoimmune thyroiditis (Hashimoto’s or Grave’s), antiphospholipid antibody syndrome and other autoimmune disorders. Also, there is evidence showing that some women might have an exaggerated immune response to the fetus (baby inside mother) because the fetus is considered half foreign to the women’s body.
How to find out the cause of my repeated miscarriages?
– Medical records and history will be reviewed with the patient and a physical exam (including pelvic exam) will be performed.
– Blood tests will be ordered to check your immune system, hormonal levels, metabolism and blood clotting tendency. Other specific tests will be ordered as indicated.
– Imaging of the uterus will be performed, including ultrasound, sonohystogram, and/or hysteroscopy (inspecting the uterine cavity with a tiny camera, can be done in the office or in the hospital)
– Chromosomal (genetic) analysis for both the woman and her partner will be recommended if there is a history of a genetically abnormal miscarried fetus.
How can I be treated to prevent another miscarriage?
Depending on the cause or risk factor identified, a treatment plan will be made. Treatment is directed to prevent or minimize the negative impact of identified causes or risk factors so that a healthy pregnancy can normally implant inside the uterus leading to a good outcome and the birth of a healthy baby.
Every patient is different from each other even though they might share the same type of problem; the level of condition severity is different and the response to treatment protocol is also different, that’s why Personalized medicine is applied to every patient. Preventing repeated miscarriages is challenging and involves both science and art.
Possible treatment includes:
– Surgery to correct problems inside the uterus if needed.
– Immune therapy such a Prednisone, Intravenous Immunoglobulin (IVIG), Tacrolimus and Plaquenil, to modulate (Fine-tune) the immune system.
– Blood thinners such as Lovenox, heparin and low dose aspirin.
– Other medications as indicated to correct hormonal or metabolic problems.
– Lifestyle modification such as regular exercise, stopping cigarette smoking or illicit drug use, limiting alcohol and caffeine and following a healthy balanced diet (sometimes more strict diet).