Recurrent Miscarriage

What is recurrent miscarriage?

Occurrence of three or more consecutive spontaneous abortion before 20 weeks. Some, however, consider two or more as a standard. It may be primary or secondary (having previous viable birth).

This problem affects approximately 1% of all women of reproductive age. The risk increases with each successive abortion reaching over 30% after three consecutive losses.

What are the causes ?

• Genetic factors (3–5%): Parental chromosomal abnormalities is a proven cause of recurrent abortion.
• Poorly controlled diabetic patients do have an increased incidence of early pregnancy failure. PCOS has also been a known cause.
• Infection—Syphilis, toxoplasmosis and listeriosis may be responsible in some cases.  Transplacental fetal infection can also occur.
• Presence of autoantibodies causes rejection of early pregnancy (15%) in the second trimesters mainly. Antibodies responsible are: antinuclear antibodies, anti-DNA antibodies (double or single stranded) and antiphospholipid antibodies.
• Anatomic abnormalities in the mother like intrauterine adhesions, uterine fibroids and endometriosis and cervical incompetence.

How is the diagnosis made at Dr Mayuri Gynecology Clinic, Jaipur?

A thorough medical, surgical and obstetric history with meticulous clinical examination is carried out to find out the possible causes. Careful history taking includes the nature of previous abortion process, history of any chronic illness etc.

Some tests to confirm the diagnosis are:

• Blood-glucose, VDRL, thyroid function test, ABO and Rh grouping (husband and wife), antibodies test.
• Ultrasonography to detect abnormalities of uterus, polycystic ovaries and uterine fibroid.
• Hysterosalpingography
• Hysteroscopy and/or laparoscopy
• Karyotyping (husband and wife) The karyotype is the chromosomal, or genetic, make-up of a person. The purpose is to find abnormalities in the parents that could be passed on to the offspring, resulting in miscarriage.
• Endocervical swab to detect chlamydia, mycoplasma and bacterial vaginosis

How can recurrent miscarriage be managed or treated in Jaipur?

The treatment recommendations for patients in Jaipur with recurrent pregnancy loss are based on the underlying cause of recurrent pregnancy loss.

• If chromosomal abnormality is detected in the couples or in the fetus, genetic counselling is undertaken.
• Women with PCOS are best treated for their insulin resistance, hyperinsulinemia and hyperandrogenemia. Metformin therapy is helpful.
• Genital tract infections are treated appropriately following culture of cervical and vaginal discharge.
• Ultrasound should be used at the earliest to detect a viable pregnancy. This will influence further management. If the fetus is viable ultrasonographically at 8–9 weeks, only 2–3% are lost thereafter and similarly fetal loss is only 1% after 16 weeks of viable fetus.
• Rest—Patient should take adequate rest and to avoid strenous activities, intercourse and traveling.

Despite different investigations, about 40–60% of recurrent miscarriages remain unexplained. However, ‘tender loving care’ (TLC) and some supportive therapy improves the pregnancy outcome by 70%.

The recurrent miscarriage may be due to poor blood supply to the pregnancy and inflammation. It is the weak immune system also that plays role in the miscarriage. After the miscarriage the chance of pregnancy does not get reduces as confirmed by Dr. Mayuri Kothiwala. Rather it is much easier to conceive after the miscarriage.