Treatments
Description of available treatments
Gynaecology
What is recurrent miscarriage?
Recurrent miscarriages are 3 or more early miscarriages.
Around one woman in every 100 has recurrent miscarriages. This is about three times more than you would expect to happen just by chance.
Why does it happen?
Often, in spite of careful investigations, the reasons for recurrent miscarriages cannot be found.
Age and past pregnancies
The older a woman is, the greater the risk of having a miscarriage. The more miscarriages, the more likely there will be another one.
Genetic factors
Three to five percent of women with recurrent miscarriages, one of the partners have an abnormality on one of their chromosomes. Although such abnormalities may cause no problem for you or your partner, they may sometimes cause problems if passed on to your baby.
Abnormalities in the embryo
Is an unlikely cause for recurrent miscarriages
Autoimmune factors
Antibodies are substances produced in our blood in order to fight off infections. Around 15 in every 100 women who have had recurrent miscarriages have particular antibodies, called antiphospholipid antibodies (aPL), in their blood this condition reduces the chances of a successful pregnancy to around 10%.
Uterine Anatomy
It is not clear how this can affect the risk of miscarriages and only major abnormalities may cause miscarriages or early labour.
Cervical Incompetence
In some women the cervix opens too early in the pregnancy and causes a miscarriage in the third to sixth month.
Polycystic ovaries
Is a condition where the ovaries are slightly larger than normal and produce more small follicles than normal. This may be linked to an imbalance of hormones. Just under half of women with recurrent early miscarriages have polycystic ovaries; this is about twice the number of women in the general population.
Having polycystic ovaries is not a direct cause of recurrent miscarriage
Infections
Unless a woman has a severe infection during pregnancy, infections in general do not cause recurrent miscarriages, there may be a role for bacterial vaginosis in relation to second trimester miscarriages.
Blood conditions
Certain inherited conditions that increases the risks of blood clots known as thrombophilia. These conditions may play a part in the causation of miscarriages.
Diabetes and thyroid problems
Diabetes or thyroid disorders can be factors in single miscarriages. They do not cause recurrent miscarriage, as long as they are treated and kept under control.
What can be done?
Supportive antenatal care
Women who have supportive care from the beginning of a pregnancy have a better chance of a successful birth.
Screening for abnormalities in the structure of your womb
An ultrasound scan, hydrosonogram or X-ray may be used to detect uterine abnormalities
Screening for genetic problems
Chromosomal analysis for both partners should be offered and followed by genetic counselling should any abnormalities be detected
Screening for abnormalities in the embryo
Checking the embryo chromosomes in case of recurrent miscarriages linked to a certain abnormality can be done using Pre-Genetic Screening or at a later stage of the pregnancy via Chorionic Villous sampling or amniocentesis.
Screening for vaginal infection
Only suggested in women who had experience a miscarriage at the second trimester that was not accounted for by any other reason
Treatment for aPL antibodies
A combination of Heparin and Aspirin started early in the pregnancy can increase the chances from 10% to 70% of a life birth.
Steroids have been used to treat aPL antibodies in recurrent miscarriage
Tests and treatment for a weak cervix
Either monitoring of the cervix using ultrasound scan or electively inserting a suture in the cervix can be employed to treat or prevent pregnancy loss due to a weak cervix.
Hormone treatment
It has been suggested that taking progesterone or human chorionic Gonadotrophin hormones early in pregnancy could help prevent a miscarriage. There is not yet enough evidence to prove whether this works.
Immunotherapy
Treatment to prevent or change the response of the immune system (known as immunotherapy) is not recommended for women with recurrent miscarriage. It has not been proven to work, does not improve the chances of a live birth and it may carry serious risks (including transfusion reaction, allergic shock and hepatitis).
It is important to point out that around 50% of women will have no apparent cause for their miscarriages and that leaves them with up to 75% chance of going on to have a successful pregnancy in future with no treatment.
Tubal Blockage
Fallopian tubes may be blocked for a number of reasons-perhaps from an infection many years ago, from previous surgery (for example for ectopic pregnancy) or inflammation caused by appendicitis or endometriosis. Whatever the cause, the effect is the same: the egg cannot travel down a blocked tube, hence cannot reach the womb to implant if it is fertilized. Depending on the degree of damage to the tubes, specialist units use techniques including micro-surgery to attempt to repair the tubes and remove the blocked segment. This can sometimes be successful (though success is far from guaranteed) but there is a risk of ectopic pregnancy (the embryo getting stuck and implanting in the tube instead of the womb). The alternative, which by-passes the fallopian tubes altogether, is in vitro fertilization (IVF). In this technique, the embryo(s) are replaced directly into the womb.