Recurrent Pregnancy Losses – Causes & Treatment
Doctor this is my third miscarriage. What should I do….
Mrs. Anita* (name changed) was ecstatic when after two previous early miscarriages her pregnancy seemed to be progressing normally till the 4th month when the ultrasound showed that the baby had stopped growing at around 9th week of pregnancy and was no longer alive. Because of her previous pregnancy losses Anita had taken a sabbatical from work, her parents had come from Bhopal to look after her so she could take adequate rest. After the ultrasound, both she and her husband were grief stricken and did not know what to do next.
Two pink lines in the urine pregnancy test mark the beginning of a nine-month journey which can bring varying experiences in different couples. For some couples, this journey brings unexpected complications as even nature can go wrong.
Almost 10-15% of human pregnancies end in abortions. Mostly these are chance events and the possibility of having a subsequent uncomplicated pregnancy is very good.
Some couples unfortunately have to deal with this complication in subsequent pregnancies also. Recurrent pregnancy loss is a significant life event which can be traumatic for both partners and may cause a feeling of personal failure.
The first ultrasound in pregnancy is usually done at around 6 to 8 weeks. At this stage the baby is very small but an ultrasound can detect baby’s heart beat and also accurately measure your baby’s age.
The fetal heart can be seen as a flicker on the ultrasound after six weeks of gestation. If not visualized your doctor may want a repeat ultrasound which is usually done after one week. Absence of fetal heart activity is commonly referred to as missed abortion.
Studies have shown that several health behavior modifications may improve the chance of a subsequent healthy pregnancy after previous abortions. These include weight loss in overweight women and cessation of smoking and limitation of alcohol intake in women planning a pregnancy.
For women having recurrent miscarriages your doctor will advise investigations based on your age, pregnancy history, family history and previous investigations/treatment to search for an underlying cause which can be identified in several cases. This includes thyroid hormone levels, blood tests to detect antiphospholipid antibodies (APLA), ultrasound to look for any abnormality in the uterus and genetic tests of the parents. The treatment varies according to the causes.
APLA syndrome is a condition in which the mother’s body makes antibodies (a type of protein) which lead to increased production of several chemicals which are associated with pregnancy complications like repeated miscarriage, high blood pressure during pregnancy and low birth weight of the baby. Most pregnant women with APLA syndrome are otherwise asymptomatic and the condition comes to light only when the required blood tests are done.
Improved outcomes are seen in APLA positive pregnancies when aspirin and low molecular weight heparin injections are started early in pregnancy.
Sometimes, the cause of recurrent miscarriage lies in the genetic makeup of the parents. In these cases, the parents are otherwise normal but due to certain rearrangements in their genetic makeup (chromosomes), they run the risk of having repeated pregnancy losses due to defective sperms or eggs. Diagnosing this condition is important because such couples also run the risk of having babies with intellectual disability and developmental delay.
Hence all couples with recurrent miscarriages should have their karyotype done. If an abnormality is detected, consultation with specialists in this field is recommended.
Sometimes, the uterus has a septum or a fibroid encroaching on the cavity of uterus or incompetent cervix which can lead to abortions. Surgical correction of these abnormalities is available and improves chances of having a subsequent successful pregnancy.
Six weeks after her third pregnancy loss, Anita was investigated and was found APLA positive. In her fourth pregnancy, she was started on low dose Aspirin and Low molecular weight heparin injections. Today she has a healthy two-year-old who keeps her on her toes.
The loss of any pregnancy is the loss of hopes and dreams invested in that unborn child. For couples who have to go through this trauma again and again provision of information and appropriate testing is necessary so if a problem is identified adequate treatment can be given.