Recurrent Miscarriage: Treatment & Diagnosis
When a woman experiences two or more successive clinical pregnancy losses, this condition is known as recurrent miscarriage. It is also known as chronic abortion or recurrent pregnancy loss. Clinical pregnancy is defined by doctors as having visible or detectable signs of a gestational sac (a cavity of fluid around an embryo), or foetal pole (thickening on the yolk sac edge of a foetus) in an early ultrasound.
Clinical pregnancies are different from chemical pregnancies, which result in a miscarriage before any physical signs of pregnancy other than a positive pregnancy test or blood test are present. 15 to 20 per cent of clinical pregnancies result in miscarriages.
How to diagnose recurrent miscarriage?
An obstetrician/gynaecologist or fertility specialist will examine the patient’s medical history and previous pregnancies to identify the reason for recurrent miscarriages. Typically, a doctor would advise getting a full physical exam, which includes a pelvic check.
A karyotype test of the embryo, which identifies and assesses the size, shape, and number of chromosomes in a sample of body cells, may be used by the doctor if repeated miscarriages are considered to be the result of a genetic defect.
Imaging tests, such as an MRI or sonogram/ultrasound, are probably performed if a doctor feels a uterine anatomical issue is the root cause of a recurrent miscarriage. If a woman has a problem with the shape of her uterus, it can be detected with an ultrasound or a hysterosalpingogram (HSG), which is an X-ray of the fallopian tubes and uterine cavity. Blood testing can be used by doctors to identify immune system issues like Antiphospholipid syndrome or thrombophilia which is the tendency of the body to form blood clots.
About half of the patients who are assessed for recurrent miscarriage have a specific diagnosis. The diagnosis of recurrent miscarriage in the remaining cases lacks a clear reason.
Depending on the patient’s maternal age, the likelihood of a positive outcome among those patients who are unsure of the origin of their diagnosis can reach up to 70%.
What is the treatment for recurrent miscarriage?
Recurrent miscarriages can be treated with lifestyle changes, medications, surgery, or genetic testing to improve the likelihood of a healthy pregnancy. Medical or surgical therapies can reduce a woman’s risk for subsequent miscarriages in certain circumstances including recurrent miscarriages.
A woman still has a 60 to 80% probability of conceiving and carrying a full-term pregnancy even after three miscarriages. The majority of the time, women choose to continue their natural pregnancy attempts. Still, in some cases, a doctor may recommend medication to assist in lowering the risk of suffering another loss.
Surgery can correct issues with a septate uterus and remove certain fibroids or anomalies caused by scar tissue etc. Since surgical repair increases the live birth rate, it is frequently the preferred treatment for anatomical problems.
A doctor may recommend blood-thinning drugs like heparin or low-dose aspirin if the patient has an autoimmune condition like APS or thrombophilia. Although a patient can use blood-thinning drugs to reduce the risk of miscarriage while pregnant, she should consult a doctor before doing so due to the increased risk of life-threatening bleeding issues.
Treatment for medical conditions like thyroid, hormone abnormalities, and abnormal blood sugar levels might increase the likelihood of a healthy, full-term pregnancy. Progesterone supplements or drugs that stimulate the brain’s dopamine receptors can help with this process.
A doctor might advise genetic counselling if a chromosomal issue like a translocation is discovered. Even though many couples with translocations can conceive normally, a doctor may advise fertility treatments such as in vitro fertilisation (IVF), which is a procedure in which a reproductive specialist combines eggs and sperm in a lab. Preimplantation genetic diagnosis (PGD) allows for the genetic testing of the embryos after which only healthy ones are delivered to the uterus. This enhances pregnancy results.
Making healthy lifestyle decisions like giving up smoking or using illegal drugs, consuming less alcohol and caffeine, and maintaining a healthy weight may reduce the risk of recurrent miscarriage.