Miscarriage

Miscarriage, often called spontaneous abortion by doctors, is the loss of a pregnancy before 20 weeks. It occurs in about 15-20% of all pregnancies. Most happen in the first three months.

Three or more miscarriages in a row may be called repeated miscarriage (or habitual abortion). Women who have repeated miscarriages need special tests to try to find the reason for them.

After several miscarriages, you may wonder whether you will ever be able to have a baby. Be hopeful. The chances of having a healthy pregnancy are good, even after more than one miscarriage. The following will help you understand the reasons for repeated miscarriages and what can be done to prevent future ones.

Causes

Often the reason for repeated miscarriage is not known. Sometimes, however, it has an identifiable cause. Examples of known causes include:

• Hormone imbalance
• Illnesses in the mother
• Disorders of the immune system
• Abnormalities of the uterus
• Environmental and lifestyle factors
• Genetic problems in either parent

If you have had more than one miscarriage, each may have had a different cause.

Hormone Imbalance

Progesterone is a hormone that prepares the lining of the uterus during the second half of the menstrual cycle to nourish a fertilized egg. If the egg is not fertilized, it is shed with the uterine lining during the menstrual flow. If the egg is fertilized and implanted into the lining of the uterus, hormones continue to prepare the uterus for pregnancy.

Early in pregnancy, it is important that enough progesterone be made to maintain the pregnancy. Otherwise, miscarriage can occur. If tests show that a woman's body is not making enough progesterone, her doctor may prescribe supplements to correct the problem.

Progesterone supplements should always be natural progesterone, not synthetic progestins. Natural progesterone can be given in pills by mouth, in vaginal capsules, by injection into muscle, or by topical creams.

Progesterone supplementation should only be given under supervision of a physician, such as an FertilityCare Medical Consultant. Blood levels will usually be used to monitor progesterone supplementation. In some cases, progesterone supplementation may be continued beyond early pregnancy.

Genetic Problems

Most chromosomal problems happen in the miscarried fetus by chance and they have nothing to do with the mother's or father's health. They are not likely to occur again in a later pregnancy. However, in a small number of cases, problems with the parent's chromosomes can cause repeated miscarriage, even if the parents are healthy.

There are tests to determine whether chromosomal problems are a factor in repeated miscarriage. These tests are very expensive and are not routinely necessary.

Illnesses in the Mother

Certain illnesses in the woman have been linked to a greater risk of repeated miscarriage:

• Endometriosis
• Hormonal dysfunction
• Systemic lupus erythematosus
• Congenital heart disease
• Severe kidney disease, especially when linked with high blood pressure
• Diabetes that is not controlled
• Thyroid disease
• Intrauterine infection

Treatment of some of these illnesses can improve the chances for a successful pregnancy. This is especially true if they can be controlled before a woman becomes pregnant. Other illnesses may need special care or monitoring during pregnancy.

Abnormalities of the Uterus

Abnormalities of the uterus, most of which can be surgically treated, are linked to repeated miscarriage:

• Congenial Abnormalities of the Uterus: These are defects present from birth. For example, a woman may have a uterus that is divided into two sections by a wall or tissue (Septate Uterus).
• Uterine Fibroids (Leiomyomata): These are benign growths (noncancerous) made up of uterine muscle tissue.
• Incompetent Cervix: An incompetent cervix begins to widen and open in the middle of pregnancy without any sign of pain or labor.

Environmental and lifestyle factors

Pregnant women who smoke have a greater risk of miscarriage than those who do not smoke. Heavy use of alcohol and illegal drugs, especially cocaine, may also increase the risk. It is also possible that exposure to high levels of radiation or toxic substances may be a factor in repeated miscarriage.

Diagnoses

Because repeated miscarriage has many possible causes, your doctor will need a great deal of information to diagnose the problem. You will be asked about your medical history and past pregnancies, as well as your life style. A complete physical exam, including a pelvic exam, is also important.

It is important to begin charting your cycles using Creighton Model FertilityCare System. This will enable you and your physician to detect early pregnancy. By using your chart as a tool, diagnostic procedures and treatment can be performed more effectively.

Creighton Model FertilityCare allows you and your physician to work in cooperation with your natural cycle. At times, cycle abnormalities will become evident in your charting.

This information is invaluable to your physician. FertilityCare Medical consultants are specially trained to use the information from the Creighton Model FertilityCare System to plan effective and efficient diagnosis and treatment.

Procedures that might also be done include:

• Laparoscopy - This is a surgical procedure in which a slender, light-transmitting instrument, the laparoscope, is inserted through the navel area and is used to view the pelvic organs.
• Blood Tests - for possible problems with hormones or the immune system.
• Hysteroscopy - In this procedure, the doctor inserts a hysteroscope (a thin, telescope-like instrument) through the vagina and cervix to view the inside of the uterus. Hysteroscopy is minor surgery that is usually performed under general anesthesia at the hospital, but sometimes can be done in the office.
• Ultrasound - In this procedure, sound waves are used to examine the fetus or view the internal organs. An ultrasound can be helpful when performed early during a pregnancy (as early as 4 1/2 weeks after estimated time of conception). It may also be performed before conception to visualize abnormalities of the pelvic organs.
• Hysterosalpingography - This is an X-ray of the uterus and fallopian tubes. It is taken after the organs are injected with a small amount of liquid dye.
• Endometrial biopsy - In this procedure, a sample of the tissue that lines the uterus is taken and looked at under microscope.

Special Care for Future Pregnancies

Sometimes the problem that caused the miscarriage can be treated. Surgery may be effective for some problems of the uterus and cervix. Treatment with antibiotics can cure infections. Hormone treatment may help in some cases even before the baby is conceived.

What You Can Do

If you have had repeated miscarriages, future pregnancies should be planned, diagnosed early and watched carefully. You can improve your chances of having a successful pregnancy in the future by doing the following:

• Have a complete medical work-up before you try to get pregnant again. It may be that the cause of the miscarriages can be found and treated by your physician.
• If you think that you might be pregnant, see your physician right away. The sooner you seek prenatal care, the sooner you can receive any special care that you may need.
• Follow your physician's instructions. He or she will tell you what you need to do to keep yourself and your baby as healthy as possible.

Coping with Repeated Miscarriage

The loss of a pregnancy — no matter how early or how late, can result in feelings of grief or discouragement that may overwhelm you. For many women, the emotional healing takes longer than the physical healing that follows a miscarriage.

Reach out to those closest to you and ask for their comfort and support. Talk to your doctor. Counseling can help both you and your spouse if you think that you cannot deal with your feelings alone.

Finally...

Even if you have had repeated miscarriages, you still have a good chance to have a successful pregnancy. This is true even if the causes of the past pregnancy losses cannot be found. Future pregnancies will need prompt, early evaluation. Your doctor will check your pregnancy closely and provide any special care you may need as your baby grows.

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