Recurring Miscarriages

Many have gone through the traumatic experience of a miscarriage, sometimes more than once.

Any woman who has gone through a miscarriage knows how traumatic the experience is. The hope and excitement of having a baby is suddenly and unexpectedly dashed.

A woman who has had three or more miscarriages is said to have a ‘Bad Obstetric History’ or BOH and must be thoroughly investigated to find the cause and seek a solution to the problem. One of the commonest causes of an early pregnancy loss is a genetic problem with the baby. During development there can be a chromosomal problem and this prevents the pregnancy from growing normally. On sonography this may be diagnosed as a blighted ovum (just a pregnancy sac but no foetus inside) or a missed abortion, where the baby grows for a few weeks but then the heart beat stops. Missed abortion may present with minimal abortion, or it may have no symptoms and may be diagnosed only on sonography. In these cases, the foetus can be sent for genetic testing and also the parents should have genetic studies (karyotyping) done.

Another common cause for repeated miscarriages is an abnormality of the womb (uterus), there may be less space inside the womb due to birth defects such as a septum (a curtain dividing the womb) or two uteri instead of one or there may be fibroids present in the womb. Many of these problems can be treated by laparoscopic or hysteroscopic surgery and the patient may subsequently be able to have a normal pregnancy.

Nowadays, we are able to diagnose immunological problems by a simple blood test. In these patients, their body does not accept the baby and treats it like a foreign body or graft and rejects it. These patients respond well to treatment with blood thinning tablets and injections.

Rarely, infections such as toxoplasmosis, herpes, cytomegalovirus etc can cause abortions. Some of these can be treated and this may help the patient in subsequent pregnancies. Hormonal deficiency can occasionally cause miscarriage and this problem can be solved by giving hormonal support during early pregnancy. Abortions in the 4-6th month are often due to weak or incompetent cervix (mouth of the womb). Taking a stitch on the cervix gives excellent results in these cases and pregnancy can often go to nine months, after this procedure.

It is important to get all the tests and diagnosis prior to pregnancy, so that the treatment can be initiated early and this gives best results.