MISCARRIAGE EDUCATION

Miscarriage 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. 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 healthy baby. Be hopeful. The chances of having a successful pregnancy are good even after more than one miscarriage. 

The following information will help you understand the reasons for miscarriage and what can be done to prevent future ones.

WHAT ARE THE CAUSES?

Often, the reason for repeated miscarriage is not known. Sometimes, however, it has a definite cause.  It’s important to note that if you have had more than one miscarriage, each may have had a different cause. Examples of known causes include:

HORMONAL 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 period. If the egg is fertilized, 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 women’s body is not making enough progesterone, her doctor may prescribe supplements to correct the problem. Depending on the blood progesterone level, your dosage may be raised or lowered or discontinued during pregnancy.

CHROMOSOMAL PROBLEMS
Most chromosomal problems happen by chance. They have nothing to do with the mother’s or father’s health. They are not likely to occur again in later pregnancy. However, in a small number of cases, problems with the parents’ chromosomes can cause repeated miscarriage. There are tests to determine whether chromosomal problems are a factor in repeated miscarriage. These tests are very expensive and are often not very useful. Therefore they are seldom ordered.

ILLNESSES IN THE MOTHER
Certain illnesses in the mother have been linked to a greater risk of repeated miscarriage:

• Endometriosis
• Hormonal Dysfunction
• Systemic Lupus Erythematosus and other autoimmune disorders
• 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 were under control before a woman became pregnant. Other illnesses may need special care or monitoring during pregnancy.

DISORDERS OF THE IMMUNE SYSTEM
The immune system is designed to recognize and attack foreign substances within the body. Antibodies are formed to help the body fight off disease and heal itself in case of infection. Normally, the mother’s body protects the “foreign” fetus from attack by her own antibodies. It is thought that this protection may be absent in the blood of some women who have had repeated miscarriages.

Other immune system problems are caused by differences between the mother and the fetus and even between the mother and the father. For instance, the mother’s own immune system may produce antibodies to the cells of her own body. This can cause pregnancy loss. Tests may show some problems with the immune system.

ABNORMALITIES OF THE UTERUS
Several abnormalities of the uterus, most of which can be treated with surgery, are linked to repeated miscarriage:
Congenital Abnormalities: 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):  Uterine fibroids are benign growths (non-cancerous) made up of uterine muscle tissue.
Incompetent Cervix: An incompetent cervix is one that begins to widen and open too early, in the middle of pregnancy, without any sign of pain or labor.

ENVIRONMENTAL AND LIFE STYLE FACTORS
Pregnant women who smoke also 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 risks. It’s possible that exposure to high levels of radiation or toxic substances may be a factor in repeated miscarriage.

DIAGNOSIS - What pertains to LCMC?
Because repeated miscarriage has many possible causes, your doctor will need a great deal of information to diagnose and past pregnancies, as well as your life style. A complete physical exam, including a pelvic exam, is also important.

Your doctor will ask you to begin charting your cycles. This will enable you and your doctor to detect early pregnancy. Also, by using your chart as a tool, your diagnostic procedures and treatment can be performed and administered more in cooperation with your natural cycle. At times cycle abnormalities will become evident in your charting. This information is invaluable to your physician.