Pregnancy loss is quite common. The majority of these losses occur before 10 weeks of gestation (pregnancy) due to chromosome errors such as trisomy (3 chromosomes instead of the normal 2 chromosomes), etcetera. Recurrent pregnancy loss however is something which is entirely different and is a condition that has resulted in two or more failed pregnancies.
It is estimated that less than 5% of women will have 2 consecutive miscarriages and only 1% will have 3 or more consecutive miscarriages. A pregnancy loss is defined as a pregnancy that has been visualized on ultrasound before the pregnancy involuntarily ends before the 20th week. It is also recognized if pregnancy tissue was identified after pregnancy loss.
Why Does It Occur?
About 12-15% of all clinically recognized pregnancies end in miscarriage. But 30-60% of conceptions will end within the first trimester (12weeks). Studies have been done on recurrent pregnancy loss, studying factors that are related to it such as genetics, age, antiphospholipid syndrome (a disorder where the immune system mistakenly attacks normal proteins in the blood), uterine abnormalities, hormonal disorders, infection and lifestyle issues.
Advancing maternal age increases the risk of a miscarriage, this is thought to be due to poor egg quality which may result in genetic (chromosomal) anomalies. There may be abnormalities in the uterus that lead to miscarriage, such as irregularly shaped uterus, presence of fibroids (benign tumor).
Miscarriage may also be due to poor blood supple to the pregnancy or inflammation. Other factors such as the woman’s immune system, hormone abnormalities such as thyroid disease and diabetes may also contribute to pregnancy loss. Other factors that were found to be associate with recurrent pregnancy loss are smoking, obesity, use of drugs such as cocaine, alcohol consumption (3-5 drinks a week) and increased caffeine (>3 cups of coffee) have been associated with an increased risk of miscarriage.
Determining the Cause
The doctor will try to determine the cause of recurrent pregnancy loss by taking a detailed medical, surgical, family and genetic history from the patient. A physical examination of the patient is also done. Other relevant lab tests will also be done to try to determine the cause of the recurrent pregnancy loss.
In patients where a genetic abnormality is found, patients are referred to genetic counseling. In uterine abnormalities, surgery may be performed to correct the defect. Other issues such as antiphospholipid syndrome, thyroid disease and diabetes, medications can be prescribed.
In 50-75% of recurrent pregnancy loss, there is no apparent causative factor. Although the diagnosis of recurrent pregnancy loss is devastating, it can be helpful to remind the patient that there is a relatively high likelihood that the next pregnancy will be successful. Prognosis depends on underlying cause of pregnancy losses and number of previous losses.
What’s the Prognosis?
Overall the prognosis for recurrent prognosis loss is encouraging as even with the diagnosis of recurrent pregnancy loss, the patient is more likely to carry her next pregnancy to term rather than have another loss.
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- Recurrent pregnancy loss. UCLA Obstetrics and Gynecology. UCLA Health. http://obgyn.ucla.edu/recurrent-pregnancy-loss. Accessed 2/5/2017.
- Evaluation and treatment of recurrent pregnancy loss: a committee opinion American Society for Reproductive Medicine. 2012; 98(5):1103-1111.