Of all pregnancies, 15-20% end in miscarriage; 75% of these in the first 12 weeks of pregnancy.
About Multiple Miscarriage
A miscarriage can be absolutely soul crushing for those who experience that loss. When one miscarriage is heartbreaking enough (yet sadly not uncommon), recurrent, multiple miscarriages can start to feel like something of a horrible nightmare that stays on a constant loop of repeat.
Recurrent pregnancy loss is defined by the loss of two or more clinical pregnancies. A clinical pregnancy is when it is documented by either an ultrasound or a pathologic diagnosis. Which is different from sporadic losses which are before 10 weeks.
Multiple miscarriage happen in 15-20% of pregnancy and shockingly early losses that occur before a missed period, range from 30-50%. The stats aren’t over yet, there is more to this. In women who have a history of two or more previous losses, the risk of yet another miscarriage increases to about 40%. In total, that’s about 5% of women who will have at least 2 consecutive miscarriages while only 1% experience 3 or more. This is why it is so important that if you or your partner has had 2 losses or more you should talk to your doctor or an infertility specialist ASAP who can begin looking into the possible miscarriage causes.
Here are some of the most common causes that can lead to multiple miscarriage:
- Genetic Problems: Genetic problems resulting in an abnormality of the developing fetus can be a major cause of miscarriage. Either partner or even both may be genetically predisposed to passing on a abnormality to the fetus. One study reports that 50-60% of all miscarriages in the first three months of pregnancy are due to chromosomal abnormalities.
- Abnormal Hormone Levels: Miscarriage can also occur when the uterine lining does not develop sufficiently. The end result is the fertilized egg risks not having the best environment for implantation and nourishment. This can be attributed to abnormal hormone levels. Women with Thyroid and Adrenal Gland problems and women with Diabetes are usually at a higher risk for miscarriage due to hormonal imbalances. In addition, an elevated prolactin level can also disrupt normal uterine lining development.
- Structural Problems: Structural problems or the shape of the uterus may cause miscarriage, usually by interfering with the implantation of the fertilized egg. Uterine fibroids, are non-cancerous growths in the uterine wall. Fibroids can cause infertility if they are blocking the opening of the Fallopian tube(s) or if their position is affecting the normal functioning of the uterine lining. A septum, (a fibrous wall which divides the uterine cavity), can cause poor implantation and easily pregnancy loss. Another cause of the structural problems is DES exposure, resulting in a T-shaped uterus also contributes to pregnancy loss.
- Cervical Issues: Another cause of miscarriage is an “incompetent cervix”, meaning the cervical muscle is weakened and cannot remain closed as the developing fetus grows and reaches a certain weight which puts pressure on the cervical opening.
- Infections: Infections such as German measles (rubella), herpes simplex, ureaplasma, cytomegalovirus and chlamydia can affect fetal development and in some cases, result in miscarriage.
- Environmental Factors: The environmental toxins you may be exposed to in the air around you can also result in fetal damage or miscarriage, especially if you experience regular exposure after 20 weeks of pregnancy. Studies also indicate that the use of marijuana, tobacco, caffeine and alcohol all can affect fetal development and result in miscarriage. Most doctors suggest that women limit or avoid their use during pregnancy.
- Immunologic Causes: One category of immunologic problems that can cause miscarriages are the antiphospholipid antibodies. Blood tests are used to detect the presence of these antibodies. If present, medication that helps thin the blood may be used. The choices are: baby aspirin (81 mg) daily, often starting at ovulation and extending into the pregnancy, and/or Heparin, a drug given by injection and used to thin the blood. Another category of immunologic causes of miscarriage are those that prevent the woman’s normal protective response to the embryo.
Some women experience signs and symptoms before a miscarriage actually occurs; others do not. Some of the signs that a miscarriage may be about to start are: vaginal spotting, which is usually dark brown and changing to pink or red; a decrease in breast tenderness or fullness; and absence of fetal movement or heart sounds. Cramping and vaginal bleeding are signs that the miscarriage is occurring. Be proactive and call your doctor immediately.
Even if ends up to be nothing wrong, a peace of mind will go a long way. If you do find that you are bleeding, try to keep track of the amount of bleeding that occurs. If you notice any tissue has passed, try to save it. This may sound strange to some, but many doctors will want it for laboratory evaluation to help determine the cause of the miscarriage.
If you have experienced more than 2 miscarriages run don’t walk, run to your Ob/Gyn or get a referral to a fertility specialist to help narrow down possible causes and determine what can be done to prevent future losses. They can run a series of tests to see if there is an underlying cause to what may be causing the reoccurring miscarriage.
Here are some of the tests your doctor may recommend:
- Hormonal Tests. Ask to have a prolactin, thyroid and progesterone level taken if you haven’t had these already. If they are abnormal and treatment is given, make sure that you are re-tested to check your levels.
- Structural Tests. A hysterosalpingogram is done to evaluate the shape and size of your uterus and to rule out possible scarring in the uterus, polyps, fibroids or a septal wall, which could affect implantation. If there is concern about the uterine cavity, a hysteroscopy (examination done in combination with laparoscopy or as an office procedure) can be done. In some women, the cervical muscle is too loose causing pregnancy loss after the first trimester. A special exam is done when a woman is not pregnant to check for an incompetent cervix.
- Uterine Lining Tests. An endometrial biopsy is done on cycle day 21 or later and will document if your lining is getting thick enough for the fertilized egg to implant. If you have a lag of two or more days in the development of the lining, you will be treated with various hormones (Clomiphene, hCG, Progesterone). It is important to have the biopsy repeated after several cycles to make sure the treatment is helping. If you are on Progesterone, discuss the various advantages of the oral, vaginal gel creams or tablets or injection routes with your doctor.
- Genetic Testing. Chromosomal tests are rarely done on tissue from a miscarriage because it is difficult to preserve the tissue for adequate studies. If chromosome testing is needed, you and your partner will have blood tests to make sure there is no translocation of genes (a condition in which the number of genes is the normal 46, but they are joined together abnormally). This condition can result in pregnancy loss.
- Immunological Tests. Blood tests to check for immunologic responses that can cause pregnancy loss include antithyroid antibodies (antibodies to thyroglobulin and thyroid peroxidase) the lupus anticoagulant factor and anticardiolipin antibodies. Lupus and anticardiolipin antibodies appear to influence blood clotting mechanisms within the placenta as it develops. There are also blood tests that check for protective blocking factors. These are essential to protect the pregnancy from being rejected by the mother’s body.
Miscarriage can leave you and your partner with many intense feelings of loss and grief. These feelings should not be dismissed or devalued. All to often they can be suppressed and misunderstood by friends and family.
Allow yourself grace in this difficult time. The grief associated with the loss not only of your baby, but also of your pregnancy is one that should be acknowledged. It is okay to feel angry and depressed. Talk to your spouse and remember, that men and women sometimes experience grief in different ways. Accept that and try to support each other.
Join a support group or a grief counselor. You may find that friends and family will have trouble understanding your loss, know there is much comfort and refuge in others who are experiencing the same heart break. Be sure to practice self-care and get the support you need to get you through this difficult time.