Recurrent miscarriages

ONE of the most devastating things a woman and her partner can experience is a miscarriage, which is worsened if it happens repeatedly. Gynaecologists become especially concerned if a miscarriage occurs more than twice, and begin further probing at this point.

So what should you do if you have recurrent miscarriages?

The first thing to do is to go and see a gynaecologist before your next pregnancy. The ObGyn will take a detailed history and do a physical examination to determine your risk for another miscarriage and to try and pinpoint the cause.

Increasing maternal age is a risk factor, and the risk for miscarriage is over 50 per cent between the ages of 40-45, going even higher over the age of 45 years. Having three miscarriages in a row increases the risk of another one to 40 per cent. Things such as cigarette smoking, caffeine, and heavy alcohol consumption are also associated with increased risk of miscarriage.

Investigations are done to determine possible common causes. Blood tests include checking for things such as diabetes, antiphospholipid syndrome and thyroid disorders. If the loss happened in the second trimester, then other inherited blood clotting disorders can also be screened for. The foetal tissue should also be tested for genetic abnormalities if there have been more than two miscarriages, and if an abnormality is found, the parents can then go on to have genetic testing and counselling.

A pelvic ultrasound will also be ordered to check for abnormalities in the shape or structure of the uterus, and for common things such as uterine fibroids. If an abnormal structure is detected, then further visualisation with hysterosalpingography (HSG), hysteroscopy, laparoscopy or three-dimensional pelvic ultrasound may be required. Sometimes surgical treatment is needed to correct structural abnormalities of the uterus and allow normal progression of a pregnancy.

For your next pregnancy, treatment will depend on the underlying abnormality detected. If a blood clotting disorder is identified, then aspirin and the blood thinner heparin are prescribed to improve the chances of a live delivery. If weakness of the cervix (neck of the womb) is suspected from the history or seen on ultrasound or examination, then a stitch is placed into the cervix. This helps to keep the cervix closed (like a purse-string) and allows the pregnancy to continue for longer. Illnesses such as diabetes or thyroid disorders are also treated with appropriate diet and medication. All chronic illness should be kept under good control. Any potentially harmful substances should be avoided in the diet, and in the work or home environment.

Research is ongoing into other ways to prevent recurrence of a miscarriage, and progesterone supplementation is prescribed for some women with spotting in early pregnancy.

The psychological and emotional impact of miscarriages should not be forgotten, and counselling is an important part of being able to manage this problem. A couple struggling with this issue should ensure they speak with a trusted pastor or professional counsellor and allow ventilation of concerns that may arise.

Dr Anna-Kay Taylor Christmas is a consultant obstetrician and gynaecologist at the Obs and Gynae Centre, Winchester Business Centre. She can be contacted at drtaylorchristmas@ gmail.com or 908-3263, 906-2265 or 325-7362.