Treatment Options for Miscarriage and Recurrent Miscarriage
Miscarriage
Miscarriage is defined as the loss of a pregnancy at less than 20 weeks gestation, although it mostly occurs in the first 10-12 weeks of pregnancy.
Approximately 15% of women who are aware of their pregnancy will experience a miscarriage. But many miscarriages actually happen before women even realise that they are pregnant. When you include this factor into the calculation, it is apparent that up to 50% of all conceptions end in miscarriage.
The most common cause of miscarriage is a chromosomal (genetic) abnormality in the baby. This issue occurs at the moment of conception, and there is no treatment or preventative measure that could have changed the outcome of the pregnancy. The risk of chromosomal abnormality increases as women get older.
Providing the right emotional support
Miscarriage can be a traumatic experience that causes significant disappointment and distress. Women may experience a range of different emotions after miscarriage, and there isn’t a single approach that is right for every person. Most women find that sharing their stories with trusted family or friends with similar experiences is helpful for their recovery.
Late Miscarriage
Most pregnancy losses occur before 13 weeks, in the first trimester. So when a loss happens between weeks 14 and 20, doctors may refer to it as a late miscarriage. The most common signs that signify a miscarriage are vaginal bleeding and strong labour-like cramps, or even preterm labour. Some women may experience no signs of miscarriage and only discover the loss of their baby during an ultrasound scan. If you notice that your baby’s movements have significantly changed or even stopped, you can always contact your doctor or maternity unit to double check.
Treatment options for late miscarriage
Once a late miscarriage is confirmed, doctors would usually provide the following treatment options to help the patient:
- Surgical evacuation
- Labour induction
Recurrent Miscarriage
Recurrent miscarriage (sometimes also called recurrent pregnancy loss) is defined as 3 or more consecutive miscarriages, and occurs in approximately 1% of women.
One miscarriage ican be distressing, so multiple miscarriages can be devastating. Both sadness and loss, along with the fear of future misacarriages can be traumatic. Thankfully, most women who experience recurrent miscarriages are still able to have successful pregnancies. In fact, over 80% of women with recurrent miscarriages have had a successful pregnancy and given birth to a healthy baby.
Causes of Recurrent Miscarriage
- Chromosomal abnormalities in either parent
- Structural abnormalities of the uterus
- Cervical incompetence
- Autoimmune conditions
- Antiphospholipid syndrome
- Advanced maternal age
- Hormone imbalances
There are many theories about other potential causes of recurrent miscarriage, including factors such as NK (natural killer) cells in the lining of the uterus, disturbances of blood clotting mechanisms, and immune system incompatibility between the parents. Whilst there is evidence to support some of these theories, they haven’t been proven to be the definitive causes.
Investigating the cause of recurrent miscarriage
Investigations looking for an underlying cause of recurrent miscarriage are usually performed after 3 consecutive miscarriages. Sometimes investigations may be conducted after 1 or 2 miscarriages in the following settings:
- Later miscarriage (that occurs after 12 weeks)
- Advanced maternal age
- Co-existing impaired fertility (applicable to those who require fertility treatment or take a longer time to get pregnant)
No underlying cause is found in approximately 50-70% of fully investigated cases. This may feel frustrating as many people feel better when they have an explanation for a problem. However, future pregnancy success rates are generally higher in unexplained recurrent miscarriages.
Treating Recurrent Miscarriage
There are numerous treatments described in the management of recurrent miscarriages, which include:
- Low dose aspirin
- Heparin
- Cervical Suture
- Uterine surgery
- Immune suppression or modulation
- Hormone support
- IVF, +/- preimplantation genetic diagnosis
The treatment that may be recommended for you will depend on the underlying cause of your miscarriages, and your personal circumstances. Sometimes your doctor may even recommend multiple treatments at the same time.
Some treatments have been shown to be effective or beneficial, while others have no or little evidence to support their use, and are considered more experimental. Therefore, it’s always important to discuss your options with your doctor before undertaking any treatment.
How Can My specialisation in High Risk Pregnancy Assist You?
For over 15 years I have been committed to caring for women who have suffered pregnancy loss, including miscarriage, recurrent miscarriage and stillbirth. As a qualified specialist in maternal-fetal medicine, I have advanced knowledge and expertise to handle complicated and high risk pregnancies.
I am able to arrange investigations, advise you on appropriate treatment strategies and options, and develop a plan that supports your health and wellbeing.
I understand the anxieties of embarking on a new pregnancy after a miscarriage, so I always strive to provide a positive and supportive environment. I can also arrange additional psychological and genetic counselling services should they be required.
If you wo
uld like to make an appointment to discuss your miscarriage history or plans for a future pregnancy, please feel free to make an appointment by contacting my rooms, or completing an online enquiry form on this website.
FAQs
What can I do to prevent recurrent miscarriage?
There’s no treatment to stop a miscarriage, but you may reduce the risk of recurrent miscarriage by practising the following preventative actions:
- Limiting your caffeine intake
- Screening for STDs
- Taking a folic acid supplement
- Getting tested for diabetes
- Quitting smoking
Should I do any tests after experiencing recurrent miscarriages?
If you have recurrent miscarriages, I can arrange tests for a range of infections or other conditions that may be the underlying causes.
Blood tests can help identify potential immune conditions, clotting disorders, or chromosome abnormalities. While testing the baby for abnormalities may not always be possible, it can help us better understand your chances of miscarrying again. A pelvic ultrasound to check for abnormalities in the shape of your uterus may also be recommended. If you had a late miscarriage, vaginal swabs may also be used to test for potential infection.
How many miscarriages does the average woman have?
While recurrent miscarriages are defined as having more than two miscarriages, some women have multiple miscarriages in a row. Approximately 1 in 6-7 pregnancies will end in miscarriage, so having a miscarriage is a very common experience - more common than most people realise.
Talking about miscarriage can be difficult and distressing, but if you are confident enough to discuss your own miscarriage, you may well be surprised at how many others will open up about their own experiences.
When is the best time to get pregnant after a miscarriage?
It is possible to ovulate and become pregnant two weeks after a miscarriage happens. However, it’s better to try conceiving again until you feel physically and emotionally ready for another pregnancy. Pregnancy after a miscarriage can be a very anxious time, so it’s important to receive the right care and support for you and your baby. Our practice can help support you during this time and guide you on how to make the right decision for your family.