Miscarriages or pregnancy loss are considered recurrent if a woman suffers 3 or more miscarriages in her first trimester OR 1 or more miscarriages in the second trimester.
Around 1% of pregnant ladies suffer from repeated miscarriages. The risk of this increases as both the wife and husband get older.
How is a miscarriage diagnosed?
Before a miscarriage can be diagnosed, pregnancy has to be confirmed. This is done using an ultrasound scan or testing for the pregnancy hormone (beta human chorionic gonadotropin).
Subsequently, a miscarriage can be identified by these signs and symptoms:
- Bleeding/Brownish discharge
- Abdominal pain (cramps)
- Sudden loss of pregnancy symptoms
What can cause repeated miscarriages?
The first factor is a history of previous miscarriages. Other risk factors are environmental such as maternal smoking, consumption of caffeinated beverages, alcohol and obesity.
Medical Conditions
- Antiphospholipid Syndrome (APS)
This is also known as the sticky blood syndrome and is an autoimmune disorder. It occurs when your body’s immune system attacks the normal proteins in your body. This in turn increases the risk of blood clots forming in the placenta, which can cause miscarriages. - Diabetes
When you have diabetes, your body is unable to produce insulin or your body is unable to use the insulin produced effectively. Insulin is crucial for balancing blood sugar levels. If these levels are not controlled properly, it can lead to many complications in pregnancy for both mother and baby. - Anti-thyroid Antibodies
The presence of anti-thyroid antibodies can delay pregnancy and even cause infertility. Ladies with high concentration of anti-thyroid antibodies in their blood might get pregnant at an older age, which can increase their risk of a miscarriage. - Polycystic Ovary Syndrome (PCOS)
PCOS can affect the quality of eggs produced by the ovaries and the function of the reproductive organs after ovulation. This increases the risk of miscarriages. - Uterine Abnormality
The uterine lining is where an embryo implants and grows. An abnormality in the uterus can lead to recurrent miscarriage as it may be due to poor blood supply to the womb during pregnancy. For example, some ladies may have fibroids in their uterus, which can also increase the risk of miscarriages.
Genetic Problems
About 2-5% of recurrent miscarriages are caused by chromosomal abnormalities in one of the parents. On the other hand, chromosomal abnormalities in the fetus accounts for 30-50% of miscarriages.
It is important to note that the risk of chromosomal abnormalities in the fetus also increases with maternal age.
Second Trimester Fetal Demise
- Congenital birth defects in the baby can lead to fetal demise, typically in the second trimester.
- Placenta dysfunction or complications in the umbilical cord can also result in fetal demise in the 2nd trimester.
- A weakened cervix in a pregnant woman results in premature dilation. If not detected in time, pregnancy cannot be held, resulting in miscarriage.
Medical Conditions
- Antiphospholipid Syndrome (APS)
This is also known as the sticky blood syndrome and is an autoimmune disorder. It occurs when your body’s immune system attacks the normal proteins in your body. This in turn increases the risk of blood clots forming in the placenta, which can cause miscarriages. - Diabetes
When you have diabetes, your body is unable to produce insulin or your body is unable to use the insulin produced effectively. Insulin is crucial for balancing blood sugar levels. If these levels are not controlled properly, it can lead to many complications in pregnancy for both mother and baby. - Anti-thyroid Antibodies
The presence of anti-thyroid antibodies can delay pregnancy and even cause infertility. Ladies with high concentration of anti-thyroid antibodies in their blood might get pregnant at an older age, which can increase their risk of a miscarriage. - Polycystic Ovary Syndrome (PCOS)
PCOS can affect the quality of eggs produced by the ovaries and the function of the reproductive organs after ovulation. This increases the risk of miscarriages. - Uterine Abnormality
The uterine lining is where an embryo implants and grows. An abnormality in the uterus can lead to recurrent miscarriage as it may be due to poor blood supply to the womb during pregnancy. For example, some ladies may have fibroids in their uterus, which can also increase the risk of miscarriages.
Genetic Problems
About 2-5% of recurrent miscarriages are caused by chromosomal abnormalities in one of the parents. On the other hand, chromosomal abnormalities in the fetus accounts for 30-50% of miscarriages.
It is important to note that the risk of chromosomal abnormalities in the fetus also increases with maternal age.
Second Trimester Fetal Demise
- Congenital birth defects in the baby can lead to fetal demise, typically in the second trimester.
- Placenta dysfunction or complications in the umbilical cord can also result in fetal demise in the 2nd trimester.
- A weakened cervix in a pregnant woman results in premature dilation. If not detected in time, pregnancy cannot be held, resulting in miscarriage.
How can the cause of repeated miscarriages be identified?
Your gynaecologist might conduct the following tests to determine the reason(s) for recurrent pregnancy loss:
- Going through your medical history to determine if there are any medical conditions
- Complete physical examination (including blood tests) to assess if there are any underlying medical conditions that need to be managed
- Ultrasound and/or X-ray of the womb
- Evaluating the chromosomes / DNA of you, your partner and the pregnancy tissue
How can a gynaecologist help to prevent the next miscarriage?
The management of recurrent miscarriages starts with determining the specific cause of your condition:
- If the miscarriage is due to medical conditions, proper management of these conditions is vital to sustaining the pregnancy
- If it is due to genetic problems in the mother or father or the fetus, early detection is important. Couples can then opt for IVF and use PGS to ensure the embryos being implanted in the lady’s womb do not have any chromosomal anomalies.
- If the miscarriage is due to cervical weakness, a simple procedure can be performed by your gynaecologist to prevent the cervix from opening prematurely.
Most importantly, learn about the options available to you and work with your gynaecologist to make the best choice.
What if there is no cause for the miscarriage?
Over 50% of recurrent pregnancy loss cases are due to unexplained factors. Various treatments may be offered, but there is no universal recommendation for treatment. Despite this, the overall chances of pregnancy can be more than 50%, even without any intervention.
Over her years of practice, Dr Kanika has helped patients with previous miscarriages achieve their parenthood dreams.
Dr Kanika’s Place of Practice
Astra Women’s Specialists Centre
Blk 185 Toa Payoh Central
#01-326
Singapore 310185
Tel: +65 6221 3837
