Recurrent Pregnancy Loss

Recurrent Pregnancy Loss

Overview

Recurrent pregnancy loss is a condition in which the woman experiences two or more clinical losses of pregnancy (or miscarriages) before 20 weeks of gestation. The clinical loss of pregnancy is diagnosed by a doctor, using an ultrasound scan. A “biochemical” loss of pregnancy is a miscarriage detected on the basis of pregnancy hormones in the blood and urine. This needs to be confirmed by an ultrasound scan to qualify as a clinical loss of pregnancy.

Signs and symptoms

Symptoms of a loss of pregnancy include heavy spotting, vaginal bleeding, discharge of tissue or fluid from the vagina and severe abdominal cramping. The patient may also experience back aches.

Causes and Risk Factors

The clinical loss of pregnancy could be caused by genetic abnormalities present in one of the parents, a uterus abnormality, use of recreational drugs during pregnancy, being overweight, excessive caffeine intake and untreated medical conditions such as thyroid disease, diabetes or thrombophilia. In over half the cases of loss of pregnancy, the exact cause remains undetermined. One loss of pregnancy does not mean the consecutive pregnancies will have problems. In fact, recurrent loss of pregnancy is quite rare and may point to a deeper genetic cause or an abnormal anatomy of the uterus that prevents attachment of the embryo to the endometrial wall.

The pregnant woman is at a risk of losing her pregnancy if she consumes drugs, alcohol or excessive caffeine. Being overweight, underweight and having thyroid disease could also put a pregnant woman at risk of miscarriage.A pregnant woman above the age of 35 has a higher risk of losing the pregnancy as well.

Complications

Recurrent loss of pregnancies can result in great emotional distress to the couple, resulting in mental health complications, which is why it is important to seek mental health care.

Diagnosis

The loss of pregnancy is clinically diagnosed by an ultrasound scan. The fertility expert will begin with a detailed medical history of the couple and their genetic ancestry. The doctor will require a karyotype analysis to check for genetic abnormalities. The uterus is then evaluated using a series of ultrasound scans, a hysterosalpingogram X-Ray, an MRI and a hysteroscopy. The doctor will be looking for polyps or scar tissue on the uterus that are getting in the way of implantation.

Treatment

The treatment for the recurrent loss of pregnancy varies according to the underlying cause. If a karyotypic defect is found in one of the prospective parents, the couple may be recommended genetic counselling, where an expert can advise them of their options. Uterine abnormalities may be corrected surgically to improve the patient’s chances of carrying their pregnancy to term. If the patient has underlying untreated thyroid disorders or diabetes, they will be put on medication that aligns with their fertility goals.

Prevention

In over half the patients who experience recurrent pregnancy loss, there is no clearly identifiable cause. However, the risk of losing a pregnancy can be reduced by maintaining a healthy weight and not consuming stimulants during the pregnancy.

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