Miscarriage is a common phenomenon observed in human reproduction. It is most often due to a chromosomal abnormality in the conception. However after two to three miscarriages, a couples’ acceptance of recurrent miscarriage due to this explanation wanes, leading them toward finding a reason.
Unfortunately a reason for recurrent miscarriage is proposed about 40% of the time. As noted on our web site: anatomical causes for miscarriage, parental chromosomal analysis, thrombogenic causes such as lupus anticoagulant and anticardiolipin antibodies, and ovarian function issues need to be considered.
Anatomical factors like a uterine septum, fibroids, and polyps can be detected by hysterosalpingogram (which is an X-ray of the uterine cavity). In some cases a pelvic ultrasound or pelvic MRI is needed to further discern abnormalities noted on HSG.
Maternal and paternal blood work for chromosomal analysis is an important step to rule out parts of one chromosome being transposed to another. A third reason for miscarriage, although uncommon are a woman having lupus anticoagulant, anticardiolipin antibodies or beta 2 Glycoprotein. These are antibodies that may set up small clots between mother and fetal blood vessels, or prevent the cells involved in implantation and formation of the afterbirth from growing. Lastly a blood test for Antimullerian hormone may prove useful. This is a blood test that can be obtained anytime during a woman’s cycle that will reflect what her ovarian reserve is, that is, how robust her ovaries are. Low AMH levels in themselves may increase the risk for miscarriage.
When a woman experiences her second or more miscarriage, the products of conception may be sent for chromosomal analysis. A chromosomal abnormality would then support that the cause of this miscarriage was a random event and not necessarily repetitive. If no abnormality is noted, then consideration to a complete evaluation for recurrent miscarriage may be the next step. Call our office at (919) 782-5911, or schedule an appointment online.
If your physician is concerned that you are at an increased risk of miscarriage, progesterone delivered vaginally may be prescribed several days after ovulation and before it is known whether you are pregnant. Although bed rest and avoidance of intercourse is often advised once pregnant and threatening to miscarry, this advice has never been proven to be sound.
Women often ask how to complete their miscarriage for a failed pregnancy. Usually we allow Mother Nature to take its course. In these cases we stop progesterone and see if a spontaneous miscarriage occurs. We would do a dilation and curettage (D and C) at Blue Ridge Surgical Center or in the office if a chromosomal analysis is needed. The main downside of D and C is that some form of anesthesia is needed for this outpatient procedure. Additionally the risks also include uterine perforation and intrauterine scarring.
After a miscarriage, your gynecologist will usually make sure that your HCG (pregnancy hormone) has dropped to zero. Even with a zero level on your HCG, and no symptoms, you may have retained small amounts of products of conception. In that case placing water or saline into your uterine cavity will be useful to rule out retained products. If all is normal, then we encourage a rest month prior to attempting to conceive. In that time women should continue to take their prenatal vitamins etc.