Suffering a miscarriage

Unwanted pregnancy loss, commonly referred to as miscarriage, is quite devastating. Couples go through distressing emotions after a miscarriage, often craving for another pregnancy as part of the healing process.

Miscarriages are very common, occurring in about 15-20% of all pregnancies. One or 2 miscarriages in the same couple are unlikely to have a recurrent cause, and usually occur by chance. They are mostly associated with chromosomal fetal abnormalities, and the spontaneous miscarriage is nature’s way of dealing with an abnormal pregnancy. Majority of such couples will successfully carry a subsequent pregnancy to term without any medical intervention. They often just need information and support, not needless expensive investigations and treatments with no proven benefit.

The situation is however different if a couple experience 3 consecutive miscarriages. This is defined as recurrent pregnancy loss and occurs inabout 1%of couples. This rate rises to 5% if recurrent miscarriage is defined as 2 consecutive pregnancy losses. The losses usually occur in the first 12 weeks, but may occur as late as up to 20 weeks of pregnancy. In such cases, it is prudent to exclude a recurrent cause that may be amenable to some interventions.

Your Gynecologist should review your medical history and circumstances surrounding the miscarriage. This may sometimes give a clue on where to direct efforts of identifying a cause. The temptation to order a barrage of random tests must be avoided, as most of these will be unnecessary and not lead to a specific diagnosis or treatment.

Known common causes of recurrent miscarriages that should be tested for include: abnormalities with blood clotting (medically known as Anti-phospholipid syndrome [APS] and Thrombophilia); uterine abnormalities; and abnormal parental chromosomes. Extra tests must be justified by the individual’s medical profile.

Women with APS or thrombophilia, and recurrent miscarriage have high chances of successful pregnancy if treated with blood thinning injections and aspirin throughout their subsequent pregnancies. Some uterine abnormalities can be surgically corrected. If the parents have a chromosomal abnormality, the only remedy is undergoing assisted conception techniques and selecting unaffected fertilized eggs (a technique called Pre-implantation Genetic Diagnosis [PGD]).

In majority of women with recurrent miscarriages, no cause will be found despite extensive tests. This is very frustrating, however scientific studies have shown that in these women, no specific treatments are warranted. The majority will have successful pregnancies just by re-assurance alone. The temptation to offer unproven treatments, usually expensive and not beneficial, must be avoided. Second opinions can be sought from Gynecologists with expertise and experience in Early Pregnancy problems.

Ultrasound imaging is usually required to confirm a miscarriage. Most women are unsure about the next steps. It is entirely safe to await spontaneous expulsion of the miscarriage, or take simple tablets by mouth to enhance the process. Going to theatre for what is commonly referred to as D&C (dilatation and curettage) is not always required. The safest and most cost-effective option should always be discussed with your Gynecologist. Psychological support should routinely be offered, together with plans of care for subsequent pregnancies.