Recurrent Pregnancy Loss- Current Scenario and Causes

Did you know that for almost 2-5% of couples are dreaming of becoming parents but unable to do so? The reason is recurrent pregnancy loss! If you're one of them, facing this challenge can be an emotional rollercoaster. If you are wondering about the causes, tests and treatments, this blog has it all.

What is Habitual Abortion or Recurrent Pregnancy Loss?

Habitual abortion, also known as recurrent pregnancy loss, refers to the occurrence of three or more consecutive miscarriages during pregnancies. It is sometimes colloquially called 'recurrent abortion.'

This condition falls within the realm of infertility, as it can make it challenging for individuals or couples to achieve successful pregnancies. Recurrent pregnancy loss can have various underlying causes, including chromosome abnormalities and other genetic factors.

Types of Recurrent Miscarriages

There are two types of recurrent miscarriages:

Early Miscarriage (Within the First Trimester)

• Often caused by genetic or chromosomal problems in the embryo.
• Approximately 50-80% of early miscarriages involve abnormal chromosomal numbers.
• Structural issues with the uterus can also contribute to early miscarriages.

Late Miscarriage

• May be the result of uterine abnormalities.
• Can be associated with autoimmune issues.
• Sometimes linked to an incompetent cervix or premature labor.

Causes of Recurrent Pregnancy Loss

Recurrent miscarriage can have various underlying causes, although doctors may not always pinpoint the exact reason. Here are some causes of recurrent pregnancy loss:

• Blood Clotting Disorders: Certain blood clotting disorders, like systemic lupus erythematosus and antiphospholipid syndrome, can lead to recurrent miscarriages. These rare immune system disorders can result in 'sticky blood,' affecting blood flow to the placenta and potentially causing clots that hinder the placenta's proper functioning. This can deprive the developing baby of essential oxygen and nutrients, increasing the risk of miscarriage. Women with recurrent miscarriage should undergo screening for antiphospholipid antibodies before pregnancy.
  
  
• Treatment often involves taking aspirin and heparin therapy to prevent excessive blood clotting.
  
  
• Thyroid Issues: Thyroid problems are linked to a higher risk of pregnancy loss and other complications. Fortunately, these problems can be easily detected through a blood test and are often manageable with treatment. Maintaining healthy thyroid function before becoming pregnant is essential.
  
  

• Thyroid Antibodies: Thyroid antibodies, small molecules in the bloodstream, can attack the thyroid, leading to improper function. Elevated levels of thyroid antibodies can heighten the risk of miscarriage. Monitoring thyroid function, especially during pregnancy, is crucial for women with these antibodies.

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• Uterine Abnormalities: An abnormally shaped womb can increase the risk of recurrent miscarriage and premature birth. This condition is typically diagnosed using an ultrasound scan, and various methods can assess the uterus's shape. Surgical intervention may be recommended based on the findings.
  
  
• Genetic Factors: In a minority of cases, recurrent miscarriage can result from one or both partners passing on abnormal chromosomes. Couples with a history of recurrent miscarriage may undergo blood tests (karyotyping) to check for chromosomal abnormalities. If issues are detected, referral to a clinical geneticist for further evaluation is necessary.
  
  
• Cervical Weakness: If late miscarriages or cervical incompetence are a concern, a cervical scan may be offered from 14 weeks to assess cervix length. Based on pregnancy history and scan results, a cervical cerclage (cervical stitch) may be recommended either before or during pregnancy.
  
  
• Natural Killer Cells: Some experts theories that natural killer cells in the uterus may play a role in infertility and miscarriage. Testing for NK cells' levels is possible but not typically available through the NHS. Some fertility clinics offer such tests, but costs can vary.

Progesterone and Recurrent Miscarriage

If you've had bleeding during your current pregnancy following one or more previous miscarriages, there's promising research about the benefits of using progesterone. The study, known as the PRISM trial and published in 2019, found that the more miscarriages you've had, the more progesterone treatment can help.

Progesterone is a hormone that plays a crucial role in thickening the uterine lining and supporting the mother's acceptance of the growing baby. It's administered in the form of vaginal pessaries (tablets) that are inserted twice daily, somewhat like using a tampon.

The study proving the effectiveness of progesterone treatment was a large-scale, carefully conducted research trial, considered the gold standard in research.

Tests for Recurrent Pregnancy Loss

When experiencing recurrent pregnancy loss, healthcare providers may recommend a series of tests to investigate the potential underlying causes. Here's an overview of the tests often conducted:

• Blood Tests: Blood tests can assess hormone levels, blood clotting disorders, and autoimmune factors that might contribute to pregnancy loss.
  
  
• Chromosomal Analysis: Both partners may undergo chromosomal analysis to identify genetic abnormalities that could affect pregnancy outcomes.
  
  
• Thyroid Function Tests: Evaluating thyroid function is important, as thyroid disorders can increase the risk of pregnancy loss.
  
  
• Hysterosalpingography (HSG): An HSG is an X-ray procedure that examines the uterus and fallopian tubes for any structural abnormalities that might hinder successful pregnancies.
  
  
• Hysteroscopy: Hysteroscopy involves a tiny camera to inspect the uterine cavity for issues such as polyps, fibroids, or scarring.
  
  
• Pelvic Ultrasound: A pelvic ultrasound can detect any structural problems in the reproductive organs, such as fibroids or abnormalities.
  
  
• Lifestyle and Immune System Assessment: A comprehensive review of lifestyle factors, including nutrition, exercise, smoking, and alcohol consumption, is conducted. Immune system evaluation may also be carried out to identify potential autoimmune factors.
  
  
• Infectious Disease Screening: Screening for infections such as syphilis, rubella, and certain sexually transmitted infections is essential.
  
  
• Endometrial Receptivity Array (ERA): The ERA test evaluates the receptivity of the uterine lining to embryo implantation, helping ensure that the timing of embryo transfer is optimal.
  
  
• Cervical Assessment: Evaluating the cervix's integrity and function is vital, as cervical insufficiency can lead to recurrent pregnancy loss.
  
  
• Genetic Testing for Embryos (PGS/PGD): In cases of repeated pregnancy loss, in vitro fertilization (IVF) with preimplantation genetic screening (PGS) or diagnosis (PGD) can be considered to select embryos without genetic abnormalities.

Treatment Options for Habitual Abortion

Habitual abortion, or recurrent pregnancy loss, can be actively addressed through various treatments and supportive measures to enhance the prospects of a successful pregnancy. Here's a more detailed look at these treatment options:

• Acupuncture & Acupressure: Acupuncture is a holistic therapy that can be applied throughout the pregnancy journey. It actively assists in reducing abdominal pain, moderating fetal movement, and promoting a smoother labour process. By using fine needles at specific points on the body, acupuncture helps alleviate discomfort and supports more comfortable childbirth.
  
  
• Psychotherapy: Psychological treatments, such as counselling and psychotherapy, offer active support for individuals and couples dealing with the emotional impact of recurrent pregnancy loss. These therapies actively provide coping strategies and emotional healing. Some individuals may also actively benefit from participating in support groups with other women who have faced similar challenges.
  
  
• Conventional/Allopathic Treatment: In cases where infections like bacterial vaginosis and trichomoniasis are involved, conventional medical treatments are essential. Active management typically includes antibiotics such as metronidazole and clindamycin, which can be taken orally or applied in gel or cream form. These treatments actively combat the infections to enhance the chances of a successful pregnancy.
  
  
• Surgical Treatment: Surgical interventions may be considered when specific conditions like ectopic pregnancy contribute to recurrent pregnancy loss. Active surgical options include:
  
  
  • Salpingostomy: This involves an active incision at the unruptured ectopic pregnancy site to remove the affected tissue.
  • Radical surgery: An active and complete removal of the affected fallopian tube.
  • Laparoscopy: An active surgical procedure that involves the exploration of the abdomen to identify and address underlying issues.

• Dietary & Herbal Treatment: Active dietary changes play a crucial role in supporting a healthy pregnancy journey. These include:
  
  
  • Actively avoiding refined carbohydrates, sugars, non-vegetarian foods, coffee, and tea.
  • Staying away from oily and fried foods.
  • Completely abstaining from smoking, chewing tobacco, and alcohol.
    
    
• Other Treatment: Active engagement in yoga practices is an integral part of maintaining overall well-being. Active 'asanas,' or yoga poses, like sarvangasana, vajrasana, bhujangasana, shalabhasana, dhanurasana, paschimottashana, and trikonasna, can actively contribute to physical and emotional wellness.

Taking a Break and Planning for a Healthy Pregnancy

After an early miscarriage, it's important to give yourself time to heal emotionally before thinking about trying again. But keep in mind that you could become fertile and get pregnant as soon as two weeks after the miscarriage. It's a good idea to talk to your obstetrician-gynecologist (ob-gyn) to figure out the best time for your next attempt.

If you decide to have another baby, it's smart to focus on your health first. Here's some general advice for anyone planning to get pregnant:

• Have a checkup with your ob-gyn before getting pregnant.
  
  
• Take a daily dietary supplement with 400 micrograms of folic acid.
  
  
• Eat well and try to get 30 minutes of exercise on most days.
  
  
• Aim for a healthy weight for your height, whether it means losing or gaining weight.
  
  
• Don't drink alcohol.
  
  
• Don't smoke.
  
  
• If you have any medical conditions, work with your healthcare team to get them under control before getting pregnant.

Conclusion

Recurrent pregnancy loss can be a tough journey for couples, but there's always hope for a happy outcome. The causes can range from genetic factors to issues with the uterus, and healthcare providers can run tests to find out why. When it comes to treatment, options encompass holistic approaches, conventional medical care, and, if necessary, surgery.

Following an early miscarriage, emotional healing is vital. It's essential to talk to your healthcare provider and prioritize your overall well-being.