Even if you’ve miscarried, you can still have a healthy pregnancy
There may be nothing sadder for parents than losing their baby in early pregnancy. Sadly, 1% of expectant mothers suffer from multiple miscarriages and recurrent pregnancy loss (RPL).
The American Society of Reproductive Medicine (ASRM) defines recurrent pregnancy loss as two or more clinically-recognized pregnancies involuntarily ending before 20 weeks gestation (first trimester). Clinically recognized means the pregnancy has been seen on ultrasound or that pregnancy tissue was identified after the loss.
The good news is that 90% of women who have miscarried go on to have a healthy baby. Even 50% of patients who have had three consecutive pregnancy losses go on to have a healthy pregnancy!
What is a miscarriage?
Miscarriage refers to the loss of an embryo or fetus before the 20th week of pregnancy. The “proper” medical term for miscarriage is spontaneous abortion, but no matter what label you put on it, it’s the unexpected loss of a child. Tragically, about 20% of pregnancies end in miscarriage. However, not all women are aware that they are miscarrying, and others do not seek medical care, meaning the real number is probably higher.
It may surprise you to know how common miscarriage is. That’s because, for some reason, talking about pregnancy loss is still considered taboo by many people. Knowing miscarriage is a relatively common experience that doesn’t make it any easier, but having access to support can help move through the loss.
Causes of recurrent pregnancy loss
Though most miscarriages occur because the fetus is simply not developing, about 50% happen because of extra or missing chromosomes. Typically, chromosomal abnormalities are the result of errors as the embryo divides and grows. The parents cannot blame themselves for these non-viable pregnancies.
Genetic abnormalities pointing to miscarriage include:
- Blighted ovum. This occurs when no embryo forms.
- Intrauterine fetal demise. The embryo forms but dies before any symptoms of pregnancy occur.
- Molar pregnancy. Both sets of chromosomes come from the father. Associated with abnormal placenta growth, there is no fetal development.
- Partial molar pregnancy. The mother’s chromosomes remain, but the father also provides two sets. This causes abnormalities in the placenta and miscarriage.
Mother’s health conditions
- Uncontrolled diabetes
- Hormonal problems
- Uterus or cervix problems (such as scar tissue or uterine septum)
- Thyroid disease
Risk factors for miscarriages
- Age. At 35 women have a 20% risk. A 40% risk at age 40. And getting pregnant at 45 puts you at 80% risk.
- Substances. Smoking, drinking alcohol, and doing illicit drugs.
- Weight. Being overweight or underweight increases miscarriage risk.
- Invasive prenatal tests. Chronic villus sampling and amniocentesis may increase miscarriage risk.
Thrombophilia: another cause of pregnancy loss
Thrombophilia is a serious genetic disorder that skews the body’s coagulation process. The body naturally creates blood clots to stop bleeding. The body usually breaks down a clot after it is used, but with thrombophilia the body fails to break down the clots. Accumulated clots can block the blood supply to key organs.
The result can be a heart attack or stroke. The clots stop blood in the veins from carrying oxygen to the cells, and they starve.
Genetic inheritance is only one way to develop thrombophilia. More prevalent is thrombophilia caused by medicine, disease, or lifestyle. Risk factors include:
- Tobacco use
- Having cancer, diabetes, or HIV
- Not moving the body for long periods
- Taking birth control pills that contain estrogen
- A family history of blood clots
- Being an older adult
Thrombophilia may be treated with anticoagulant medication. Also known as blood thinners, this medicine greatly reduces the chances of blot clots.
Recurrent pregnancy loss testing
Effective recurrent pregnancy loss testing is determined after a high-risk pregnancy specialist has After reviewing a detailed medical record surgical history, and family genetic history and performing a physical examination a specialist can decide on effective recurrent pregnancy loss testing.
Genetic Testing: Doctors can identify potential abnormalities by testing the karyotype of both partners — their chromosomal make-up. The test can identify abnormalities that could be passed on the offspring.
Uterine Abnormalities: The uterus and uterine cavity) will often be evaluated. Tests may include an X-ray, MRI, or hysteroscopy. The doctor will look for abnormalities such as polyps (growths of the lining of the uterus), fibroids, or scarring.
Hormone Testing: Your doctor may check thyroid function and thyroid antibodies as well as prolactin, the hormone responsible for breast milk production.
Ovarian Reserve: Ovarian reserve tests indicate how well an ovary is functioning. Some studies indicate that poorer ovarian function, as shown by these hormone tests, may be related to chromosomal abnormalities of the eggs in the ovary.
Recurrent pregnancy loss treatment
Treatment recommendations for patients with recurrent pregnancy loss depend on the underlying cause. No matter what the results of the work-up are, the chance for a successful future pregnancy is high: 77% if the workup showed no abnormalities, and 71% if an abnormality was found.
Sometimes, however, if there is a high risk of miscarriage, genetic testing may suggest that the parents pursue fertility treatments. While recurrent miscarriage is different from infertility, fertility doctors can help determine if in vitro fertilization (IVF), surrogacy, or other treatments can help you have a healthy baby.
A gynecologist or fertility specialist may determine that cervical or uterine abnormalities are preventing carrying a full-term pregnancy. In that case, your fertility clinic can help you find a suitable gestational carrier.
A benefit of IVF is access to preimplantation genetic testing (PGT). The fertility clinic can check for genetic abnormalities in the embryos and implant the most viable embryo.
A doctor you can trust
One ingredient of a healthy pregnancy that cannot be understated is access to a skilled, experienced OB/GYN you trust. A doctor that knows you and your medical history can sometimes predict your outcome because they know your risk factors.
And a doctor you trust to not only listens, but hears you can get you appropriate tests and treatments earlier than those terrible doctors who dismiss or belittle their patients’ concerns.
Dr. Thaïs Aliabadi – LA’s Best OB/GYN
As one of the nation’s leading OB/GYNs, Dr. Thaïs Aliabadi offers the very best in gynecological and obstetric care. Together with her warm professional team, Dr. Aliabadi supports women through all phases of life. She fosters a special one-on-one relationship between patient and doctor.
We invite you to establish care with Dr. Aliabadi. Please click here to make an appointment or call us at (844) 863-6700.
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