Many couples are facing problems related to fertility issues and pregnancy, and miscarriage is one of the most common problems.

Miscarriage is the spontaneous loss of pregnancy before the fetus reaches the age of viability, which is in the first 24 weeks.

There are many reasons why it happens, but sometimes the cause cannot be identified, and the majority are not related to anything the mother has done.

Recurrent miscarriage is the loss of 3 or more pregnancies in a row and is reported to affect 1% of couples.

The loss of pregnancy at any stage can be a devastating experience, and this has a major impact and mainly psychological one on the couple.

For this reason, the causes should be identified, investigations done, and treated accordingly.

What are the causes of recurrent miscarriages?

Many causes and risk factors are related to recurrent miscarriages, and they include:

1. Advanced maternal age, with a highest risk when the mother is above 40 years.

2. Genetic factors play a major role in recurrent miscarriages.

3. Cervical weakness or due to some congenital problems in the uterus such as having a septum.

4. Chronic medical problems, including uncontrolled diabetes, epilepsy, thyroid disorders, and thrombophilia which is an abnormality of blood coagulation that increases the risk of blood clots.

5. Disorders in the immune system that can also cause an increase risk for blood clots such as antiphospholipid syndrome.

A significant proportion of cases remain unexplained despite detailed investigations.

These cases are categorized under the group of  “unexplained recurrent miscarriage”, and usually have an excellent prognosis for their future pregnancy without any intervention.

Each woman with recurrent miscarriages should be evaluated properly by her doctor, examined and investigations ordered. According to the findings, treatment options can be chosen.

What’s the management of recurrent miscarriages?

Treatment options for the couple will target the cause for the recurrent pregnancy loss.

• Diabetes and thyroid disorders

  patients are advised to get pregnant when the disease is under control, to reduce the incidence of miscarriage.
   

• Cervical weakness

   (also known as cervical insufficiency) Some of them should be monitored closely during their pregnancy to detect signs of cervical weakness by ultrasound before 24 weeks, and others need to be treated with an operation called “cervical cerclage” , in which the doctor uses a suture to keep the cervix closed.

Which option to choose depends on the case itself, and the decision is to be made by the doctor.

• Congenital uterine problems

   such as those having a uterine septum can undergo surgery “septum resection”, but there is insufficient evidence to assess the effect of surgery in preventing further miscarriage.
   

• Antiphospholipid syndrome

  these cases are treated with medications, they are given a combination of low dose aspirin and heparin injections daily, this combination is found to significantly reduce the rate of miscarriage by 54%.

The same treatment is usually used for patients with thrombophilia, as both will lead to the formation of blood clots.

• Genetic abnormalities

  Patients with genetic abnormalities have a high chance of a healthy baby in future untreated pregnancy reaching 70%.

But they still have the option of testing the embryos before getting pregnant in a procedure called preimplantation genetic diagnosis, which include testing the embryos before transferring them to the mother’s womb in an IVF procedure, which means it necessitates couples to undergo IVF.

The most important thing is to ensure that women who have suffered miscarriages receive the full care and support that they need.

Women who have suffered recurrent miscarriages, or the loss of a baby in the later stages of pregnancy, are likely to need additional antenatal care in subsequent pregnancies, and may also receive investigations to try and find out whether they could be at risk of another miscarriage