Miscarriage

Miscarriages are extremely distressing in couples trying to conceive. The initial elation of a positive pregnancy test can turn to despair if the pregnancy repeatedly fails. More than three miscarriages in a row are called 'recurrent miscarriage' and are usually investigated.

What causes recurrent miscarriage?

There are many different causes for miscarriage, including genetic causes, hormonal problems (including low levels of progesterone hormone, polycystic ovaries, premature menopause) blood clotting disorders, infections and structural problems of the uterus and cervix. Pregnancies may miscarry at different times; the most common time for a pregnancy to miscarry is in the first trimester (before twelve weeks gestation). Later miscarriages are usually due to structural problems within the uterus or infections. However, many miscarriages occur for no obvious reason; research continues into this group.

Tests

Investigations include:

• Blood tests
• Testing of hormones, thrombophilia (clotting) including anti-phospholipid antibodies, and autoimmune checks.
• Ultrasound scan of the ovaries
• This will determine whether you have polycystic ovaries, which may be treated by prescribing use of an insulin sensitising agent called Metformin ; this improves the quality of the developing egg and therefore improves implantation.
• Ultrasound scan of the uterus and cervix (neck of uterus)
• This will also tell whether there is increased risk of a late miscarriage due to problems keeping the pregnancy in the uterus mechanically.

Treatments

These include hormonal manipulation, steroids to suppress the production of antibodies, and occasionally surgical treatments such as the insertion of a cervical stitch to prevent the cervix giving way when the pregnancy achieves a certain weight.