• Uterine Fibroids Uterine Fibroids
  • Abnormal Pap Smears Abnormal Pap Smears
  • Fertility Management Fertility Management
  • Hysterectomy Hysterectomy
  • Laparoscopy Laparoscopy
  • Abdominal Utrasound Abdominal Utrasound
  • Hysteroscopy Hysteroscopy
  • Endometrial Ablation Endometrial Ablation
  • Tubal Ligation Tubal Ligation
  • Menopausal Care Menopausal Care
  • Menstrual Disorders Menstrual Disorders
  • Pregnancy Scans Pregnancy Scans
  • Childbirth Childbirth
  • Prenatal Care Prenatal Care
  • Recurrent Miscarriage Recurrent Miscarriage
  • Prenatal Emergencies Prenatal Emergencies

Recurrent Miscarriage

Miscarriages are a heart-breaking experience for pregnant women. Miscarriage is the loss of a pregnancy before 24 weeks gestation and occurs in 15 – 20% of all recognised pregnancies. Recurrent miscarriage is when a woman experienced two or more consecutive miscarriages.

In most cases of miscarriage, no cause is known. For couples with recurrent miscarriage, around 20 per cent will have some kind of abnormality detected.

The detected causes include:

  • Genetic factors
    problems with the genes or chromosomes of the foetus are the most common causes of miscarriage. These are usually not problems inherited from parents but occur spontaneously, by chance, in the embryo. In rare cases, one or both parents can carry a genetic mutation that causes miscarriage.
  • Hormonal imbalances
    abnormalities of the uterine lining associated with both first and second-trimester pregnancy losses.
  • Congenital abnormalities
    include double uterus and uterine septum. Other abnormalities include uterine polyps, fibroids and scar tissue inside the uterine cavity.
  • Cervical incompetence
    complicates about one per cent of pregnancies. Women with incompetent cervix often have rapid miscarriages between 16 and 18 weeks. This condition can be successfully treated with a stitch to help hold the cervix closed.
  • Autoimmune conditions
    anti-phospholipid syndrome is the cause for recurrent miscarriage in 3 to 15 per cent of women. Dr Essel recommends that women with recurrent miscarriage be tested for lupus anticoagulant and anti-cardiolipin antibodies to determine if they have this problem.
  • Thrombophilias
    Excessive blood clotting in the placenta

Recurrent miscarriage is diagnosed and treated in the following ways:

  • Management of recurrent miscarriages and sub-fertility
  • Specialist blood testing
  • State of the art 3D ultrasound imaging
  • Specialist uterine surgery
  • Clinical trials
  • Counselling
  • Dedicated early pregnancy service
  • Specialist antenatal clinic

With the use of ultrasound, it is easier for Dr Essel to determine whether an embryo has died or was never formed. Either if the findings that Dr Kwabena may find, will mean that a miscarriage will definitely happen. Dr Essel takes a multidisciplinary approach to the investigation and management of recurrent miscarriages. Referrals are accepted for women who have had two or more miscarriages.


Recurrent early miscarriages (within the first trimester) are usually caused by genetic or chromosomal disorders in the embryo, with aberrant chromosomal numbers accounting for 50-80% of spontaneous losses. Uterine structural issues can also cause early miscarriage.

Subfertility is a term used to describe diminished fertility that is accompanied by a period of undesirable non-conception.

Subfertility and infertility are frequently used interchangeably; however, they are not synonymous. Subfertility is the inability to conceive. After a year of trying, infertility is defined as the inability to conceive naturally. The chance of conceiving spontaneously exists with subfertility, but it takes longer than usual.