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.

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