Recurrent Miscarriage

Overview

Recurrent miscarriage is a sequence of 3 or more consecutive spontaneous loss of pregnancy during the first 22 weeks of gestation. It affects approximately 1-2% of couples trying to conceive.

Signs and Symptoms

Abnormal vaginal spotting or bleeding usually bright red or brownish in colour, Abdominal or low back pain, Expulsion of "fleshy” mass from the vagina, Failure of pregnant uterus to grow

Common Causes

Genetic problems in the fetus, Endocrine disorders such as diabetes, hyperthyroidism, hypothyroidism, Immunological disorders (antiphospholipid syndrome), Infection such Toxoplasmosis, Rubella, Anatomical abnormalities such as cervical incompetence, bicornuate uterus, uterine fibroid, Abnormal blood supply of placenta, Lifestyle factors such as smoking, alcohol consumption, recreational drugs Exposure to environmental toxins such as arsenic and lead

Risk Factors

Advanced maternal age (more than 35 years old), Advanced paternal age (more than 40 years old), Number of previous miscarriages, Smoking, Caffeine consumption , Excessive alcohol intake, Endocrine disorders such as diabetes, hyperthyroidism, hypothyroidism and antiphospholipid syndrome, Inherited and acquired thrombophilias, Embryonic chromosomal abnormalities, Anatomical abnormalities such as cervical incompetence, bicornuate uterus, uterine fibroid, Infections

Investigation Techniques

Medical history, Pelvic examination, Blood tests including thyroid function tests, blood glucose levels, coagulation profile, anticardiolipin antibody levels or lupus anticoagulant, Cervical or vaginal cultures, Pelvic ultrasound, Three-dimensional pelvic ultrasound, Hysteroscopy, Laparoscopy, Parental karyotyping

Treatment and Prevention

Alpha-1 blockers , Topical nitroglycerin ointment , Dihydropyridine calcium channel blockers , Anticoagulant, , Local Anesthetic Injection such as Lidocaine Avoid precipitating factors such as nicotine, cold exposure,