Understanding Recurrent Miscarriage: Causes, Diagnosis & Treatment

Introduction

Recurrent pregnancy loss—also called recurrent miscarriage—is an emotionally and physically draining experience for women and their families. If a woman experiences two or more pregnancy losses before 20 weeks, it is termed recurrent miscarriage.

This blog, based on insights from Dr. Mini Salunkhe, outlines the causes, diagnosis, and treatment of recurrent pregnancy loss to help affected couples find clarity and hope.

What Is a Miscarriage?

A miscarriage refers to the spontaneous loss of a pregnancy before 20 weeks of gestation. Recurrent miscarriage is defined when this happens two or more times. It has both emotional and physical impacts, often leaving women with feelings of grief and confusion.

Major Causes of Recurrent Pregnancy Loss

Dr. Mini Salunke explains that there is usually an underlying medical reason behind repeated miscarriages. Identifying the cause is crucial for planning future pregnancies. Below are the common causes:

1. Anatomical Causes

Problems with the structure of the uterus or cervix can prevent the fetus from growing properly. These include:

• Congenital uterine abnormalities (like septate uterus)

• Uterine fibroids or adhesions (scar tissue inside the uterus)

• Incompetent cervix – a weak cervix that opens too early in pregnancy

2. Genetic Causes

Sometimes the sperm or egg may carry chromosomal abnormalities, or the fetus may develop genetic defects:

• Random mutations during fertilization

• Genetic issues in one or both parents

• Higher risk in consanguineous marriages (close relatives)

• Family history of genetic disorders

3. Hormonal & Metabolic Disorders

Hormonal imbalances or maternal health conditions can also cause miscarriages:

• Advanced maternal age

• Thyroid disorders (hypothyroidism or hyperthyroidism)

• Polycystic ovary syndrome (PCOS)

• Diabetes

• High blood pressure

4. Immunological Causes

One key immunological disorder is Antiphospholipid Antibody Syndrome (APLA), where the immune system attacks healthy cells, causing:

• Blood clots in small blood vessels

• Microvascular clotting in the placenta

• Sudden loss of fetal heartbeat after it was initially detected

5. Infections

While less common, chronic uterine infections or infections from the TORCH group (Toxoplasmosis, Rubella, CMV, Herpes) can also contribute to pregnancy loss.

How Is Recurrent Miscarriage Diagnosed?

A complete work-up is necessary to determine the root cause, including:

• Pelvic ultrasound to assess uterine shape and cervix

• Hysterosalpingography (HSG) to evaluate uterine cavity and fallopian tubes

• Genetic testing (karyotyping) for parents and previously lost pregnancies

• Hormonal blood tests for thyroid, prolactin, insulin resistance, etc.

• Immunological testing for APLA and clotting disorders

Treatment of Recurrent Miscarriage

The treatment depends on the underlying cause:

For Anatomical Issues:

• Surgical correction of uterine abnormalities

• Cervical cerclage (a stitch in the cervix) for incompetent cervix

For Genetic Issues:

• Genetic counseling for the couple

• Consider preimplantation genetic testing (PGT) in IVF if required

For Hormonal Imbalances:

• Medication for thyroid, diabetes, or PCOS

• Hormonal support such as progesterone supplementation

For Immunological Factors:

• Blood thinners (e.g., aspirin or heparin) in case of APLA

• Close monitoring throughout pregnancy

For Infections:

• Targeted antibiotic or antiviral therapy before conception

Importance of Preconceptional Counseling

Before planning another pregnancy, preconception counseling is crucial. This includes:

• Optimizing maternal health (weight, sugar levels, thyroid)

• Lifestyle modifications

• Genetic risk assessment

• Planning pregnancy under specialist supervision

During Early Pregnancy: Monitoring & Support

For women with a history of recurrent miscarriages:

• Regular prenatal checkups

• Bed rest if advised

• Progesterone supplementation

• Immediate medical attention for any spotting or bleeding

Conclusion

Recurrent pregnancy loss is distressing but often treatable once the underlying cause is identified. With the right diagnosis, counseling, and treatment, many women go on to have healthy pregnancies.

If you or someone you know is struggling with recurrent miscarriage, visit Momstory – Sahyadri Hospital, Hadapsar to consult with Dr. Mini Salunkhe and take the next step toward hope and healing.