Recurrent pregnancy loss/abortions is defined as two or more consecutive spontaneous pregnancy losses. About 1% of couples trying to have children are affected by recurrent miscarriage.
MOST COMMON CAUSES ARE -
1. Chromosomal disorders - chromosomal problem (aneuploidy and translocation )of one or both partners can lead to recurrent miscarriages
2. Endocrine disorders-Hypothyroidism and diabetes mellitus leads to increased miscarriages.women with Polycystic ovarian syndrome (PCOS ) have higher loss rates related to hyperinsulinemia and excess androgen. Inadequate production of progesterone may set the stage for recurrent miscarriages.
3.Blood clotting disorders- Thrombophilia, Factor V Leiden gene mutation may lead to increased risk of miscarriage
4. Antiphospholipid syndrome is a autoimmune disease that is a common cause of recurrent miscarriages
5.Anatomical cause-the structure of the uterus and cervical incompetence may cause premature pregnancy losses
6.Infections-Maternal infections such as toxoplasmosis, rubella, herpes, cytomegalovirus, measles can lead to recurrent miscarriages
7. Unexplained causes
8. Less common causes include long time exposure to smoking ,alcohol and drugs .HOW TO MANAGE?
1. USG –TRANS VAGINAL SONOGRAM TO DETECT anatomical abnormalities and congenital malformations of uterus
2. Parental karyotype to detect chromosomal problems
3. Blood tests for thrombophilia and antiphospholipid syndrome
4. Thyroid function and blood sugar tests
5. Tests for screening infections
1. Visit a high risk obstetrician for pre conceptional counselling and regular antenatal checkup
2. To start prenatal vitamins (folic acid 5 mg ).
3. Optimisation of blood sugar levels and hyperinsulinemia with oral hypoglycemic drugs( Metformin ) has to be done .
4. Optimization of thyroid hormone levels with thyroid medication is essential .
5. You may be asked to take low dose aspirin (75 mg) in pregnancy.
6. Daily subcutaneous injection of low molecular weight heparin (in case of thrombophilia and autoimmune disease) may be required.
7. In some cases immunotherapy with immunoglobulins may be tried for better outcome .
8. Eat a well balanced diet.
9. Do regular exercise.
10. Avoid drugs, smoking, alcohol, and limit caffeine intake.
11. Weight management is very essential for successful pregnancy.
12. Avoid stress and maintaining healthy lifestyle with proper sleep and a positive approach are the key to success in managing recurrent miscarriages.