Miscarriage

Pregnancy loss can be emotionally devastating to both mother and father. Frequently, the response tends to be why me, and what could we have done differently? It is important for these couples to realize that the miscarriage is usually not a result of something that they have done, it is also important for them to realize that they are not alone.

Miscarriage before the 20^th week of pregnancy is unfortunately quite common. It occurs in up to 20% of women who have missed a period and know that they are pregnant. This means 1 out of every 5 pregnancies. The number of losses is even higher if we consider all conceptions, meaning each time that fertilization occurs. Of all conceptions, 50% do not progress to a viable pregnancy. These losses will occur before the woman misses her period, so she never knows that she was even pregnant.

After one miscarriage, a couples chance of becoming pregnant again, and carrying that pregnancy to term is still very good. The odds start to work against you after 3 or more miscarriages, which is referred to as recurrent pregnancy loss. This is usually the point that most doctors would begin investigating the possible causes. However, if a couple has suffered through 2 losses and if they are concerned enough, most doctors will begin the investigation early. The important point here is that even after a lengthy and usually expensive work-up to determine the cause, the reason for the miscarriage will only be discovered in 40-50% of the cases. But there is some good news, even without treatment, couples who have had 3 miscarriages will be able to have a full term pregnancy 50-70% of the time.

As previously mentioned, the cause of recurrent miscarriage is often never known. Sometimes, however, the cause can be identified as a result of either: genetic problems, certain maternal infections, hormonal imbalances such as diabetes or thyroid problems, immune system disorders, or anatomic problems of the uterus. For cases in which a particular cause can be identified, treatment could potentially improve a couples chance of successful pregnancy. Another area of concern are environmental factors. For example, women who smoke are at a higher risk of pregnancy loss than non-smokers. In addition, heavy use of alcohol or illegal drugs, especially cocaine, could increase the risk of miscarriage.

An area of this problem not to be overlooked is the emotional impact on both parents. As an OB/GYN physician, having to tell a couple that they have had a miscarriage is one of the toughest parts of my job. It is perfectly normal for these couples to experience significant grief and despair. It is also likely that self-blame and sometimes even denial will occur. Resist the urge to blame yourself. Neither one of you needs this type of self -punishment at this critical time. Instead, reach out to your family, your friends and your physician. These people can provide the support that is so crucial at this stressful time.

In summary, even though it is difficult to determine the cause of miscarriage, the chance of a subsequent successful pregnancy is good. When your next pregnancy occurs, be sure to see your physician early, so that close monitoring can be initiated.

References:

Bibliography
1) Novak’s Gynecology, Twelfth Edition, Jonathan S. Berek, MD, Williams &Wilkins, Baltimore, 1996.
2) Predicting Recurring Miscarriage: What is Important? Quenby, S.M., et. al., Obstet and Gynec, Vol. 82, No. 1, July 1993.
3) Clinical Gynecologic Endocrinology and Infertility, Fifth Edition, Leon Speroff, MD, Williams & Wilkins, Baltimore, 1994.
4) Repeated Miscarriage, ACOG Patient Education, #AP100,1995.
5) Early Pregnancy Loss, ACOG Technical Bulletin #212, September 1995.