Miscarriages and Their Reasons

Miscarriages are a very frequent complication of pregnancy. 15%% of pregnancies are end with a miscarriage, but with this rate, the very early (and unknown ones) are not included, and the real rate is estimated to be 30%%.

There are a lot of reasons why miscarriages are happening. We can distinguish 3 groups (reasons) due to the container, reasons due to the content, and reasons due to failing relationship between container and contents.

Container reasons:

This means reasons due to the uterus. Two groups can be distinguished:

• Cervical gaping, which is the only reason to propose a cervical bounding at the next pregnancies, and which is generally responsible for late (17 - 20 weeks) miscarriages.
• Uterine malformations : hypoplasia, septums, fibroma, synechia....

Contents reasons:

Due to the fetus:

Chromosomic malformations are responsible for 60 % of spontaneous miscarriages. Repetitive miscarriages must include a chromosomic study to eliminate this reason, which is rarely detected on the analysis of the product of abortus.

Other malformations are also responsible for miscarriages, but they happen generally later in the pregnancy. Twins and multiples pregnancies can also be responsible for late abortus.

Due to the liquid:

Hydramnios(excess of amniotic fluid) is known to be responsible for late miscarriages.

Relationship between contents and container:

These reasons are multiple:

• Infections : listeria, toxoplasma (a genus of sporozoan parasites, which can be transmitted from an infected mother to an infant in utero or at birth.), herpes, syphilis…hormonal reasons: Progestative insufficiency is now very debatable.
• General reasons: diabetes, thyroid disfunction, systemic diseases (lupus…), high blood pressure, alcohol and tobacco intoxications…
• Immunologic reasons are probably responsible of most of repetition spontaneous miscarriages.

Treatments of miscarriages:

During the miscarriage:

If the mother is of negative rh blood group, prevention by immunization must be done, every time.

If the bleeding is important, surgical treatment with aspiration is the only one which can stop the bleeding, associated to treatment of the hemorrhage effects.

If the bleeding is low, and the miscarriage confirmed and the patient at less than 8 amenorrhea weeks, a medical treatment can be tried. If the evacuation is not sufficient, or if more than 8 weeks, or if the bleeding increases, surgical evacuation is recommended.

After the miscarriage:

It's recommended to wait a few months before beginning another pregnancy (in my practice, I say « 2 months »).

If the miscarriage is in relationship with a cervical gaping, this must be proved (radiology or test) and then a cervical bounding can be proposed at the next pregnancy. Some uterine malformations can also have a surgical treatment.

All general diseases (diabetes…) must be stabilized before beginning a new pregnancy. Drugs (alcohol, tobacco…) are generally better when not used ;-)

Repetitive miscarriages - generally, we use to say at least 3 following ones (which is different than 3 but with normal pregnancies between) - can have an etiologic enquiry, which means genetics and immunologic enquiry in second intention: due to the cost of these exams, they are realized at the end of the enquiry.

In conclusion, if the miscarriage is really a bad moment for the mother, she must always keep in mind that one woman in three will have one in her lifetime, and that the next pregnancy will be the good one!

I wish to all of you marvelous nights of healthy crying babes!

References:

Joel Kompanietz, M.D. CNGOF,

OBGYN.net International Representative, France

Centre Hospitalier BP 538

81207 Mazamet cedex - France

Joel.Kompanietz@obgyn.net