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6 Potential Causes of Miscarriage and Recurrent Pregnancy Loss (RPL)

By Satu Kuokkanen, MD, PhD

May 2nd, 2016 at 11:31 am

image courtesy of David Castillo Dominici/ freedigitlaphotos.net

Experiencing a pregnancy loss is always devastating for individuals hoping to establish or expand their family. Patients describe a range of grieving emotions related to the loss of a person they never had a chance to meet, love and share the future.  This grieving process may last anywhere from few weeks up to several years.  Not surprisingly, I have heard from many patients that one of the most difficult coping times was around the expected due date of the pregnancy that they miscarried.

 

It may be somewhat comforting for patients to know that they are not alone. In fact, miscarriage is the most common pregnancy complication and it affects 1 in every 6-8 confirmed pregnancies, that’s 12-15%. The risk of miscarriage increases with maternal age. While women younger than 30 years old have a 10-12% risk of pregnancy loss, the risk is four fold higher for women in their 40’s. Identifying a potential cause may help with the emotional impact of the pregnancy loss whether it is isolated or recurrent loss.

 

Recurrent pregnancy loss (RPL) is diagnosed after a woman has had two or more consecutive miscarriages and RPL affects 1 in 20 couples who are attempting to conceive. While isolated miscarriages are commonly due to chromosomal and genetic abnormalities, other factors are responsible for RPL. These factors vary depending on the gestational age of the pregnancy loss. Evaluation of potential RPL causes is important in determining whether therapy is available to the patient.

 

6 Potential causes of RPL:

 

  1. Congenital and acquired structural uterine factors. A uterine septum, a partial or complete division of the uterine cavity, is the most common congenital structural uterine abnormality.  Uterine septum and bicornuate uterus (“heart shaped womb”) have been linked to RPL. Acquired structural uterine pathologies that distort the normal uterine cavity include endometrial polyps that are skin tag-like growths of the uterine lining, fibroids that are affecting the uterine cavity, and intrauterine scarring that can develop after surgical procedures, such as dilatation and curettage (also known as D&C).  Radiology studies of the uterus with saline ultrasound (‘water sonogram”) or magnetic resonance imaging (MRI) are standard methods to evaluate the womb.

 

  1. Chronic endometritis is inflammation of the uterine lining. This condition is diagnosed by sampling of the uterine lining with an endometrial biopsy or D&C.

 

  1. Structural chromosome abnormalities of the parents is a rare but known cause of RPL. A simple blood test of both parents to assess numeric and structural chromosomal component (karyotype) is done.

 

  1. Abnormalities of blood clotting.  The well-known condition in this category is anti-phospholipid antibody syndrome (APAS) which women can acquire during their reproductive years. Anti-phospholipid antibody levels can be measured in blood for diagnostic purposes.

 

  1. Endocrine-related abnormalities include elevation in alterations in thyroid hormone secretion and diabetes with uncontrolled blood sugar levels.  Also, women with polycystic ovary syndrome (PCOS) appear to have heightened risk of pregnancy losses.

 

  1. Environmental and lifestyle factors have also been linked to an increased risk of miscarriages. Such factors may include maternal obesity, cigarette smoking, and exposure to environmental toxins. How these factors may impact pregnancy or pregnancy loss differs and is still being studied at the current time.

 

It is important to remember that, although painful, an isolated miscarriage may often be followed by a healthy and successful pregnancy. And that, RPL, while devastating, can be caused by a factor that may be treated with proper, specialized medical care. In either case, your dream of parenthood may still be within reach.

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Have you suffered one or miscarriages, been treated for an underlying cause, and gone on to have a successful pregnancy?

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