Recurrent Miscarriage

This information is designed to give an overview of recurrent miscarriage, the physical process and the options women have. There are also links to current projects, which are funded by Wellbeing of Women to try and prevent this happening so frequently.

Losing three or more pregnancies in a row (recurrent miscarriages) is uncommon and affects around 1 in 100 women. Even in cases of recurrent miscarriages, an estimated three quarters of women go on to have a successful pregnancy in the future.

Overview

Recurrent miscarriage is a medical term for the loss of three or more consecutive pregnancies, before 23 weeks gestation. Recurrent miscarriage can be a deeply traumatising experience which can have devastating effects, not only on women but also on their relationships with others. Sadly around 1 woman in every 100 will experience recurrent miscarriages. Experiencing recurrent miscarriage does not necessarily mean that a successful pregnancy is not possible. Most couples that have had recurrent miscarriages still have a good chance of a successful birth in the future.

Causes

Unfortunately the exact cause of recurrent miscarriage is not always known even after investigation. Wellbeing of Women are funding research into this area (link). 

Abnormal Embryos and Genetic Factors: Abnormality with the embryo is the single most common cause of miscarriage. This means that most miscarriages are a result of nature preventing the birth of babies with serious birth defects. Abnormalities in the chromosomes of the parents can also play a large role in the outcome of the pregnancy.

 Autoimmune Factors: In general antibodies are helpful as they usually serve the role of protecting against infections. However, sometimes a woman's own antibodies can be the cause of a miscarriage. 

Womb structure & weak cervix: Anatomical abnormality in the womb can cause the pregnancy to cease, but it is still unclear how exactly the pregnancy is lost. In some cases the cervix opens too early, causing miscarriage in the third to sixth month.

Other factors: There are a number of other pre-existing factors which may affect the success of a pregnancy such as diabetes, thyroid problems, and polycystic ovaries.

Antiphospholid /Hughes Syndrome:

 

Some women who have had three or more miscarriages in a row (recurrent miscarriages) have a higher than usual level of an antibody called antiphospholipid (aPL) in their blood. There is evidence that APS is responsible for around one in five cases of recurrent miscarriage. The aPL antibodies are known to cause blood clots. These blood clots can block the supply of blood to the foetus, which can cause a miscarriage.

Antiphospholipid syndrome (APS), also known as Hughes syndrome, is a disorder of the immune system that causes an increased risk of blood clots and miscarriages.  APS is an autoimmune condition. This means the immune system, which usually protects the body from infection and illness, attacks healthy tissue.

It is not known what causes the immune system to produce abnormal antibodies, but like other autoimmune conditions, both genetic and environmental factors are thought to play a part.

People with APS are at risk of developing conditions such as deep vein thrombosis (a blood clot that usually develops in the leg) and arterial thrombosis (a clot in an artery), which can cause a stroke or heart attack.

Pregnant women with the syndrome have an increased risk of having a miscarriage, although the exact reasons for this are uncertain.

Blood tests designed to help identify the antibodies (proteins) responsible for APS are essential in diagnosing the syndrome. Three main types of antibodies can be measured:

·         anti-cardiolipin

·         anti-B2 GPI

·         the lupus anticoagulant

As there is no cure for APS, treatment aims to reduce the risk of developing further blood clots.

Anticoagulant medicines, such as warfarin, or an antiplatelet, such as aspirin, are usually prescribed. These reduce the likelihood of blood clots forming when they are not needed but still allow clots to form when you cut yourself.

Research has shown that a combination of aspirin and heparin (a medicine used to prevent blood clots) can improve pregnancy outcomes in women with Hughes syndrome. Treatment can help improve the outcomes of pregnancy in 75–80% of women.

 

Symptoms 


See miscarriage symptoms HERE.

Diagnosis & Treatment

Women who have had recurrent miscarriages are often referred to specialist centres. Women should be offered blood tests, a pelvic ultrasound scan and further investigations may also be recommended. However, despite thorough investigations, it may still be impossible to find the exact cause.

Supportive and correct antenatal care is imperative for all expecting mothers, as it ensures that the correct screening programs and treatments are carried out. This is especially important for women who have had recurrent miscarriage or for women who have an existing condition such as polycystic ovaries.

 

Read Women's Stories

Debbie's story-
 

Debbie suffered 5 Miscarriages and an Ectopic pregnancy over a period of 7 years. She also found out that she has Endometriosis. During these years Debbie was put on medication to help her fertility, had blood tests and tried IVF. She found out that Dr Siobhan Quenby (who has been funded by Wellbeing of Women in a number of studies) was researching recurrent miscarriage. After being part of this new research and treatment she then went on to have her son Samuel.

 
We began trying for a baby when I was 33 years old in May 1999.”

Debbie and her family then went through 7 years of emotional and physical turmoil until January 2004. 
I had read an article in a national newspaper about a lady who had suffered a lot of miscarriages and was tested for NK cells in the lining of her womb as they thought they could be attacking the foetus.In January 2005 I had an appointment at Liverpool Women’s Hospital and met Dr Siobhan Quenby. I then found out that the NK cells in my womb were at 19% and the normal range is between 4-5% so therefore I was a candidate for her research trial and I could try taking a course of steroid treatment.To my amazement in June 2005 I found out I was pregnant, I was extremely nervous, it was my sixth pregnancy and I had some bleeding. I then went into labour at 39 weeks and our beautiful baby boy was born on February 21st 2006 weighing 6 lb 8oz and he was just perfect. We named him Samuel as this meant “answers to prayers for a child” and he was truly our little miracle from heaven! I feel so lucky as for some women this treatment was not successful. However, I truly believe the steroid treatment that Dr Quenby put me on was the reason this pregnancy survived, so I would like to thank her for all her hard work in researching miscarriages.


If you would like to tell us your story so we can help and inform other women; there is more information available HERE

Expert Interview - Podcast

Expert interview with Dr Siobhan Quenby

This interview was recorded in November 2009.

To listen to podcast, please go to the podcast menu in the miscarriage section HERE.

Recurrent Miscarriage: Text Version

Hello we are joined today by Dr Siobhan Quenby to discuss recurrent miscarriage. Thank you Siobhan for joining us today. Can I start by asking you, what exactly is a recurrent miscarriage?

So a recurrent miscarriage means that you have had several miscarriages in a row. As a doctor we have a strict definition of what a miscarriage is, and that is in fact three miscarriages in a row. However if you’ve only had two miscarriage it’s still perfectly reasonable to see a doctor and discuss this, although the doctor may not do as many tests on you as if you had had three in a row.

Could you explain some of the reasons for recurrent miscarriage?

So there are some known reasons for a miscarriage, one of these is sticky blood in the context of recurrent miscarriage, is antiphospholipid syndrome. This is something that can be easily tested for by the doctor and has an effective treatment.
There are some other things which are thought to be associated with recurrent miscarriage and these involve problems with your thyroid gland, having diabetes or having a condition called polycystic ovary disease, it can also be genetic conditions or conditions in your uterus that maybe causing your miscarriages and I will go on to explain these in more detail later.

Is it more common in older mothers?

Yes the older you are the more likely you are to miscarry. There is a very simple reason for this; all the eggs you will ever have are born with you, so as you are getting older the eggs are getting older and there is an increased incidence of a genetic abnormality in the eggs. This particularly becomes important after the age of 35 and even more so after the age of 40 so if you do conceive after the age of 40 you are much more likely to miscarry than a younger woman. However even at this age you have plenty of healthy eggs and there is plenty of possibility you will have a completely normal pregnancy.

Do the genetics of the parents play a role?

Yes some people have what is called a translocation, which is a genetic abnormality which is easily detected by a blood test, it means that although the parents are normal themselves they will pass on a genetic abnormality to their offspring. This genetic abnormality is so serious that it usually results in miscarriage, however it is a rare cause of recurrent miscarriage only occurring in 2-4% of people suffering with the condition. Even if you do have this abnormality there is a chance you will still have a normal pregnancy, as there is every possibility that the baby will inherit your healthy genes and then you end up with a healthy baby.

What kinds of tests can be done to investigate the cause of recurrent miscarriage?

Most people who have recurrent miscarriage are referred to a hospital doctor, there they will do a series of blood tests such as the test of sticky blood, and in most hospitals they do more tests for sticky blood, this is called a thrombophilla screen. They test you thyroid and your diabetic level, they also do an ultra sound scan to check for PCOS, quite often they will also look at your uterus with the ultra sound scan or sometimes look into your uterus with a hysteroscopy. They will also take the blood from both the mother and father to see if there are any genetic conditions.
What about a disease such as Asherman’s Syndrome?

Ashermans Syndrome is a rare cause of recurrent miscarriage. It seems to occur after you have had an operation in your womb. What it means is the two sides of the womb stick together, so you have adhesions or little filmy pieces of tissue in your uterus this can cause infertility and problems with miscarriage. However it is easily treated by gynaecologists and can be detected by a hysteroscopy.

What research is being done to investigate the causes?

One of the problems with recurrent miscarriage is that it is very difficult to find the cause. So despite all these blood tests and scans and looking in your uterus, there is no obvious cause for recurrent miscarriage. So Wellbeing of Women is funding research to look into the new reasons behind recurrent miscarriage. One of the areas that I am particularly looking in is looking at the lining of the blood, rather than the blood in people with recurrent miscarriage, and I found some people with recurrent miscarriage have more of the NK cells in the lining of the womb, and this research is funded by Wellbeing of Women and I am using the research to develop a new treatment, however that is still in the testing stage. Wellbeing of Women is also funding research into the link between PCOS and recurrent miscarriage and it is funding a tissue bank that will give us new causes and answers in the future.

Can you tell us a bit more about your research?

So basically I have been working very hard to try and understand what is wrong in the lining of the womb for people who suffer with recurrent miscarriage compared with those who don’t. I found that these women have more of what we call NK (natural killer) cells in the lining of their wombs. However the problem with finding that was we didn’t know why that caused the recurrent miscarriage. With funding from Wellbeing of Women we were able to do further research to discover that this causes more blood vessels in the womb and these abnormalities in blood vessels seem to be the cause of recurrent miscarriage.

Is there anything that can be done to prevent a women suffering further with recurrent miscarriage?

Initially you need to have all the blood tests. Some of the conditions we have talked about are treatable; so for example if you have sticky blood we know from research done in London, that if you have aspirin and heparin it prevents miscarriage. If you have a problem in your uterus such as Ashermans Syndrome it may also be treatable. Other things we still need to do further research. We need to do further research to understand what to do with people suffering from PCOS and recurrent miscarriage and people who have these high NK cells and recurrent miscarriage. But the exciting thing is that there is lots being done in these subjects and probably the best thing you can do at the moment is become part of the research surrounding these projects.

There are a number of myths surrounding recurrent miscarriage, one of which is many women believe it is their fault that she suffered.

This is a very common feeling as women always blame themselves but it really isn’t their fault. The most common reason for a miscarriage is that the baby is abnormal and it is nature’s way of preventing an abnormal baby getting to term. Some people think it is because they smoked cigarette or had a glass of wine, but these things definitely don’t cause a miscarriage. Another common thought is that because you had a previous termination of pregnancy it causes a miscarriage, but this isn’t true at all either.

Another misconception is that you can stop a miscarriage by lying down?

This is absolutely not true at all, lying down will make no difference at all. And in fact lying down for a very long period of time when you are pregnant can actually be harmful as it increases your risk of getting blood clots.

Many people believe that if you have had one miscarriage you will be certain to have another is this true?

No. 15% of pregnancies result in miscarriage so having one miscarriage out of three births is deemed normal. Although having three or more in a row may increase the risk a bit and these people should be seen by doctors who will help them more intensively through their pregnancy.

There are a number of things people believe cause a miscarriage such as sex, lifting small children, drinking or smoking, or excessive exercise?

None of these things have definitely been linked to miscarriage, whether the pregnancy continues or not is down to a complicated interaction between the mother’s and baby’s cell in the uterus. However if you have had one miscarriage, your anxiety levels will be considerably raised and therefore I would advise that you book in at your doctors for an ultrasound early in your pregnancy to reduce your anxiety.

I would like to thank Siobhan for joining us today.

It’s been a pleasure.

Common Myths

There are a number of myths surrounding recurrent miscarriage and it can be an emotional time for a woman who often feels responsible for her pregnancy ending. Here Dr Quenby gets to the bottom of some of the most common myths in circulation.

It is a woman's own fault if she has a miscarriage

This is a very common feeling as women always blame themselves but it really isn’t their fault. The most common reason for a miscarriage is that the baby is abnormal and it is nature’s way of preventing an abnormal baby getting to term. Some people think it is because they smoked cigarette or had a glass of wine, but these things definitely don’t cause a miscarriage. Another common thought is that because you had a previous termination of pregnancy it causes a miscarriage, but this isn’t true at all either. You can stop a miscarriage by lying down

This is absolutely not true at all, lying down will make no difference at all. And in fact lying down for a very long period of time when you are pregnant can actually be harmful as it increases your risk of getting blood clots.

 

If you have had one miscarriage you will be certain to have another

No. 15 percent of pregnancies result in miscarriage so having one miscarriage out of three births is deemed normal. Although having three or more in a row may increase the risk a bit and these people should be seen by doctors who will help them more intensively through their pregnancy.

 

The following activities can cause a miscarriage: sex, lifting small children, drinking or smoking, or excessive exercise

None of these things have definitely been linked to miscarriage, whether the pregnancy continues or not is down to a complicated interaction between the mother’s and baby’s cell in the uterus. However if you have had one miscarriage, your anxiety levels will be considerably raised and therefore I would advise that you book in at your doctors for an ultrasound early in your pregnancy to reduce your anxiety.

Research
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Page last updated February 2013

 

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