Spontaneous miscarriage can be a very distressing and unfortunately common occurrence for women and couples. It is thought that approximately one in three pregnancies miscarry, around two-thirds of which occur before you even realise you are pregnant.
Miscarriage refers to the loss of a pregnancy before week 20. For some women, this heartbreak happens more than once, a situation termed recurrent miscarriage or recurrent pregnancy loss. Recurrent miscarriage is defined as two or more pregnancy losses, which adds an additional layer of emotional and medical complexity for those navigating this difficult path. Recurrent pregnancy loss affects between 1-4% of Australian couples trying to conceive.
Most miscarriages are a result of chromosomal abnormalities in the foetus that occur at random. If you have experienced a pregnancy loss, it is important not to blame yourself as it was most likely not due to anything you did or did not do. There are many risk factors associated with an increased chance of pregnancy loss. Some risk factors are well-established, while others come with less consistent evidence of an association, such as excessive caffeine or alcohol intake, maternal obesity, or fever.
Unfortunately, around 50% of couples who experience repeated pregnancy loss will not have a clearly defined cause.
The most significant risk factor for miscarriage is maternal age. Statistics report a miscarriage rate of:
As women age, the quality of their eggs decreases, resulting in a higher risk of compromised DNA. Chromosomal abnormalities can prevent an embryo or foetus from developing normally.
Your uterus, also known as the womb, is an organ specifically designed to hold and protect your growing baby. However, structural abnormalities can interfere with the blood supply to the uterus and/or placenta, general function of the placenta, or physically restrict the space in your uterus available to the baby as it develops.
Uterine problems known to increase the risk of a miscarriage include uterine fibroids, septums (abnormal wall dividing the uterus into two spaces), polyps and adhesions.
Certain chronic conditions can increase your risk of experiencing a pregnancy loss. These are mainly cardiometabolic conditions, which include type 2 diabetes, high blood pressure (hypertension), and obesity. Poor cardiovascular and metabolic health can interfere with the function of the placenta during pregnancy.
Other chronic illnesses associated with miscarriage include Cushing syndrome, endometriosis, and Crohn’s disease.
Thrombophilia refer to a group of blood clotting disorders characterised by an overactive blood clotting mechanism. Thrombophilias can be acquired, the most common of which is known as antiphospholipid syndrome, or genetic, such as Factor V Leiden thrombophilia. Excessive blood clotting disrupts the blood flow between mother and developing baby as clots form in the placenta, restricting the supply of oxygen and vital nutrients.
Damaged genetic material in the sperm from the male reproductive partner may contribute to an increased risk of miscarriage as the embryo is less likely to develop properly. Higher levels of sperm DNA fragmentation are found in older men, those with obesity or varicocele (swollen veins in the testicles), and men who smoke.
Miscarriage symptoms can include:
A missed miscarriage, also known as a silent or delayed miscarriage, is one that occurs with no symptoms. It is typically found during a routine pregnancy ultrasound and can be particularly devastating as your body may still feel pregnant and the finding has come as a shock.
Pregnancy loss may be diagnosed with blood tests that measure your levels of pregnancy hormones, and ultrasound imaging. Sometimes, multiple tests are required to confirm the miscarriage diagnosis.
Miscarriage treatment may vary based on your stage of pregnancy and symptoms. Dr Huang will guide you through your options, understanding that this can be a very difficult time. Miscarriage treatment may involve:
If you have suffered two or more pregnancy losses, Dr Huang will organise investigations to better understand any underlying causes and to inform the early care she provides for your next pregnancy.
Tests for recurrent miscarriage may include:
In the immediate days and weeks after a pregnancy loss, Dr Huang will discuss and recommend treatment options similar to treatment for a single miscarriage.
Moving forward, your treatment for recurrent miscarriage focuses on addressing any underlying causes if one can be identified with testing. This may involve surgical correction of issues such as uterine septum or polyps, medications to restore a normal hormone balance, or interventions for immune disorders, such as aspirin and heparin medication for women with antiphospholipid syndrome.
If a genetic issue in either yourself or your partner was determined to be contributing to the pregnancy losses, Dr Huang may recommend genetic counselling. This helps you to understand your options for improving the chances of success of your next pregnancy, and may involve fertility treatments such as IVF with preimplantation genetic testing, or using donor eggs or sperm.
Pregnancy loss can be an incredibly difficult experience, and it is important to know that support is available. If you would like additional information or support, resources such as Pink Elephants, Red Nose Grief and Loss, or The Miscarriage Association of Australia may be helpful. These organisations provide practical guidance, peer support, and counselling services for individuals and families affected by miscarriage and pregnancy loss.
