Miscarriage and Recurrent Pregnancy Loss: Causes, Investigations and Treatment
Why early pregnancy loss happens and how it presents; expectant, medical and surgical management; investigations after recurrent miscarriage and the next pregnancy.
Op. Dr. Sadık Kükrer, MD
Obstetrician & Gynecologist · Adana, Türkiye
Pregnancy loss affects about 10–15% of recognised pregnancies in the first 12 weeks; it is common, yet it often has a profound emotional impact. Most early miscarriages result from chance chromosomal abnormalities in the embryo and are not related to anything the mother did. For couples who have experienced two or more losses, investigation for an underlying cause is recommended.
Symptoms and when to seek help
- Vaginal bleeding or spotting
- Cramping lower abdominal or back pain, similar to or stronger than period pain
- Passage of tissue
- A sudden reduction in pregnancy symptoms
- Bleeding that soaks a pad every hour, fever, offensive discharge or faintness requires urgent care.
Causes
- Chance chromosomal abnormalities in the embryo (the commonest cause)
- Advanced maternal age
- Antiphospholipid syndrome
- Poorly controlled diabetes and thyroid disease
- Structural uterine problems: septum, polyps, submucous fibroids, adhesions
- Smoking, heavy alcohol use and some medications
Diagnosis
Diagnosis is made with transvaginal ultrasound and, where needed, serial beta-hCG. In very early pregnancy a repeat scan after 7–14 days may be required for a definitive answer. For other causes of bleeding see bleeding in pregnancy, and for the distinction from an ectopic pregnancy see ectopic pregnancy.
Management options
- Expectant management: allowing the tissue to pass naturally; usually complete within two weeks.
- Medical management: misoprostol, with mifepristone where appropriate, hastens the process.
- Vacuum aspiration: for heavy bleeding, infection or incomplete miscarriage; a brief and safe procedure.
- Rh-negative women receive anti-D immunoglobulin where indicated.
Investigating recurrent pregnancy loss
After two or more losses, recommended assessment includes:
- Antiphospholipid antibodies (lupus anticoagulant, anticardiolipin, anti-beta2 glycoprotein)
- Thyroid function and thyroid antibodies
- Assessment of uterine anatomy with 3D ultrasound, hysteroscopy or MRI
- Chromosome analysis of the couple and genetic testing of pregnancy tissue in selected cases
- Glucose, body mass index and lifestyle review
Treatment and the next pregnancy
Antiphospholipid syndrome is treated with low-dose aspirin and heparin, a uterine septum or polyp with hysteroscopic surgery, and thyroid dysfunction with medication. Even when no cause is found, early pregnancy care and support give a high chance of a live birth next time. Pre-conception folic acid, stopping smoking and a healthy weight are advised; do not hesitate to seek support for the emotional impact of your loss.
Op. Dr. Sadık Kükrer, MD manages pregnancy loss and investigates recurrent miscarriage in Adana, Türkiye.
Frequently asked questions
How common is miscarriage?+
About 10–15% of recognised pregnancies miscarry in the first 12 weeks. The risk rises with maternal age and increases markedly after 35.
What causes miscarriage?+
About half of early miscarriages result from chance chromosomal abnormalities in the embryo and are not expected to recur. Other causes include advanced maternal age, poorly controlled diabetes and thyroid disease, antiphospholipid syndrome, structural uterine problems (septum, polyp, submucous fibroid), smoking, heavy alcohol use and certain infections.
What are the symptoms?+
Vaginal bleeding, cramping pain similar to or stronger than period pain, passage of tissue and a sudden reduction in pregnancy symptoms such as nausea or breast tenderness. Some miscarriages cause no symptoms and are detected on a routine scan (missed miscarriage).
Is surgery always needed after a miscarriage?+
No. In suitable cases the pregnancy tissue may pass naturally, or the process may be hastened with medication such as misoprostol. Vacuum aspiration is offered for heavy bleeding, signs of infection, incomplete medical management or patient preference. The choice is made together with your clinician.
What is recurrent pregnancy loss?+
The European Society of Human Reproduction and Embryology (ESHRE) defines recurrent pregnancy loss as two or more pregnancy losses. Investigation is recommended in this situation.
Which investigations are performed?+
Antiphospholipid antibodies, thyroid function and antibodies, glucose and, where relevant, prolactin are checked. The uterus is assessed with 3D ultrasound, hysteroscopy or MRI. Chromosome analysis of the couple and genetic testing of pregnancy tissue are recommended in selected cases. No cause is found in about half of couples.
When can I try again?+
You may try again once bleeding has stopped and you feel physically and emotionally ready; many women prefer to wait for one period. Continuing folic acid is advised. Even after unexplained recurrent loss, the chance of a live birth in the next pregnancy is high.
Would you like to book a consultation?
For pregnancy monitoring, women's health, and gynecologic surgery in Adana, get in touch with Op. Dr. Sadık Kükrer.
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