15-20% of all clinically detected pregnancies end in spontaneous miscarriage. Many factors, including maternal age, affect the risk of miscarriage. While the risk of miscarriage is 12% in women under the age of 20, this risk increases to 26% in women over the age of 40. Considering the pregnancies that are aborted unnoticed, the spontaneous abortion rates are actually higher. In other words, some pregnancies are lost just before the start of menstruation.
For a woman who miscarries once, the recurrence rate is less than 30%. A woman who has previously had a spontaneous miscarriage will later have a successful pregnancy with a rate of 80-90%.
However, some women experience multiple pregnancy losses. Recurrent pregnancy loss is defined as 3 consecutive spontaneous miscarriages before the 20th week or when the fetal weight is less than 500 g. After 4 pregnancy losses in these women, the risk of repeat miscarriage is more than 54%. Recurrent pregnancy losses occur in 0.5-1% of all women. There are many reasons for recurrent pregnancy losses. However, no cause is found in 50% of women. It is generally thought that many factors, rather than a single factor, are effective in recurrent miscarriages.
What are the factors that cause recurrent pregnancy losses?
A) Genetics Factors
Chromosomal disorders are the most common cause of spontaneous abortion. If a fetus is formed, chromosomal abnormalities are responsible for 60% of miscarriages in the first 3 months. The resulting fetus may have increased or decreased chromosomes. Abnormalities are most commonly observed in chromosomes 13, 16, 18, 21 and 22.
Crosomal anomalies belonging to the parents may also cause recurrent miscarriages. Studies conducted on couples with recurrent miscarriages have shown that this rate is 2-3%. Parents are generally normal in appearance.
B) Anatomical Disorders
The second important reason is congenital or acquired anatomical disorders. Anatomical disorders inherent in women generally cause miscarriages after the first 3 months. Abnormalities such as septa (curtains) in the uterus, double-horned uterus, and double uterus are frequently observed. ir. In other words, congenitally, the female internal genital organs have not completed their development.
Even if the gestational week progresses in such women, the results are generally poor. Premature birth, fetal development retardation and baby's development abnormalities occur at birth. Anatomical disorders that cause recurrent pregnancy losses in women may also be acquired.
The main acquired anatomical disorders that cause miscarriages are as follows:
C) Hormonal reasons
The progesterone hormone secreted by the ovaries ensures the continuation of the pregnancy in the uterus. provides. If this hormone is released insufficiently, we may experience recurrent miscarriages. Poorly controlled diabetes and thyroid diseases may also be the cause of miscarriage.
D) Diseases related to the body's immune system
Disorders related to the body's defense system may also recur. may cause miscarriage. They usually cause miscarriages that occur after the first 3 months. Substances that we call antibodies are produced in the woman's body, either against her own tissues or against the formed embryo. These cause small clots in the vein, which we call thrombosis. As a result, not enough blood can be sent to the tissues. When this phenomenon occurs in the tissue we call the placenta (popularly known as the baby's partner), which provides nutrition to the fetus, the blood flow to the fetus is also disrupted. Thus, miscarriages occur.
E) Infections
They are responsible for a very small portion of recurrent miscarriages.
F) Environmental Factors
Smoking, alcohol, some drugs, ionizing radiation, anesthesia gases, some heavy metals, and some dermatological preparations (especially those containing vitamin A) may cause recurrent miscarriages.
G) Unknown Factors
In 50%-60% of women with recurrent miscarriages, no determined cause can be found.
How to get diagnosed?
We use some tests to diagnose women with recurrent miscarriages.
The main ones are as follows:
- A good history of the patient should be taken. The patient's CV, family history, and detailed work-related interests are taken.
- Cultures are taken to investigate infections.
- Thyroid function tests, blood sugar, and immunological factors are investigated.
- Genetic research is performed on both couples.
- Endometrial biopsy can be performed to detect hormonal factors. The progesterone hormone level in the blood is determined.
- Imaging methods including hysterosolpingography, pelvic ultrasound, computerized tomography or magnetic resonance can be used to detect anatomical anomalies. Again, hystereroscopy or diagnostic laparoscopy can be performed under anesthesia for diagnosis.
Treatment for recurrent miscarriages
As we mentioned before, the rate of miscarriage is 50% in women with recurrent miscarriages. No cause has been found.
If the cause is not found, treatment is given based on the cause. If the cause is not determined, supportive treatment is generally recommended.
- If miscarriages are due to genetic reasons, genetic counseling is recommended.
- If the cause of miscarriages is anatomical anomalies, surgical treatment is usually required.
- If hormonal anomalies are detected, treatment is given and the missing hormone is supplemented.
- If infection is diagnosed, it is treated with appropriate antibiotics.
- Environmental factors are corrected. If someone smokes or drinks alcohol, they are encouraged to quit. If there is exposure to toxins, this is prevented.
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