Habitual miscarriages - symptoms and causes of the problem. What tests to perform?.

What are habitual miscarriages?

Miscarriages Habitual onset is a problem faced by 3-4% women worldwide (1). They occur when 3 subsequent pregnancies spontaneously and spontaneously terminate. Habitual miscarriages include both:

• terminated pregnancies,

• empty foetal eggs,

• miscarriages of live pregnancies,

• as well as biochemical pregnancies - i.e. pregnancies whose only symptom was an elevated concentration of beta-HCG (2) in the blood.

There is a generally accepted principle that after one miscarriage, women who are considered healthy should not undergo detailed diagnostics because On average, 15% pregnant women experience the loss of a clinically diagnosed pregnancy, only 2% - 2 consecutive pregnancy miscarriages and only 0.4-1% - 3 consecutive pregnancy losses. The relatively high percentage of one-off losses is a common occurrence, which helps to reassure patients and give great hope that the development of the next pregnancy will be normal.

The danger of not treating habitual miscarriages is that with each subsequent miscarriage, the chance of delivering the next pregnancy decreases. After two miscarriages, the risk of another miscarriage is 33%, and after four, the probability of losing the next pregnancy increases to 66-70% (3).

Modern knowledge allows the cause of miscarriages to be found only in 50% patients undergoing diagnosis.

Causes of recurrent spontaneous abortions

Without proper diagnosis, it is difficult to determine what is causing the miscarriage, as the causes of habitual miscarriages can vary greatly. The most common causes can include: anatomical, immunological, genetic, endocrinological, infectious, thrombotic and environmentally induced causes. However, causes of miscarriages such as (4) should not be forgotten either:

• abnormalities of the uterine structure,

• insufficiency of the luteal phase of the cycle

• severe systemic disorders (uncompensated diabetes, metabolic disorders, renal failure),

• thyroid disorders,

• prolonged stress,

• malnutrition,

• stimulants,

• certain medicines,

• obesity.

Appropriate and detailed diagnosis of habitual miscarriages will help pinpoint the cause and enable proper treatment, unfortunately in some cases several causes overlap or after detailed diagnosis the cause cannot be found.

Symptoms of spontaneous miscarriage

The symptoms of spontaneous miscarriage can vary depending on the stage of the pregnancy. Often, in the case of an early miscarriage, occurring in the first few weeks, the woman does not even realise she was pregnant and takes the bleeding caused by the miscarriage as monthly bleeding.

Sometimes this spotting or bleeding is the first and only symptom of a miscarriage.

Its duration is a very individual feature. In some patients, the bleeding may be short and intense, while in others it lasts for several days, gradually intensifying.

Some patients may experience uterine contractions or lower abdominal pain. Others signal a weakening of pregnancy symptoms preceding the miscarriage (relief of nausea, reduction of breast tone). Apart from bleeding/spotting, symptoms of spontaneous miscarriage can be very subjective and individual (5).

Tests after miscarriage - which ones to do?

A correct and thorough diagnosis of miscarriages makes it possible to determine the cause and to undertake treatment that will enable the future development of the pregnancy to proceed properly until a happy termination. Among the most commonly performed investigations after miscarriages, the following tests are mentioned (6):

• histopathology,

• fetal genetics,

• genetic parents,

• imaging for diagnosis of uterine defects

• hormones,

• for thrombophilia.

Do not forget to perform a blood count to determine markers of infection. Performing immunological tests after a miscarriage can also shed light on the cause if it was not diagnosed earlier.

Fetal genetic testing - why is it so important?

Fetal genetic tests are a very important part of the diagnosis of recurrent miscarriages. They can show whether the genetic abnormality of the fetus is what is causing the miscarriage - including chromosomal defects and aberrations, which are one of the most common causes of miscarriages.

These tests are carried out on material taken during a uterine cavity curettage or material secured by medical personnel, sometimes the patient herself during a spontaneous miscarriage.

Genetic testing of parents

Genetic testing before pregnancy enable the number and structure of chromosomes to be assessed. Some changes in the karyotype, even if they do not affect the health of the carrier of the defective gene, can lead to the termination of a pregnancy.

Pre-pregnancy genetic testing will determine if there is a mutation in the maternal karyotype of the genes for coagulation factors (responsible for the normal structure of the coagulation system and the occurrence of thrombophilia) and MTHFR and (whose aberrations reduce folic acid absorption while raising homocysteine levels, which can cause miscarriages) (7).

What other tests should be performed after a miscarriage?

The more tests that are carried out after miscarriages, the more accurate the diagnosis and the better the chance of knowing the cause of the miscarriage. If pre-pregnancy genetic testing or histopathological examination of the fetus does not indicate a reason for the spontaneous termination of pregnancy, it may be helpful:

• determination of infection markers (8) - intrauterine infections can lead to miscarriages and premature births.

Infections in particular rubella, toxoplasmosis, cytomegalovirus and chlamydia.

• immunological tests (9) - include tests for antiphospholipid syndrome (APL), tests for placental antigens (APA), antinuclear antibodies (ANA) and anti-TG and anti-TPO,TRAB tests

• hormone tests - taking into account prolactin, thyroid hormones and sex hormones,

• Ultrasound of the reproductive organs - to visualise the anatomy of the uterus and to determine whether any abnormalities may lead to miscarriage.

• Hysteroscopy- assessment of the uterine cavity - adhesions, uterine septum, submucosal myomas, polyps.

The above tests help to detect the cause of recurrent miscarriages and implement targeted treatment that will enable the couple not only to get pregnant, but to bring the pregnancy to term and fulfil the dream of having their own child. It is advisable to perform at least some of them after the second miscarriage, thus increasing the chance of a healthy and normal pregnancy.

Substantive consultation:

dr. med. Jolanta Omiecina - Specialist gynaecologist-obstetrician

Bibliography:

1. MICHALAK, MAGDALENA, DARMOCHWAŁ-KOLARZ, DOROTA, LESZCZYŃSKA-GORZELAK, BOŻENA, et al. Causes, diagnosis and treatment of habitual miscarriages-part I. GinPolMedProject, 2011, vol. 1, pp. 15-30.
2. Malinowski, A., and J. R. Wilczynski. „Habitual miscarriages, in Pathology of early pregnancy, ed.” T. Paszkowski, IZT, Lublin (2004): 67-100.
3. MICHALAK, MAGDALENA, DARMOCHWAŁ-KOLARZ, DOROTA, LESZCZYŃSKA-GORZELAK, BOŻENA, et al. Causes, diagnosis and treatment of habitual miscarriages-part I. GinPolMedProject, 2011, vol. 1, pp. 15-30.
4. Palka, Agnieszka. "Habitual miscarriages-causes." (2012).
5. MICHALAK, MAGDALENA, et al. Causes, diagnosis and treatment of habitual miscarriages-part I. GinPolMedProject, 2011, 1: 15-30.
6. ZAWIŁA, Karolina. Recurrent miscarriages diagnosis and treatment. A model of care for the miscarrying patient. 2015.
7. SULEJ, Aneta, et al. Evaluation of the karyotype of pregnant women with threatened miscarriage. EJMT, 2015, 4: 9.
8. SIKORA, JERZY; BAKON, I. G. O. R.; DEMBNICKI, TOMASZ. The importance of infectious agents in miscarriage and preterm birth. Gynaecology and obstetrics-medical project, 2011, 2.20: 35-46.
9. ROZMUS-WARCHOLIŃSKA, Wioletta; SZLAGA, Agnieszka; SKRZYPULEC, Violetta. Immunological causes of habitual miscarriages.

See similar articles

Genetic causes of infertility

Thrombophilia and getting pregnant