What is Recurrent Pregnancy Loss(RPL) counselling ?
Recurrent pregnancy loss is defined as having two or more miscarriages. After two miscarriages, a thorough physical exam and testing are recommended.
RPL counselling tells you about:
1. Possible reasons for your miscarriages.
2. Investigations that you may be offered.
3. Possible options for treatment.
Why does miscarriage occur?
About half of miscarriages occur randomly when an embryo receives an abnormal number of chromosomes during fertilization. This type of genetic problem happens by chance. There is no medical condition that causes it. But the chance of this problem increases with age.
There are a number of other causes that can cause miscarriages:
- Genetic: In a small number of couples who have repeated miscarriages, one partner has a chromosome in which a piece is transferred to another chromosome. This is called a translocation. People who have a translocation usually do not have any physical signs or symptoms, but some of their eggs or sperm will have abnormal chromosomes. If an embryo gets too much or too little genetic material, it often leads to a miscarriage.
- Certain problems in uterus(womb): There are many congenital problems that can occur in womb, one of the most common that has been linked to miscarriage is a septate uterus. In this condition, the uterus is partially divided into two sections by a wall of tissue. Certain problems can occur later like Asherman syndrome in which there is scarring in the uterus. Sometimes fibroid and polyps which are benign(non cancer) growth in uterus may be the cause.
- Antiphospholipid syndrome(APS): this is an autoimmune disorder that affects blood clotting can cause a variety of medical problems. APS can occur alone or with other autoimmune diseases, such as lupus.
- Diabetes Mellitus: Diabetes, especially if the disease is poorly controlled, can increase the risk of pregnancy loss. Keeping blood sugar levels in the normal range before pregnancy and throughout pregnancy can decrease the risk.
- Thyroid disorders: Problems with the thyroid gland that are not treated can increase the risk of miscarriage. Treating thyroid problems can decrease the risk.
- Polycystic ovarian syndrome.
What tests are available?
To help find the cause of repeated miscarriages, your doctor would ask about your medical history and past pregnancies. A complete physical exam, including a pelvic exam, may be done.
You may have blood tests to detect problems with the immune system, sugar and thyroid testing. Testing may be done to help detect genetic causes of repeated miscarriages. Imaging tests may be considered to find out if a uterine problem is causing repeated miscarriages.
If I get the tests done, will I know the cause of my miscarriage?
Physical examination and tests will help you rule out the common causes of miscarriages, however In more than half of women with repeated miscarriages, no cause can be found for the pregnancy loss.
If no cause is found, what are my chances of having a successful pregnancy?
Even if no cause is found, the chances of having a successful pregnancy without special treatment are good. About 65-70 in 100 women with unexplained recurrent pregnancy loss have a successful next pregnancy.