Wednesday, December 12, 2007

A heartbreaking loss

Recurrent miscarriage is devastating, but there may be an underlying cause.

Even though most of us realise that miscarriage is not only common, but in many cases “for the best” (being one of nature’s ways of stopping a pregnancy that might otherwise have resulted in a baby with major life-threatening health problems), miscarriage of a much-wanted baby can be heartbreaking nonetheless.

Imagine then the heartache and devastation felt by those many would-be parents who experience recurrent miscarriages.

In Australia, miscarriage is defined as a pregnancy that ends before 20 weeks gestation (loss of a baby after 20 weeks gestation is termed stillbirth); a miscarriage before 13 weeks is considered an “early miscarriage”, whereas miscarriage after 13 weeks is termed “late miscarriage”.

The majority of miscarriages (an estimated 80 per cent) will occur before 12 weeks, and indeed the time of highest risk is in fact immediately after conception and implantation, with an estimated 50 per cent of all fertilised eggs coming away with what is simply perceived as a normal or slightly late menstrual period.

In the case of such “unnoticed miscarriages”, the woman remains unaware that she was ever pregnant.

Recurrent miscarriage is defined as three or more consecutive miscarriages of recognised pregnancies.

What causes recurrent miscarriage?

It is estimated that around 70 per cent of miscarriages at under 12 weeks gestation are the result of a chromosomal abnormality in the foetus.

With increasing maternal age, the incidence of chromosomal abnormalities in the foetus rises.

A genetic abnormality in one or both parents is another possible underlying cause of recurrent miscarriage.

Toxic environmental factors, including certain noxious chemicals and drugs, are also associated with an increased risk of miscarriage and recurrent miscarriage.

Medical problems in the mother, such as poorly controlled diabetes or thyroid disease, autoimmune conditions (such as lupus), hormonal imbalance, an infection and, particularly in the third world, chronic infectious diseases such as malaria or TB, may increase the risk of recurrent miscarriage.

Around one in six to 10 women with a history of recurrent miscarriage are found to have a structural abnormality in the uterus. Some studies have also implicated paternal age as a risk factor for miscarriage.

In many cases, however, no reason for the recurrent miscarriages can be identified.

What can be done?

In the first instance, counselling and support to help deal with the emotions and disappointment are very important aspects of caring for any couple who has experienced recurrent miscarriage.

Couples may be reassured to learn that statistically, of those who have had a successful pregnancy prior to the miscarriages, around 70 per cent will have a further successful pregnancy; and of those who have had no previous successful pregnancy, around 60 per cent will go on to have a healthy baby.

The doctor caring for the couple will recommend various tests in an effort to identify any possible underlying cause for the miscarriages, such as medical conditions or abnormalities.

In around 50 per cent of cases of recurrent miscarriage, no abnormality will be found, in which case a chromosomal defect in the foetus is the most likely underlying cause.

Your doctor may give you advice regarding lifestyle issues such as stopping smoking or consuming alcohol and drugs.

In certain specific situations your doctor may prescribe aspirin, heparin or steroid medication during subsequent pregnancies. It is vitally important to follow your doctor’s advice here and never take it upon yourself to self-administer something, since even a drug as seemingly ubiquitous as aspirin can have potent effects.

Always tell your doctor about any drugs, supplements or herbal preparations you are taking as even products that are termed “natural” may have harmful effects.

Most importantly, look after yourself, take time to relax and don’t blame yourself. Guilt and feelings of self-blame are a very normal part of the experience of grief and loss.

Talk to your doctor about any ongoing feelings of distress and, if necessary, seek further counselling and support.

Talking can help. The Bonnie Babes Foundation is a charity that provides 24-hour counselling seven days a week for families that have experienced the loss of a baby through miscarriage, stillbirth or prematurity or related issues such as infertility.

For more information visit the website at


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