A miscarriage is a spontaneous abortion that occurs up to the twenty-eighth obstetric week. According to doctors, this development is observed in about fifteen to twenty percent of women with a confirmed pregnancy. And sometimes a miscarriage happens again — in subsequent pregnancies. In this case, doctors talk about habitual miscarriage or habitual miscarriage.
Habitual miscarriage: definition of the concept
In recent years, doctors have made significant progress in researching the frequency and prevalence of the problem of spontaneous abortions — miscarriages. Thanks to advances in medicine, performing a full medical examination now reveals the underlying causes of pregnancy loss in about sixty to seventy percent of couples.
Doctors usually talk about recurrent miscarriage only when a couple has had at least three or more spontaneous pregnancy losses. However, data on ectopic pregnancy or hydatidiform mole (a rare disease of the fetal egg) are not included in this definition.
However, studies show that the likelihood of having a recurrent miscarriage after two consecutive miscarriages is as high as after three such cases. Therefore, doctors now prefer to conduct diagnostic examinations of a couple after two confirmed miscarriages.
Doctors warn: chance of recurrence
The main problem of habitual miscarriage is the high probability of recurrence. So, if the couple’s pregnancy is the first, then spontaneous abortion can occur in fifteen percent of cases of confirmed conception. And if there was a single loss of pregnancy, then the risk of relapse increases and amounts to fifteen to twenty-one percent. When doctors talk about recurrent miscarriage (after two or three losses), the risk rates reach twenty-five to thirty-three percent.
What is the risk of relapse?
When assessing the likelihood of recurrence of spontaneous abortion, the doctor may focus on:
- The age of the patient. After all, the risk of pregnancy loss increases by an order of magnitude with age, even without taking into account the viability of the embryo. This is largely due to natural hormonal changes.
- Factors leading to miscarriage. So, the likelihood of a recurrent miscarriage directly depends on the root cause of the previous pregnancy loss. For example, in patients with submucosal leiomyoma, the risk of recurrent miscarriage is as high as seventy percent if the tumor has not been surgically removed. And in the presence of hormonal disorders, for example, with a deficiency of progesterone, the probability of miscarriage reaches almost one hundred percent if the patient does not take medication to increase the amount of this hormone in the body.
- The results of a previous pregnancy. The likelihood of miscarriage increases with each successive miscarriage, and a pregnancy that ends in a live birth reduces the risk of a poor outcome in subsequent pregnancies.
- Number of births in the past. Doctors say that with a significant number of births in the past, the likelihood of habitual miscarriage increases.
- Features of gestational age. There is evidence that the likelihood of recurrent miscarriage increases in proportion to gestational age with a previous pregnancy loss. In other words, if a spontaneous abortion occurred in the early stages of gestation, then the likelihood of its recurrence is somewhat lower than with a late miscarriage.
- Previous oligomenorrhea. As statistics show, with a menstrual cycle longer than thirty-four days, the likelihood of miscarriage increases.
What to do? How to keep the pregnancy?
In order to prevent the occurrence of the problem of habitual miscarriage, a woman needs to undergo a complete examination after a pregnancy loss has occurred, identify the causes of such a development of events and undergo a course of therapy in accordance with the indications found.
Planning for the next pregnancy should be carried out exclusively under the supervision of the attending physician, taking into account the history. At the same time, the woman is shown dispensary observation in the antenatal clinic.
After a successful pregnancy, patients suffering from a habitual miscarriage should be especially attentive to their health, adhering to an appropriate diet, work and rest, being sufficient time in the fresh air. If necessary, the doctor may prescribe medications to maintain the pregnancy, for example, hormonal medications.
If the patient has manifestations of isthmic-cervical insufficiency, a special suture is applied to the uterine neck, which helps to narrow the area of the internal os and successfully maintain pregnancy.
Many doctors recommend that their patients with a diagnosis of «habitual miscarriage» when carrying a child, go to the inpatient department for the period of time when the last time there was a spontaneous abortion. Constant medical monitoring increases the likelihood of timely diagnosis of possible violations and helps reduce the risk of relapse.
Also, many doctors insist on the need for psychotherapy in the treatment of habitual miscarriage. After all, pregnancy loss is a serious mental trauma, and if it is repeated repeatedly, it can cause the formation of a pathological conditioned reflex. Therefore, in order to successfully save a child, a woman needs to overcome the fear of a habitual miscarriage, which is possible during planned and complex therapy under the supervision of a psychotherapist.
In the event that a patient with habitual miscarriage has any symptoms indicating a threat of termination of pregnancy, she is shown immediate hospitalization and therapy aimed at maintaining the pregnancy. Even after the elimination of the manifestations of the threat, a woman needs to stay in the inpatient department for at least another one and a half to two weeks.
Obstetrics / Ed. Savelieva G.M. — 2000
Etiological factors of habitual miscarriage / Airapetov D.Yu. // obstetrics and gynecology — 2011 — #8