Recurrent miscarriage - Information for patients Gynaecology - PROUD TO MAKE A DIFFERENCE - Sheffield Teaching Hospital
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Recurrent miscarriage
Information for patients
Gynaecology
PROUD TO MAKE A DIFFERENCE
SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUSTYou and your partner have been referred to the Recurrent Miscarriage
Clinic following your recent miscarriage / treatment on Ward G1. Your
appointment will be in approximately 2-3 months to allow your body
time to recover from your recent miscarriage / treatment.
We advise that you do not try to conceive prior to being seen in the
Recurrent Miscarriage Clinic. We also advise that you use a
non-hormonal method of contraception (i.e. condoms) as pregnancy
and hormonal contraceptives can prevent certain tests being performed.
We understand this is a difficult time for you and you may find the
following information helpful.
What is a miscarriage?
Miscarriage is the spontaneous loss of a pregnancy before 24 weeks of
gestation. Unfortunately this is common and affects 1 in 4 of all
pregnancies. Most early miscarriages are caused by a chance
chromosome defect of the developing pregnancy (embryo). It is rare for
this to happen again in a future pregnancy. This is more common in
women over the age of 40 years.
What is recurrent miscarriage?
Recurrent miscarriage refers to three or more consecutive spontaneous
miscarriages.
How often does it happen?
Recurrent miscarriage affects 1 out of 100 couples who are trying to
become pregnant.
page 2 of 8What are the causes of recurrent miscarriage?
There are many different causes for recurrent miscarriage. However, in
about half of women with recurrent miscarriage no clear cause can be
found. This is known as unexplained recurrent miscarriage and most
women will go on to have a healthy pregnancy without any particular
medical treatment.
The information below explains some of the possible causes, the tests
used to investigate the causes and possible treatments.
The doctor or nurse will be happy to discuss these with you in more
detail.
1. Chromosomal abnormalities
Sometimes it is suspected that patients with recurrent miscarriage may
carry a chromosomal defect. If your doctor suspects this, you may be
offered a blood test for this and be offered genetic counselling if a
defect is found.
2. Hormonal problems
Women with irregular periods may find it harder to become pregnant
and may be more likely to miscarry. Polycystic ovary syndrome (PCOS)
may be a cause of irregular periods and is found in 1 out of 10 women
with recurrent miscarriage.
An underactive thyroid may also increase the risk of you having a
miscarriage.
3. Shape of the uterus (womb)
Abnormalities of the uterus occur in 2 out of 10 women with recurrent
miscarriage. However not all these abnormalities cause fertility
problems. Some abnormalities may affect the way that the pregnancy
implants into the endometrium (lining of the womb).
page 3 of 8Possible abnormalities are:
• Fibroids (benign, non-cancerous tumours) that grow in the uterus.
• A division or partition of the uterus (septum)
• Scar tissue (adhesions) present within the uterine cavity
The abnormality may be found by doing a transvaginal ultrasound or
from a special x-ray (hysterosalpingogram) or after a camera
examination of your uterus (hysteroscopy). Treatment of the
abnormality will vary depending on the type of abnormality but it may
involve an operation.
4. Blood clotting disorders
Some women will have an unusual blood clotting tendency (sticky
blood). This may prevent the embryo from implanting successfully in the
endometrium or may make the small blood vessels in the developing
placenta more likely to become blocked by small clots, leading to a
miscarriage.
Clotting disorders that are linked to recurrent miscarriage are:
• Antiphospholipid Syndrome
• Factor V Leiden
• Prothrombin gene mutation
If you have recently been pregnant, testing for these problems would
need to be done 12 weeks after the end of a pregnancy to give more
accurate results. Your doctor may advise you to avoid a pregnancy for a
further 12 weeks if the results are abnormal as the blood test will have
to be repeated.
Treatment often involves the use of a small dose of aspirin and blood
thinning injections during the pregnancy. Your doctor will explain these
to you.
5. Cervical weakness (cervical incompetence)
page 4 of 8Cervical weakness happens when the cervix (neck of the uterus) is too
weak to carry the weight of the developing pregnancy. This can cause a
miscarriage in the second trimester (after 14 weeks) of pregnancy.
There is no test for cervical weakness. Your doctor will ask you about
your past pregnancy history and you may also need to have ultrasound
scans when you are pregnant.
A cervical suture (stitch) can be inserted to strengthen the cervix when
you are next pregnant. This is usually a small operation carried out
under anaesthetic in pregnancy and your doctor will advise you if you
need this operation.
6. Defects of the endometrium
The endometrium is very important in pregnancy. The fertilised egg
implants into the endometrium and it helps provide nutrition to the
embryo.
Recurrent miscarriage has been linked to an increased number of
natural killer (NK) cells in the endometrium. It is thought that these NK
cells cause the endometrium to reject the pregnancy. This is still an area
of research and there is no proven treatment.
7. Unexplained
In about half of all couples with recurrent miscarriage, no cause will be
found. This is described as unexplained recurrent miscarriage. Couples
may be comforted to know that the next pregnancy is successful in up
to 70% of those with unexplained recurrent miscarriage.
page 5 of 8Why are tests done after three miscarriages?
The risk of further miscarriages increases with each consecutive
miscarriage. Most women will have a successful live birth after one or
two miscarriages. 4 out of 10 women who have had three consecutive
miscarriages are at risk of having another miscarriage. Therefore tests
are done after three miscarriages.
What routine tests will I be offered?
Your doctor will discuss tests that you need with you in the clinic. These
will be tailored to your history and any other medical problems that you
may have.
Is there anything I can do to help myself?
Having a healthy lifestyle, such as moderate exercise and weight
control, reducing alcohol and caffeine consumption and stopping
smoking may all be of benefit.
Is there anything I should take?
You should take folic acid prior to becoming pregnant and for the first
12 weeks of pregnancy. This will protect the baby from conditions such
as spina bifida. Diabetic or epileptic patients require a higher dose of
folic acid.
It is also advisable to take vitamin D before and throughout your
pregnancy.
page 6 of 8What support can I receive during my next pregnancy?
If you have had a miscarriage it is very normal to be frightened and
worried during your next pregnancy. You should contact Gynaecology
Ward G1 for advice once you have had a positive pregnancy test.
Who can I contact if I have any questions?
If you have any concerns or need any further information then please do
not hesitate to contact:
• Gynaecology Ward G1: 0114 226 8225
Where can I find more information?
• The Miscarriage Association:
www.miscarriageassociation.org.uk
• Royal College of Obstetricians and Gynaecologists:
www.rcog.org.uk
page 7 of 8Alternative formats can be available on request. Please email: sth.alternativeformats@nhs.net © Sheffield Teaching Hospitals NHS Foundation Trust 2021 Re-use of all or any part of this document is governed by copyright and the “Re-use of Public Sector Information Regulations 2005” SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email sth.infogov@nhs.net PD8258-PIL215 v5 Issue Date: May 2021. Review Date: May 2024
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