Understanding Repeated Pregnancy Loss

If you are pregnant and you lose the baby before 20 weeks, it is called a miscarriage. Most miscarriages happen before 12 weeks. This is the end of the first trimester. Many happen before you even know you are pregnant. In the past, a woman who miscarried many times might never know why it happened. Today, more and more women are finding out the causes of their recurrent (repeated) pregnancy loss.

Repeated pregnancy loss is when you have 3 or more miscarriages in a row. This usually happens in the first trimester or early second trimester. Miscarriages are common. You have a 15% to 20% chance of your pregnancy ending in miscarriage.

If you have lost one pregnancy, don’t worry. Your chances of carrying the next pregnancy to full term stay about the same as if you had never had a pregnancy loss. The chance of having a pregnancy loss again after 2 pregnancy losses grows with each loss. The risk for repeated pregnancy loss goes up with age. If you are age 40 or older with previous repeated pregnancy loss, you have a much higher risk compared with younger women.

Why it happens

There are many different reasons for pregnancy loss. Ask your health care provider about these possible reasons:

  • Genetic Problems. Problems with the genes or chromosomes of the baby are the most common reason for a first pregnancy loss. This often happens all of a sudden, by chance, in the embryo. This is usually less often the cause for women with repeated pregnancy loss.

  • Problems with the uterus. Problems with the uterus make up for both first and second trimester pregnancy losses. Problems you are born with (congenital) include double uterus or uterine septum. Other problems are uterine polyps, fibroids, and scar tissue inside the uterine cavity.

  • Incompetent cervix. If you have an incompetent cervix, you will lose the pregnancy around 20 weeks. This problem can be treated with a stitch to help hold the cervix closed.

  • Being exposed to certain chemicals. If you or your partner is exposed to certain chemicals, it could cause pregnancy loss. Some chemicals that may be linked to it include: anesthetic gases (nitrous oxide), pesticides, formaldehyde, benzene, ethylene oxide, arsenic, lead, mercury, and cadmium. You and your partner should talk with your health care provider about any chemicals in the workplace.

  • Endocrine problems. Some endocrine problems have been linked to pregnancy loss. These include diabetes (that is not controlled), severe thyroid problems, or luteal phase defect.

  • Smoking, Drinking, and Drug Use. Smoking, drinking, and illegal drug use can cause repeated pregnancy loss. You should not smoke. You should also avoid alcohol and drugs during pregnancy.

  • Immune Problem. An immune problem called antiphospholipid syndrome causes repeated pregnancy loss in some women. This problem can be treated with low-dose aspirin and heparin.

Testing and treatment usually isn’t done until after the third miscarriage in a row. However, it can be done after a second miscarriage if you are age 35 or older. A lot of the testing and treatment is controversial. Also, the reasons that treatments work are not well understood.

Getting pregnant again

It is likely that you will go on to have a healthy baby even if you’ve suffered repeated pregnancy loss. Informative and caring counseling also seem to play a big role.

These things can raise your chance of having a healthy and successful pregnancy:

  • Having a healthy lifestyle

  • Taking a folic acid supplement

  • Quitting smoking

  • Controlling your weight

  • Drinking little or no alcohol

  • Reducing the amount of caffeine in your diet

Miscarriage

What is a miscarriage?

Miscarriage is usually defined as an early pregnancy loss. Miscarriage is also called spontaneous abortion. Types of miscarriage include the following:

  • Threatened. Spotting or bleeding in the first trimester may or may not mean a miscarriage will occur. About 10% to 20% of women will miscarry in the first trimester. The woman is monitored for further bleeding. Ultrasound exams  are usually done to monitor growth of the fetus and to monitor fetal heartbeat.

  • Complete. The fetus, placenta, and other tissues are passed with bleeding

  • Incomplete. Only a part of the tissues are passed; some remain in the uterus. There may be heavy vaginal bleeding.

  • Missed abortion. The embryo or fetus dies, but is not passed out of the uterus. Sometimes, dark brown spotting occurs, but there is no fetal heartbeat or growth.

  • Septic. Miscarriage that becomes infected, the mother develops fever and may have bleeding and discharge with a foul odor; Abdominal pain is common. This is a serious condition and can result in shock and organ failure if not treated. Antibiotics and dilation and curettage (D & C) may be necessary. This procedure uses special instruments to remove the abnormal pregnancy.

  • Recurrent. 2 or more miscarriages.

What is an incompetent cervix?

Fetal loss in the second trimester may occur when the cervix is weak and opens too early. This is called incompetent cervix. In some cases of incompetent cervix, a health care provider can help prevent pregnancy loss by suturing the cervix closed until delivery, called a cerclage.

How is miscarriage diagnosed?

The most common signs of miscarriage are vaginal spotting or bleeding, passing of tissue, and cramping. Ultrasound is usually used to diagnose miscarriage. If the fetus is no longer in the uterus, or there is no longer a fetal heartbeat, miscarriage is diagnosed. Other tests that may be used include pregnancy blood tests for the hormone human chorionic gonadotrophin (hCG). No increase in this hormone level or a decrease can indicate that the pregnancy is not growing.

Treatment for miscarriage

Treatment for miscarriage in early pregnancy includes a procedure to remove the fetus and other tissues if they have not all been naturally passed. The procedure is called a surgical evacuation of the uterus, or a dilation and curettage (D&C). Anesthesia is used as the procedure can be painful to the mother. The cervical opening is dilated (opened) and either suction or an instrument called a curette is used to remove all the pregnancy tissues inside the uterus. These tissues may be sent to the lab for culture or testing for genetic or chromosomal abnormalities. However, not all miscarriages require a D&C. An early miscarriage may also be treated with expectant management or the drug misoprostol.

Later pregnancy loss may need a different procedure using hormones such as prostaglandin or Pitocin to cause the uterus to contract and push out the fetus and tissues.

Pregnancy loss does not usually cause other serious medical problems, unless an infection is present, or unless a missed abortion occurred in which the fetus and other tissues are not passed. A serious complication with a late miscarriage is disseminated intravascular coagulation (DIC), a severe blood clotting problem. This is more likely if there is a long time (usually a month or more) until the fetus and other tissues are passed.

Douglas T. Carrell, Ph.D., H.C.L.D.

Doug Carrell received his Ph.D. degree in reproductive physiology from the University of Utah in 1995, after receiving a M.S. degree in cellular and developmental biology from Brigham Young University. Dr. Carrell has worked in the area of research and treatment of human infertility for 30 years. Dr. Carrell is ... Read More

Specialties:

Andrology, In Vitro Fertilization, Reproductive Endocrinology & Infertility

Locations:

Andrology & IVF Laboratories (801) 581-3740

Jessie A. Dorais, M.D.

Jessie Dorais, M.D. as a Clinical Assistant Professor, in the Division of Reproductive Endocrinology and Infertility. Dr. Dorais received a Bachelor of Science degree in Biology from Brigham Young University in 2003, and her M.D. from the University of Illinois, College of Medicine in 2007. She completed her O... Read More

James M. Hotaling, M.D., M.S., FECSM

Dr. Hotaling has significant training in both the clinical aspects of male fertility and genetic epidemiology and he is currently the only fellowship trained male infertility/andrology expert in Utah. He completed a 6 year residency in urology at the University of Washington, elected to pursue a year of sub-sp... Read More

Erica B. Johnstone, M.D.

Erica B. Johnstone, M.D., M.H.S., is a gynecologist and reproductive endocrinologist in the Division of Reproductive Endocrinology and Infertility. Dr. Johnstone clinical interests include reproductive endocrine disorders and all types of infertility, and she also works with hormonal disorders in children and ad... Read More

William R. Keye, M.D.

William R. Keye, M.D., is a board-certified physician specializing in obstetrics and gynecology, as well as reproductive endocrinology and infertility. He received his medical degree from the University of Minnesota, and was an original member of the University of Utah’s I.V.F.(in vitro fertilization) team. He s... Read More

Specialties:

Reproductive Endocrinology & Infertility

Locations:

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Andrew K. Moore, M.D.

Dr. Moore is pleased to bring the University of Utah’s world-class reproductive medicine closer to home for Utah Valley and southern Salt Lake county residents. He has office hourse each week in South Jordan and Orem. Dr. Moore's clinical interests include the full breadth of reproductive endocrinology and fer... Read More

C. Matthew Peterson, M.D.

Matthew Peterson, M.D., is a Reproductive Endocrinologist in the University of Utah Department of Obstetrics and Gynecology. Dr. Peterson received his undergraduate degree, magna cum laude from Brigham Young University in 1977 and his M.D. from the University of Utah in 1981. His residency training in obstetrics... Read More

Reproductive Medicine services are available at the Utah Center for Reproductive Medicine as well as multiple locations through out the state of Utah, including Centerville, Orem, South Jordan and Park City. Our reproductive endocrinologists offer a wide range of services including:

  • Infertility counseling
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  • IUD insertion and removal
  • Annual gynecological exams
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  • In vitro fertilization
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Our highly trained reproductive endocrinology specialists are experts in both the treatment and research of infertility and our clinic consistently boasts one of the highest success rates in the nation.

Neighborhood Health Center Locations:

Utah Center for Reproductive Medicine 675 Arapeen Way, Suite 205
Salt Lake City, Utah 84108-1237
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University of Utah Health Care
Centerville Health Center
26 South Main
Centerville, Utah 84014
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Dixie Regional Medical Center 544 South 300 East
St. George, UT 84770
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McKay Dee Hospital 4401 Harrison Blvd.
Ogden, UT 84403
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University of Utah Health Care
Redstone Health Center
1743 W. Redstone Center Drive, #115
Park City, Utah 84098
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University of Utah Health Care
South Jordan Health Center
5126 W. Daybreak Parkway
South Jordan, 84095
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Utah Valley Regional Medical Center
Woman’s and Children’s Clinic
1034 N 500 W
Provo, Utah 84604
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