This is three or more spontaneous miscarriages before the
20th week of pregnancy. Approximately 1-2% of couples have this problem.
There may be abnormalities related to uterus or coagulation
disorders as well as 50% of them.
Reasons:
It is usually caused by genetic disorders and problems in
embryo formation. It may also be associated with chronic systemic diseases such
as hypothyroidism, hormonal disorders, systemic lupus erythematosus, kidney
disease, uterine anomalies, cervical insufficiency, and some infections.
Since only 1 miscarriage is an event seen in many women,
people who make 3 miscarriages are evaluated to investigate the cause of
miscarriage.
The risk of
miscarriage again increases as the number of miscarriages previously
experienced in women increases:
15% risk of miscarriage after 1 abortion
Risk of miscarriage after 2 abortions 24%
3% low risk of miscarriage after 30%
Risk of miscarriage after 4 abortions 40-50%
The risk of
miscarriage increases with increasing maternal age:
Average risk of miscarriage under 30 years of age 7-15%
Average risk of miscarriage between the ages of 30-34 8-21%
Average risk of miscarriage between the ages of 35-39 17-28%
Average risk of miscarriage above 40 years of age 34-52%
Causes of
recurrent miscarriages:
1. Immunological factors
2. Disorders related to thrombophilic factors
3. Endocrine (hormonal) factors
4. Anatomical factors (uterine anomalies etc.)
5. Genetic Factors
6. Infectious Factors
7. Environmental Factors and Nutrition
8. Maternal diseases
9. Sperm related factors
Among the above reasons, causes related to immunological
factors are most frequently encountered. But in 50% of women with recurrent
miscarriages, no reason can be found despite all the research.
Immunological
causes: Causes caused by pathologies related to the immune system in
the body. Antiphospholipid syndrome is from this group. To investigate these
causes, studies such as anticardiolipin antibody, lupus anticoagulant and ANA,
anti-troglobulin antibody are performed. In patients with such pathologies,
drugs such as aspirin and heparin are rarely used, and rarely immunosuppressive
therapy.
Causes of
thrombophilia: These patients have a tendency to clot. These patients may
have a history of vascular occlusion and stillbirth. Many genetic mutations
inherently increase the tendency to clot. The most common of these clotting
disorders are:
- Factor V Leiden Mutation (Activated Protein C resistance)
- Prothrombin G20210A Mutation
- Methylene Tetrahydrofolate Reductase Enzyme Gene Mutation
(hyperhomocysteinemia)
- Antithrombin 3, Protein C, Protein S deficiency
In treatment, low dose of Aspirin and heparin (blood thinning
needle) are used.
Endocrine
(hormonal) causes: Luteal phase defect, Polycystic Ovary Syndrome, Diabetes
Mellitus, Thyroid Diseases, Hyperprolactinemia.
In the first trimester of pregnancy (in the first 3 months),
the frequency of both miscarriage and fetal anomalies increased in pregnant
women with poor blood sugar control and high HbA1c levels. Therefore, those
with diabetes before pregnancy should be monitored very tightly in terms of
blood sugar controls. It was observed that the risk of miscarriage does not
increase if blood glucose control is well done.
Anatomical
factors: There may be fibroids, uterine septum, congenital anomalies
in the uterus, intrauterine synechia. These causes may need to be corrected
surgically.
Cervical
insufficiency: It is a problem that usually occurs suddenly without pain
and bleeding, which continues with recurrent cervical dilation and the
introduction of pregnancy material into the vagina and causes recurrent
miscarriage. These patients are sutured to the cervix at 13-14 weeks of
gestation (McDonald's cerclage).
Genetic
factors: 3.5-5% are detected in habitual miscarriage. Miscarriage is
often seen in the first trimester. Balanced translocations are most common. In
the investigation of the cause of habitual miscarriage, karyotype analysis can
be performed, especially in couples with stillbirth and anomaly birth history.
Environmental
factors and nutrition:
Recurrent miscarriage is detected in 5-10%.
Although
their relationship with recurrent miscarriages is controversial, possible
factors are:
- Cigaret
- alcohol
- Excessive coffee consumption
- Organic solvents
- Heavy metals (Hg, Pb)
- Anesthetic gases
- Medication use
Maternal
diseases:
Some
diseases of the mother also attracted attention as a reason for recurrent
miscarriages:
- Diabetes mellitus (Diabetes)
- Chronic hypertension
- Kidney diseases
- Systemic lupus erythematosus (SLE)
- Antiphospholipid antibody syndrome
- Celiac disease
- Thyroid diseases
-ECTOPIC PREGNANCY
-HETEROTOPIC PREGNANCY
-SILENT MISCARRIAGE (MISSED MISCARRIAGE)
-MOLAR PREGNANCY
-OVARIAN PREGNANCY
-CERVICAL PREGNANCY
-CERVICAL INSUFFICIENCY
