Tarangini has just been told by her obstetrician that her pregnancy is not growing. She is 2 months pregnant and the baby has no heartbeat on ultrasound. She and her husband are devastated. This is their third pregnancy that has ended in a miscarriage.

What is recurrent or repeated miscarriage?

The term recurrent or repeated pregnancy loss is used when miscarriage occurs consecutively in three or more pregnancies. When this occurs before 12 weeks (3 months) of pregnancy, it is classified as recurrent ‘early’ pregnancy loss.

It is important that the miscarriages are properly documented. Some women may have a delayed period followed by a positive pregnancy test but the ultrasound may not show any pregnancy in the uterus. This is called a ‘biochemical pregnancy’.  These ‘pregnancies’ should not be considered a miscarriage.

What causes recurrent miscarriage?

Many factors can lead to recurrent miscarriage though the cause cannot be found in almost 50 percent of repeated miscarriages. The common causes of repeated miscarriage are chromosomal abnormalities, the presence of specific antibodies called antiphospholipid antibodies and abnormalities in the woman’s uterus.

Medical problems related to obesity, such as diabetes and polycystic ovaries, can also lead to repeated miscarriages.

Chromosomal problems

 More than half of miscarriages in the first 3 months of pregnancy are caused by problems with the chromosomes of the fetus. Chromosomes are threadlike structures found in the nucleus of most living cells, carrying genetic information in the form of genes. A miscarriage can occur if there are too many or too few chromosomes. There can also be problems with the genes they carry. Extra or missing chromosomal material can result in an abnormal fetus. Miscarriage is nature's way of ending a pregnancy in which the fetus is abnormal.

Antiphospholipid syndrome

Antiphospholipid syndrome is a disorder of the immune system. A blood test can show the presence of these antibodies, called anticardiolipin antibodies and lupus anticoagulant.

Uterine abnormalities

Some abnormalities of the uterus are associated with repeated miscarriage. Though not common, they include a uterus that is divided into two sections by a wall of tissue (septate uterus) and a condition where the cervix opens up painlessly after the 4^th month of pregnancy (cervical incompetence).

What tests are required for repeated miscarriage?

Most obstetricians will ask for tests after the second miscarriage and not wait for a third miscarriage.

The two common tests done are a blood test for the presence of antiphospholipid antibodies and evaluation to rule out an abnormality of the uterus. A good quality ultrasound scan (including a 3D scan) or a hysteroscopy (where a thin, lighted telescope-like instrument is introduced into the uterus) will reveal abnormalities of the uterus that could have lead to repeated pregnancy loss.

Usually a chromosomal test for the couple is done if there have been three or more miscarriages. Sometimes one of the partners has a chromosomal abnormality which can get passed down to the fetus and cause a miscarriage. Even in this case, the couple has a 75 percent chance of having a normal pregnancy.