Recurrent Pregnancy Loss: Why Does This Keep Happening?
I have given birth to two children, ages five and three. Both were born by cesarean. The first section was due to mild pregnancy-induced hypertension (PIH) and failure to progress/unripe cervix/one week overdue. With my second pregnancy I took one baby aspirin a day suggested by my doctor to help insure the PIH didn't happen again. I ended up having an elective cesarean. Since then, I have lost three babies: one, at five months; the next at 10 weeks, and the third at 5 months. My doctor referred me to a perinatologist for the last baby I ended up losing. He in turn has now referred me to a reproductive endocrinologist. All tests came back negative (cardiolipin, anti-phospholipid, and lupus). Also the DNA tests checked out okay. My doctor still thinks its due to the blood clotting factor, simply because I took baby aspirin with my second normal pregnancy. I am 36 and have no health problems that I know of. Any ideas as to what could be going on in my body?
Question:Peg Plumbo CNM
Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more
What a considerable amount of grief you have suffered. Miscarriage is difficult enough but second trimester pregnancy loss is very difficult to reconcile.
I am assuming that you did not suffer from incompetent cervix and that you have been tested for infections such as bacterial vaginosis, trichomonas, chlamydia and beta strep, which can cause premature loss.
Incidence of chromosomal anomalies in miscarried pregnancies falls with each trimester. This means that if you lost a baby beyond 12 to 14 weeks, the chances that it was due to a chromosomal defect are lower than with first trimester losses (but still present). Among embryos less than 30mm in crown to rump length, the frequency of abnormal structural development was 70 percent in one study versus those embryos in the 30 to 180 mm group where frequency was 25 percent. When the baby has normal chromosomal development and is still lost, the reasons are generally unknown. But after age 35,the incidence of pregnancy loss with chromosomally intact fetus increases dramatically. However, the loss could still be due to an isolated mutation or the combination of other factors such as chance, environmental or biochemical cause.
Mycoplasma hominis and ureaplasma urealyticum are both organisms that have been implicated in pregnancy loss. These can be cultured from the vagina or cervix. Treatment with specific antibiotics before conception may improve outcome.
Maternal conditions such as thyroid autoantibodies can be associated with later losses. Smoking and alcohol use has also been implicated. It seems unlikely that you could have developed a clotting deficiency after having two normal babies.
Because these losses occurred post cesarean, it might be possible that adhesions within the uterus could be a cause. If there has been endometrial damage, this could be seen on hysterosalpingogram (X-rays with dye.)
Incompetent cervix, if the losses were the result of painless dilatation of the cervix followed by fetal expulsion, could be considered.
Most would recommend that you resume taking the small doses of aspirin with a subsequent pregnancy.
It sounds like you are being well cared for and are getting the appropriate referrals, but a second opinion, if one is available, might be a good idea. Have the perinatologist review your surgical records and reculture your cervix.
Chatting with some other parents who have experienced similar losses, either online or in a support group, is often helpful for mental health as well as for information on other providers and other causes of late pregnancy loss.
I hope this has helped a bit but in the majority of these cases, the causes are unknown. I wish you the best with your next pregnancy.
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