Recurrent Miscarriage – Q&As with Mr Radwan Faraj, Consultant Obstetrician & Gynaecologist
Mr Radwan Faraj, Consultant Obstetrician & Gynaecologist
Claremont Clinics: Monday EVE
Recurrent Miscarriage – Questions & Answers
What is recurrent miscarriage?
A miscarriage is when you lose a pregnancy at some point in the first 23 weeks. When this happens 3 times or more, doctors call this recurrent miscarriage. For women and their partners, it is a very distressing problem.
Around 1 in every 100 women experience recurrent miscarriages. This is about 3 times more than you would expect to happen just by chance, so it seems that for some women there is a specific reason for their losses. For others however, no underlying problem can be identified; their repeated miscarriages may be due to chance alone.
What are the possible causes of more than 1 miscarriage?
I would look at the couple’s history and the details of the pregnancy losses they have suffered. Investigations are then carried out to check factors such as cervical weakness (incompetence), ovarian reserve and look for conditions such as Antiphospholiapid Syndrome and Thrombophilia. Couple karyotypes will be also tested looking for any chromosomal abnormalities.
Testing can also identify uterine abnormalities. Procedures used to carry out testing include Trans-Vaginal Ultrasound and Hysterosalpingogram. MRI would also be useful in certain uterine anomalies.
Are there any treatments available?
We can offer treatment, for example, where uterine abnormalities are discovered, hysteroscopic surgery to divide a uterine septum can be offered to improve the woman’s ability to continue her pregnancy full term. Studies have shown a significant decrease in miscarriage rates from 80% to 17% with this surgery.
During the consultation, couples are given further information about recurrent miscarriage and they have the opportunity to discuss existing conditions which may contribute to pregnancy loss, such as Polycystic Ovary Syndrome (PCOS).
Couples with chromosomal problems will be referred for genetic counselling and offered prenatal diagnosis in the next pregnancy.
I can offer reassurance to couples and help them understand that their outcome may be good, depending on their age and the amount of recurrent miscarriages they have experienced.
For women with Antiphospholipid Syndrome, treatment with low-dose Aspirin and LMW Heparin injections in the early part of the pregnancy would be indicated. This may improve the chances of a live birth up to about 7 in 10 (compared to around 1 in 10 if no treatment is given).
Treatment includes supportive care such as visits to the early pregnancy assessment unit providing ultrasound scans at an earlier stage of the pregnancy for couples who have had recurrent miscarriages. Evidence suggests that attending the early pregnancy assessment unit can reduce recurrent miscarriages and women aged 30 have up to an 80% successful outcome after 3 recurrent miscarriages.
GPs need to be aware that obesity is linked with 73% of recurrent miscarriages and that it would be useful to offer weight management to women trying to conceive.
Do you offer a Recurrent Miscarriage service at Claremont?
Yes, I see recurrent miscarriage patients in my Claremont clinics and am helping many couples to have successful pregnancies.
The clinic deals with couples who have experienced 3 or more consecutive pregnancy losses during the first or second trimester. Occasionally, we start investigations after the second miscarriage.
A private consultation with Mr Faraj at Claremont is £160 if you don’t have health insurance. To book an appointment, call our friendly Private Patient Team on 0114 263 2114 or email firstname.lastname@example.org. You will need a referral letter from your GP or you can see one of our Private GPs if you prefer.
Copyright Radwan Faraj, 2016.