by Dr. Naveed Khan, MD
The air in the office is filled with sadness. Two of our patients had miscarriages this morning. The first patient had conceived after her first cycle of IVF. The baby started off growing a little slowly and by today stopped growing altogether. The second lovely patient had conceived twins after multiple failed IVF cycles and this was her last attempt. Unexpectedly, both the fetuses stopped developing – everything had looked perfect 2 weeks ago.
Unfortunately, spontaneous miscarriage is a common complication in early pregnancy. Miscarriages occur in up to 20% of clinical pregnancies, which are pregnancies where a sac is seen inside the uterus. If one includes biochemical pregnancies, which are very early miscarriages found by positive hormone levels but before any structures are seen inside the uterus, 25% of all pregnancies are lost. Generally, the frequency of miscarriages decreases with increasing gestational age.
Why Does Miscarriage Happen?
The natural question to ask and wonder is “Why did this happen?” Frequently, there is no exact explanation as to why pregnancy loss occurs. Most often the miscarriage did not result from anything that the couple did or did not do. The few risk factors for miscarriage that a person can control are smoking, alcohol consumption, cocaine use, morbid obesity, high levels of caffeine intake and possibly the use of non-steroidal anti-inflammatory drugs if used around the time of conception. There are many other risk factors that can increase the risk of miscarriage that can’t be controlled such as advanced maternal age, previous history of miscarriage, Celiac disease, anatomic issues, trauma, and genetic or developmental abnormalities of the fetus.
Unfortunately, there are no medical treatments that can prevent a first trimester pregnancy loss. Early in pregnancy one can follow the blood levels of the pregnancy hormone BhCG to see if the hormone levels are rising appropriately. Later in pregnancy, one can check a vaginal ultrasound for reassurance that the fetus is growing adequately. Fortunately, after a single miscarriage there is a greater than 80% chance that the next pregnancy will not result in a miscarriage and will go on to delivery.