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Recurrent Miscarriages Introduction:
Definition: A miscarriage is a pregnancy loss under 20 week gestation from the last menstrual period. A recurrent miscarriage is a term traditionally applied after three successive miscarriages. Incidence:
Aetiology:
Management:
Hystersalpingogram, Hystroscopy and fluoroscopy will be useful to assess the anatomy of the uterus and tubes. Ovum tracking with serial ultrasound scans and serial serum progesterone assays will help in diagnosing ovulatory factors (corpus luteum failure). After all these investigations 50% of recurrent abortions will be found to have no abnormalities and these should be attributed to chromosomal defect in the conception. Dr. S. Kalaichandran, MD
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It is a sad commentary on our society and its ignorance when a woman who had a miscarriage, instead of getting sympathy and support, is made to feel that it is somehow her fault. It is all too common to find recurrent
miscarriages leading to divorce. This article is written to give basic information about miscarriages. The reader is
advised to consult the family doctor or the gynecologist for specific problems. 
Early pregnancy loss is much more common than the average person understands. Using the very sensitive pregnancy tests that are available now, we know that 1 in 2 pregnancies end in very early miscarriage. In the past the majority of these would have been passed off as late or heavy menses. Even after a clinically diagnosed pregnancy, 1 in 5- 6 pregnancies end in a miscarriage between 4 & 20 week gestation.
Chromosomal abnormalities in the
conception: Seven out of 10 miscarriages under 12 week gestation are due to chromosomal abnormalities in the
conception. This is more common with increase in maternal age. In women over 40 years of age, 1 in 3 will have a miscarriage on this account. If we include the very early miscarriages too, 3 out of 4 pregnancies end in miscarriages in this age group.
Miscarriages, like infertility, is a problem of a couple and they should be checked. The majority can be
reassured. Of those who had a successful pregnancy before 3 miscarriages, 70% will have a successful pregnancy. Of those who had no previous successful pregnancy, a full 60% will have a successful pregnancy. Education and
reassurance with these good statistical odds may be all that is needed. Education about smoking, alcohol and drug abuse is also important; fortunately this is not a problem among Indian women at present.
Counseling is needed on pre-conceptual folate prophylaxis to prevent neural tube defect and miscarriages. 
Karyotyping may be useful if there is a family history of recurrent miscarriages or the couple are closely related to each other before marriage as is often the case in India. Screening for diabetes, thyroid disease and auto immune factors will rule out these conditions.
