Recurrent Pregnancy Losses are Preventable

Recurrent Pregnancy Loss: Causes, Prevention, and Expert Insights from Liv Hospital

A miscarriage before 20 weeks of pregnancy is called a pregnancy loss. Prof. Dr. Arda Lembet, an obstetrician and perinatology specialist at Liv Hospital, says that 10–15% of recognized pregnancies end in miscarriage. This means early pregnancy loss is more common than many families think. Dr. Lembet explains that genetic factors, especially problems with the number or structure of embryo chromosomes, cause 50–75% of pregnancy losses. While most miscarriages happen only once, about 1% of fertile women have three or more in a row. This is known as recurrent pregnancy loss (RPL) or recurrent miscarriage.

Spec. MD. Hafsa Uçur says that with the right medical evaluation, many causes of recurrent pregnancy loss can be found and treated. Miscarriage is emotionally hard, but learning about its causes helps doctors guide couples toward safer and more successful pregnancies in the future. Careful diagnosis, along with emotional support and the right preventive steps, can greatly improve long-term results.

When Should Pregnancy Losses Be Examined?

A single early miscarriage usually does not need a lot of testing, but some situations do call for a closer look. If a heartbeat was seen in the embryo before the miscarriage, or if the loss happens in the second trimester, more tests are strongly recommended. Traditionally, doctors defined recurrent pregnancy loss as three or more miscarriages in a row. However, today, many doctors suggest starting tests after two losses, especially if the family wants answers sooner.

Furthermore, any pregnancy loss after 12 weeks is considered clinically significant and warrants detailed evaluation. Early diagnosis allows doctors to uncover issues that may otherwise remain hidden and reduces the risk of repeating the same outcome in future pregnancies.

There are some situations where early testing is a good idea, such as:

• A normal karyotype analysis from previously collected miscarriage tissue
• Maternal age over 35, when egg quality naturally begins to decline
• A history of infertility or difficulty conceiving
• An abnormal karyotype results in either parent
• A previous loss occurring after a confirmed fetal heartbeat
• Known uterine structural abnormalities or hormonal imbalances

If any of these risk factors apply, doctors may start genetic, anatomical, hormonal, and immune system tests before you try to get pregnant again. Finding any problems early can help with planning and increase the chances of a healthy pregnancy.

What Are the Causes of Recurrent Pregnancy Loss?

Recurrent pregnancy loss usually has more than one cause, so several conditions may contribute to repeated miscarriages. A thorough evaluation helps doctors find the specific cause or combination of causes, allowing them to create a treatment plan tailored to each patient. The most common causes are anatomical, immune, genetic, and blood-clotting factors.

1. Anatomic Factors

Problems with the structure of the uterus are some of the best-known causes of recurrent pregnancy loss. These issues can be present from birth or develop later in life.

Common structural issues include:

• Uterine septum: a wall that divides the uterus into two parts, which can lead to poor blood supply to the embryo.
• Unicornuate uterus: a uterus with only one working side, which can make it harder for an embryo to develop.
• Uterine didelphys: a rare condition where a woman has two separate uterine cavities.
• Bicornuate uterus: a heart-shaped uterus with two cavities, which may limit fetal growth.
• Fibroids (myomas): non-cancerous growths that can change the shape of the uterus.
• Intrauterine adhesions (Asherman’s syndrome): scar tissue inside the uterus, often caused by past surgeries or infections.

These problems can make it harder for an embryo to implant, reduce the space needed for the baby to grow, or affect blood flow to the placenta. The good news is that many of these issues can be fixed with surgery, which often improves the chances of a healthy pregnancy.

2. Immune System Factors

In some women, the immune system may mistakenly see pregnancy tissues as foreign and attack them. Autoimmune disorders are a key factor to consider in cases of recurrent pregnancy loss.

The most common immune-related conditions include:

• Systemic lupus erythematosus (SLE)
• Antiphospholipid syndrome (APS)

APS is particularly associated with recurrent miscarriages, preeclampsia, and blood-clotting issues. If detected early, doctors can provide targeted therapies, such as low-dose aspirin, heparin, or other medications, to help protect the pregnancy.

3. Genetic and Chromosomal Factors

Genetic problems cause about half to three-quarters of early miscarriages, especially in the first trimester. These issues often happen by chance during fertilization, but sometimes one parent carries a balanced chromosomal change that raises the risk of miscarriage.

Key points include:

• Chromosomal abnormalities prevent normal embryo development.
• Many abnormalities are random, but some can be inherited.
• A karyotype analysis of both parents can identify significant genetic risks.

Genetic counseling is often suggested to help assess possible outcomes and discuss assisted reproductive options if needed.

4. Coagulation and Placental Problems

Blood clotting disorders, called thrombophilias, can reduce blood flow to the growing placenta. When circulation is limited, the embryo may not get enough nutrients and oxygen, which can cause pregnancy loss.

Thrombophilias can be:

• Inherited: examples include Factor V Leiden mutation, Prothrombin mutation, or Protein C/S deficiency.
• Acquired: for example, antiphospholipid antibodies.

Placental insufficiency or early detachment can also cause repeated pregnancy losses. If these problems are found, they are often treated with:

• Early intervention during pregnancy

• Blood thinning medications

• Close monitoring

• Lifestyle modification

What Diagnostic Procedures Are Used?

To identify the causes of pregnancy loss, doctors use a range of genetic, imaging, and laboratory methods.

1. Karyotype Analysis: A genetic test using blood samples from the mother and father to detect chromosomal abnormalities.
2. Advanced Imaging: Techniques like 4D ultrasonography, hysterosalpingography (imaging of uterus and fallopian tubes with contrast dye), hysteroscopy, and laparoscopy help detect structural or anatomical abnormalities.
3. Thrombophilia and Immunological Testing: These blood tests evaluate congenital or acquired clotting disorders and immune-related causes. The thrombophilia panel, genetic mutation screening, and lipoprotein(a) measurement are key parts of this evaluation.
4. Prenatal Chromosomal Analysis: For women who become pregnant after previous losses, chromosomal analysis during pregnancy through amniocentesis, chorionic villus sampling (CVS), or cordocentesis provides essential genetic information.

Early diagnosis not only helps identify the cause but also allows the medical team to plan personalized treatment before and during pregnancy.

Can Recurrent Pregnancy Loss Be Prevented?

Yes. With modern diagnostic tools and targeted treatments, most recurrent pregnancy losses are preventable. Once the underlying reason is identified, medical specialists can recommend appropriate therapies, including hormonal support, blood-thinning medications, surgical correction of uterine abnormalities, or lifestyle adjustments.

Emotional support and regular follow-up with obstetric and perinatology specialists also play a crucial role. Today, many women with previous miscarriages go on to have healthy pregnancies and healthy babies thanks to comprehensive evaluation and personalized care.

* Liv Hospital Editorial Board has contributed to the publication of this content .
* Contents of this page is for informational purposes only. Please consult your doctor for diagnosis and treatment. The content of this page does not include information on medicinal health care at Liv Hospital .

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