Why does a Miscarriage happen? | Types of Miscarriages | Dr. Prachi Benara

Most of us today will agree that it is still okay not to be pregnant but more emotionally traumatizing is to lose a pregnancy in between a miscarriage or an abortion. Hello friends, I am Dr Prachi Banara, Senior Fertility Specialist in Gurgaon. Miscarriage is losing a pregnancy before 20 weeks. Unfortunately, 10-15% of the total pregnancies end up in a miscarriage. There is a sigh of relief because these pregnancies are a nature's way of clearing those pregnancies which were not well made and were destined to give rise to an abnormal child. In other words, it's nature's way to remove those pregnancies which are not well made. But today let's understand what are the causes of miscarriage. The causes of miscarriage depends upon the time of miscarriage and hence they are classified into 1st trimester miscarriages which are within 12 weeks and 2nd trimester miscarriages which are beyond 12 weeks. Let's first broadly understand about 1st trimester miscarriages. 1st trimester miscarriages are mainly due to chromosomal abnormalities in the embryo or the baby. What does this mean? Chromosomes are thread-like structures which carry information from the parents to the offspring. It is a mixture of information from father and mother. In case if these chromosomes do not combine in a healthy way, this pregnancy is an abnormal pregnancy and generally ends up in a miscarriage. Sometimes the doctor advises cleaning of the womb and sending these tissues for genetic testing called karyotype to understand the chromosomal makeup of the baby. Second most common reason of 1st trimester miscarriage is the increasing age of the woman. You'll be surprised to know that around 35 years of age, 1 in every 7 pregnancy miscarries. At 40 years, this ratio is generally 1 in every 3-4 pregnancies. At 45 years, it is every second pregnancy which leads to a miscarriage. The other common reasons of miscarriage can be certain hormonal disorders like increased prolactin levels, abnormal thyroid levels like hypothyroid or hyperthyroid, PCOS. Certain other conditions like uncontrolled hypertension or uncontrolled diabetes can also lead to 1st trimester miscarriages. One recently studied cause of miscarriage is autoimmune disorder which is also known as antiphospholipid antibody syndrome. In this disorder, due to certain antibodies in maternal blood, the small blood vessels leading to nutrition or blood supply of the baby gets coagulated and hence the blood supply of the baby stops and leads to miscarriage. A simple test called APLA is done to rule out this condition and do not worry, there are medical treatments available for this condition also. Another very important cause of miscarriage is increased DNA fragmentation index of the sperm which leads to fragmented DNA and hence can also be an important factor in 1st trimester miscarriages. Now let's concentrate upon 2nd trimester miscarriages which generally happen beyond 12 weeks. The most common reason of 2nd trimester miscarriages are abnormal shapes of the uterus. Sometimes there can be an abnormal septum in the uterus, there can be certain fibroids or polyps which can lead to miscarriages. The 2nd most important factor is known as cervical incompetence or weak cervix. So cervix is the mouth of the uterus which holds the pregnancy inside. In case the cervix is weak, it relaxes and can lead to preterm labour or miscarriage. Sometimes cervical stitches are applied on the mouth of the womb to prevent circumstances. Other factors can be certain infections of the genital tract, presence of high grade fevers, all of them can also be associated with 2nd trimester miscarriages. In majority of conditions, in spite of various investigations, no definitive reason can be delineated for the miscarriage. It's also at the same time very important to understand what cannot cause a miscarriage. Eating a papaya, eating a pineapple, bending down, using stairs, wearing heels, falling down, travelling are generally not associated with miscarriages. These are all myths. No medical guideline, no clinical guideline has any data to support if they can cause a miscarriage. Now most importantly, let us understand what needs to be done if a woman is suffering from miscarriages. Number 1, it is very important to understand the chromosomal makeup of the parents and run a simple blood test called karyotype which can make us understand the chromosomal structure of the parents. In case of abnormality, further testing of the embryo called embryo biopsy or PGTA through an IVF cycle is required for these couples to conceive a normal child. Second is to understand the internal structure of the uterus by performing a 3D scan. Sometimes a hystroscopy is also required which is taking a camera inside the womb and studying the womb from inside in cases of second trimester miscarriages. A simple test to test autoimmune condition called APLA is necessary for a woman who has had more than 2 miscarriages and also to understand the DNA fragmentation index of the semen is necessary before this couple further plans a pregnancy. In case the DFI is above 15%, certain antioxidants are given prior to conception. So when can we plan next? There is no medical guideline to understand when can we plan next. Important is the woman and the partner should be emotionally and mentally ready for the next pregnancy and if in case you are having any chronic condition that has led to miscarriage it is important to stabilize that condition before you plan the next pregnancy. Do not blame yourself. It is not you who have caused a miscarriage. Please take a balanced diet, exercise, get yourself checked by a gynecologist or a fertility specialist before you try to conceive a child again and do not forget miscarriages are bound to happen because majority of the miscarriages are nature's way of preventing those pregnancies which were not well made. Do not panic, relax, visit a gynecologist. Thank you.