How can we ensure that I will not miscarry again?
It is an understandable cry from the heart from couples who experience the devastation of recurrent pregnancy loss that there must be one explanation and one perfect treatment. Even if a cause is identified we are unlikely to achieve success rates better than 75% within the foreseeable future. Half of the fifteen percent of pregnancies that miscarry can be attributed to a genetic problem of the embryo and we do not have a remedy for this. It is only in the last ten years that we have begun to find some treatable explanations for recurrent miscarriages.
For those with identified antiphospholipid antibody problems aspirin alone or in combination with heparin has been shown to be beneficial. Twenty percent of women have PCOS (Q7.2) and this syndrome may perhaps account for a greater proportion of recurrent miscarriages. Metformin looks promising on theoretical grounds but we still lack the scientific proof that is required. The role of bacterial infection and the possible benefit of antibiotics is an example of a new area that is being investigated. There is a suggestion that 'tender loving care', with frequent assessment during pregnancy, may help. There is no evidence that hormone support in pregnancy or low-dose aspirin for those without evidence of antiphospholipid antibody problems improves the outcome.
There is some evidence that metformin treatment for PCOS may be beneficial but more robust research is required before it can be implemented in routine clinical care.
Related Medical Abstracts - Click on the paper title:-
- Metformin reduces abortion in pregnant women with polycystic ovary syndrome. (2006-01)
- A randomized study of thromboprophylaxis in women with unexplained consecutive recurrent miscarriages. (2006-02)
- Anticoagulants for the treatment of recurrent pregnancy loss in women without antiphospholipid syndrome. (2005-01)
- Recurrent miscarriage: pathophysiology and outcome. (2005-02)
- Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. (2005-03)
- Recurrent miscarriage syndrome and infertility due to blood coagulation protein/platelet defects: a review and update. (2005-04)
- Pregnancy loss, polycystic ovary syndrome, thrombophilia, hypofibrinolysis, enoxaparin, metformin.(2004-01)
- Pregnancy outcome in patients with a history of recurrent spontaneous miscarriages and documented thrombophilias. (2004-02)
- Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first-trimester spontaneous abortion: a pilot study.(2001-01)
- Guides for practitioners. Recurrent miscarriage: Principles of management. (1998)
- The outcome of in vitro fertilization in unexplained habitual aborters concurrent with secondary infertility (1997)
- Oocyte donation in women with recurrent pregnancy loss (1996)
- Recurrent spontaneous miscarriage - Current trends and management (1996)
