Recurrent miscarriage and pregnancy issues

Dear Ask The Doctor: I am having miscarriage problems. I had 1 missed miscarriage 10 years ago (was10 weeks when this was discovered-baby died earlier) d and c, followed by a termination the same year, then in 2010 I had spontaneous rupture of membranes at 25 weeks. I stayed in hospital and baby was born in a state, but live at 30 weeks. No reason was found for pprom. I have since missed miscarried in August, had another d and c(9weeks-only yolk was seen in sac) and also this week, my 11th wk of preg(baby measured 7wk 5 days and previously had heartbeat at 6 and 7 week scans). I live in england. I am 36. What advice could you give me? Thank you.

Dear Claire: Recurrent pregnancy loss is a heart-wrenching experience for a parent and I understand your concern. Most cases of early pregnancy loss (termination of pregnancy before 20 weeks) are unrecognised.

There can exist more than 1 cause of early pregnancy loss. Genetic factors (aneuploidy, mendelian disorders), immunologic causes, anatomic problems, infections (TORCH group), endocrine and environmental causes  have all been known to cause pregnancy loss.

Most spontaneous miscarriages are caused by an abnormal karyotype of the embryo. Recurrent miscarriages may result from recurrent chromosomal abnormalities of the embryo which is not inherited or a structural abnormality inherited from one parent.

I would advise you to consult your doctor for further examination and evaluation. If a suspected genetic cause of miscarriage is thought of, the standard of care is to offer genetic counseling. Because advanced age increases the risk of an abnormal karyotype in a conceptus, amniocentesis is routinely offered for all pregnant women of advanced maternal age, which is defined as women older than 35 years. I wish you well, and hope I could answer some of your queries.