Pregnancy After Recurrent Loss


Q: I am a 33 year old woman currently pregnant with twins (naturally conceived - no fertility drugs). Prior to this pregnancy, I suffered two mcs (both stopped developing between 6-6.5 weeks), my last one being in February. I went for a seven week ultrasound which showed a heart rate of 89 for one baby and 104 for the other. They were both measuring a few days small (6 weeks, 2 days) but I expected this as I believed I conceived later than day 14. The Radiologist and u/s Tech felt that the heart rate was normal for the size of the babies but my doctor was concerned "given my history and the fact that we can't identify a problem." My doctor feels that the issue is egg quality (since nothing else can be found but I have a small left ovary and apparently, the follicles appear small).

My concern is, during this pregnancy I haven't had really any symptoms. In my last two, I did, though nothing extreme. If anything, what few symptoms I had don't even feel very pronounced at this point. I'm terrified of having another miscarriage (especially twins - how devastating) and I'm not sure where to go from here. What advice do you have for someone my age who has experienced recurrent loss? Should I be worried about the lack of symptoms and lower heart rates during this pregnancy? What are my chances of a successful outcome now and in the future? Is there anything else I can do to achieve a successful pregnancy? I feel like at 33, I'm running out of time.

Symptoms:  - lack of symptoms
- lower heart rate (both around 100 though this didn't concern the Radiologist)
- recurrent pregnancy loss
- no no cause for pregnancy losses (other than assumed egg quality given my age)

A:   Approximately 60 - 70 percent of women who have had two or more miscarriages in the past go on to have a normal pregnancy and child birth subsequently. The causes of recurrent miscarriages range are many such as genetic causes, structural abnormalities of the womb, infections, blood coagulation defects, immunological defects etc.
You should not be concerned about the heart rates of the twins at present as it is too early for that. It is a good sign that your pregnancy has progressed beyond 6 weeks I.e the time of the earlier miscarriages. I would suggest that you follow up with your obstetrician regualarly,take all prenatal vitamins and avoid any excessive physical or emotional stress. You could also discuss with your obtetrician, the various screening tests that can be done in the first and second trimesters for chromosomal abnormalities, gestational diabetes etc. Regular ultrasounds and prenatal check ups go a long way in preventing a bad outcome. It would also be wise to register with a OBGY unit or hospital that has ready access to a neonatal intensive care unit and all facilities for neonatal resuscitation. These are the basic precautions that you could take in ensuring the safe delivery of your babies. I suggest you rest a lot, eat healthy, sleep well, avoid stress and keep faith that things shall be fine.

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