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What Causes Miscarriage, Pregnancy Loss, and Stillbirth?


Pregnancy Loss & TTCAL Info Spot

Information on pregnancy loss, grief, coping, ttcal & more.

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  #1  
October 4th, 2009, 09:28 AM
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Question: What Causes Miscarriage, Pregnancy Loss, and Stillbirth?

Answer: After miscarriage, most couples want answers. Many people wonder if the loss happened because of something they did or whether the causes of miscarriage could have been prevented somehow. Usually, the answer to that question is no. Miscarriage is rarely anyone's fault, and sometimes pregnancy loss is even a predetermined outcome at the time of conception.

Even though we know pregnancy loss usually does not happen because of anything the mother (or father) did, doctors cannot always explain why miscarriages do happen. The medical recognizes a few known miscarriage causes, and theories are aplenty with much ongoing research and controversy.
Sporadic, one-time pregnancy losses are usually caused by chromosomal abnormalities in the developing baby. The medical community widely recognizes this explanation. In many cases, doctors assume this as the default explanation for first time miscarriages -- with good reason, given that most couples go on to have a normal pregnancy after one miscarriage.

In most cases, a baby lost to miscarriage has a problem in the chromosomes, such as extra chromosomes or missing genes that cause the baby to stop developing and eventually to be miscarried. Because chromosomal flaws are usually random, one-time events, most doctors do not initiate testing for miscarriage causes after the first miscarriage.

Anyone can have a miscarriage due to chromosomal flaws, regardless of age, but the highest risk for this particular problem is in mothers over 35.
Two miscarriages in a row qualifies as recurrent miscarriages -- and the cause is less likely to be two random chromosomal errors in a row. After the second loss, most doctors will start the process of testing for recurrent miscarriage causes because the odds are higher that the woman may have a detectable problem causing the losses.

About half the time, doctors can find a cause for recurrent miscarriages and then the woman can be treated in her next pregnancy. The other half of the time, tests do not reveal a cause -- but even with two unexplained miscarriages, a woman can get pregnant again and still have greater statistical odds of a normal pregnancy than another loss.


In recurrent miscarriages, causes are much more controversial than in single miscarriages. Some doctors will test for and treat particular problems while others will not. Widely recognized causes of recurrent miscarriages include the following:
  1. Problems with the structure of the uterus
  2. Blood clotting disorders, such as antiphospholipid syndrome
  3. Certain chromosomal conditions, such as balanced translocation
Many doctors feel that low progesterone and other hormonal imbalances may cause recurrent miscarriages. Treatment with progesterone supplements is fairly common after one or two miscarriages, but not all medical practitioners agree on the practice. Some practitioners also feel that immune system malfunctions, such as high levels of natural killer cells, may be a culprit in some women but others dispute this view.
Stillbirths (losses after the 20th week) and premature births usually have different causes from earlier miscarriages, although chromosomal errors in the baby can cause stillbirths. The most common causes of stillbirth and very early preterm labor are cervical insufficiency, problems in the placenta, and preterm labor due to medical issues in the mother.

Regardless of the cause, if you have had a miscarriage, be sure to seek out emotional support from friends and relatives or look for support groups if you don't have an adequate in-person support structure. You should not have to go through this alone. Your doctor should be able to give you information on whether you need testing for miscarriage risk factors and causes.

Sources:
American College of Obstetricians and Gynecologists, "Repeated Miscarriage." Medem. Sept 2005. American College of Obstetricians and Gynecologists. 20 Sep 2007. Check, J.H, R.M. Weiss, and D. Lurie. "Analysis of serum human chorionic gonadotrophin levels in normal singleton, multiple and abnormal pregnancies." Human Reproduction 7. 8 (1992) 1176-1180. 20 Sept 2007.

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Last edited by Celena; October 4th, 2009 at 10:04 AM. Reason: seperating paragraphs
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October 4th, 2009, 10:13 AM
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One of the first questions that most women ask their doctors after any kind of pregnancy loss is, "Why did this happen to me?" Most of the time, the doctors don't have much of an answer.

Although the medical community has a large number of possible explanations for miscarriage causes and stillbirth causes in general (by far the most frequent cause for miscarriages and a large percentage of stillbirths is chromosomal abnormalities), doctors can rarely explain what caused any specific pregnancy loss.

This can be hard to accept.

After a pregnancy loss, many women feel an intense need to have answers. Many embark on research missions, learning everything they can about miscarriage and stillbirth in an attempt to find some kind of answer for what happened and whether there is any way to reduce risk. It can be frustrating that so many answers, such as "random chromosomal abnormalities," are out of anyone's control. Many want to find someone or something to blame for the loss, and in the absence of answers, they look for a reason to blame themselves, finding it easier to have someone to blame than no one.

Blaming yourself can feel like a way of regaining control when you feel helpless, and these feelings are totally normal (even though miscarriages are almost never anyone's fault). Unfortunately, however, thinking along these lines can be a significant source of stress. Sometimes you can control your exposure to some miscarriage risk factors, and other times you can seek testing for recurrent miscarriage causes if you have had two or more miscarriages. But sometimes you simply have to find a way to be at peace with what happened.




Obviously that is easier said than done. But here are some ideas for how to move forward.
  • If you are at all religious, you might find comfort in prayer -- doing good deeds, spending time in meditation, or attending services in your chosen faith.
  • You can keep researching. This can be a two-edged sword for some women. On one hand, continuing to research should reinforce the idea that your miscarriage was not your fault; on the other hand, in this day and age there is so much information out there that it can be hard to digest it all.
  • Try again (if you want to). Many, many women (and men) find it easier to cope with a pregnancy loss if they try for a new pregnancy. Although a new pregnancy can generate anxiety, most people who grieve miscarriages do so because of an inherent desire to start (or build on) a family -- and beginning to try again can feel like taking a step toward fulfilling that desire.
  • Find a place to talk about your feelings. Talk to close friends or to your partner, and if these are not appropriate outlets in your circumstances, look for an in-person or online support group where you can talk to others who have had a pregnancy loss.
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01/07/2011@ 6wks3ds EDD 08.28.2011 7/ /11 @6wks5ds EDD 02.27.12












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