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Infertility

2nd Miscarriage

07/01/2008

Question:

I`ve had 2 mis-carriages the 1st in Jan 2007 at 17 weeks and yesterday june 18 at 5 1/2 weeks. Before both pregnancies I had several blood tests done, levels checked and sonograms, everything came back normal. I`ve even saw 2 different perinalaogist! I`ve been taking baby aspirin and folic acid since the 1st mis-carriage. The recent pregnancy the doctor gave me progesteron suppositories at week 4. I have switched doctors twice because no one can tell me what is wrong with me!!! Not only does it hurt physically, but it kills me mentally. Right now I`m at a loss and don`t know what to do. Should my Husband be tested for anything? Is it something that is in the inside of my body that may be causing this. Do you have any advice for me or any suggestions for my doctor? I also got pregnant in 2004 and my blood pressure went to 210/170, I had an emergency C-section at 22 weeks and my baby died 3 days after. Please, I need all the help I can get this is affecting me mentally and affecting my marriage and my family... Thanking you in advance

Answer:

The definition of recurrent pregnancy loss is 2 or 3 (depending upon who you read) consecutive 1st trimester (<12 weeks) losses.  A basic work-up consists of uterine cavity evaluation, chromosomal analysis in both partners (blood tests), autoimmune testing (blood tests), thrombophilic or "clot-friendly" work-up (blood tests), and hormonal testing. 

It is important to remember that causes for losses in the first trimester may be very different than those in the second trimester. It is also unclear as to whether your most recent loss was a chemical pregnancy (positive blood test but too early to see a clinical pregnancy by ultrasound), or a clinical pregnancy (able to see with ultrasound).   It is very likely that your first trimester loss occurred by chance alone. 

Even though you do not have 2 first trimester losses, I would suggest talking to your doctor about whether any or all of these tests would be appropriate for you.  If all testing were normal, you do have the option of taking heparin or lovenox empirically with your next pregnancy.  This is a daily injection which would theoretically prevent clotting in small blood vessel that supply the fetus.  Although the risk is small with this treatment, a definitive benefit has not yet been demonstrated.

Finally, your pregnancy outcome in 2004 sounds as if it were caused by pre ecclampsia, and is probably not related to your 2 current pregnancy losses.

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Response by:

Daniel B Williams, MD Daniel B Williams, MD
Formerly:
College of Medicine
University of Cincinnati