CAUSE OF MISCARRIAGE - CHROMOSOMAL ABNORMALITIES
50 - 60 % of first trimester and 20% of second trimester miscarriages are due to chromosomal abnormalities within the fetus. The factors leading to this cause include chromosomally abnormal sperm or egg, abnormal cell division of the fetus, and chromosomal abnormalities of mother and / or father.
Chromosomal abnormal sperm or egg will create a fetus that is genetically abnormal. Therefore, the woman's body will reject the fetus and be a cause of miscarriage. Majority of these miscarriages will occur early in the pregnancy and a lot of women will not even know that they were pregnant.
Chromosomal abnormalities of the mother or father require special genetic testing and should be performed by a genetic counselor. The genetic counselor can evaluate the 23 pairs of chromosomes from both the mother and father and assess their risk for recurrent miscarriages. Most physicians require that a couple have at least two if not three miscarriages before referring them for genetic testing.
CAUSE OF MISCARRIAGE - INFECTION
Infection usually is only a cause of miscarriage once especially since majority of these infections are tested for and acute infections are diagnosed and treated at time of miscarriage.
CAUSE OF MISCARRIAGE - INFECTION #1 - Chlamydia is an extremely common sexually transmitted disease in the United States (actually it is the most common reported bacterial STD). The danger of chlamydia is that there may be no symptoms of infection. Chlamydia can actually cause a women to become infertile especially if she develops pelvic inflammatory disease. The good news is that chlamydia can be prevented with safe sexual practices and easily treated with antibiotics before it becomes a cause of miscarriage.
CAUSE OF MISCARRIAGE - INFECTION #2 - Cytomegalovirus (CMV) is a common community virus and over half of the adult population in the United States are infected by the age of forty. Individuals who are not immunosuppressed are usually unaffected by the virus. Transmission of the virus is through close contact of bodily fluids. A women who becomes infected for the first time with CMV can pass the virus onto her unborn child. The best prevention of CMV is good personal hygiene, but there is nothing anyone can do to eliminate the risk of becoming infected with CMV.
CAUSE OF MISCARRIAGE - INFECTION #3 - Genital herpes is a sexually transmitted disease caused by the herpes simplex virus (HSV). Individuals infected with genital herpes for the first time develop burning or itching in the genital area with development of small clusters of blisters. Women who have their first outbreak during pregnancy have a increased risk of transmitting the virus to their unborn child. However, if the women has had an outbreak before the risk of transmittion to her fetus is much less.
CAUSE OF MISCARRIAGE - INFECTION #4 - Rubella also known as the German Measles is a virus which has been implicated as a cause of miscarriage. Majority of the population has been vacinated against this virus. Therefore, when a woman becomes pregnant she will be tested to assess her immune status. If a couple is considering to become pregnant, the women should have her rubella immune status tested. If the woman is not immune she should receive the vaccination prior to becoming pregnant.
CAUSE OF MISCARRIAGE - INFECTION #5 - Syphilis is a bacterial infection that is usually caused by sexual contact. Syphilis is exteremly dangerous to an unborn child and is a cause of miscarriage or stillbirth. Women are tested for syphilis early in their pregnancy and treated accordingly if they are positive for syphilis. If the woman has risk factors for possible syphilis infection then she needs to be tested early within the pregnancy.
CAUSE OF MISCARRIAGE - INFECTION #6 - Toxoplasmosis is a parasitic infection found to be a cause of miscarriage. The parasite divides within the intestines of a cat and is expelled through their feces. Therefore, anyone handling cat feces in the liter box or outside the house are at risk of becoming infected with toxoplasmosis. There are other ways to become infected such as eating undercooked meat. If a woman becomes infected prior to her pregnancy she should have built immunity to the parasite, which will decrease the chances of affecting her unborn child. Therefore, most believe that a first time infection with toxoplasmosis is the only danger to an unborn child.
CAUSE OF MISCARRIAGE - IMMUNE DISORDER
A immune disorder is a cause of miscarriage and are usually found after a work-up for recurrent micsarriages.
CAUSE OF MISCARRIAGE - IMMUNE DISORDER #1 - Antiphospholipid antibodies (also lupus anticoagulant or anticardiolipin antibodies) are antibodies that affect the normal function of blood vessels and clotting. These antibodies can either cause narrowing of the blood vessels or cause blood clots in the blood vessels. During pregnancy blood clots form between the mother and fetal circulation and are the cause of miscarriage.
CAUSE OF MISCARRIAGE - IMMUNE DISORDER #2 - A man's sperm is foreign to a woman and there for can create a response from the woman to attack and destroy the sperm which usually in the first trimester is a cause of miscarriage. Again there will be recurrent miscarriages until this immune disorder is diagnosed as the cause of miscarriage. There is not much known about this entity however, there is ongoing research to better understand and develop treatment plans.
CAUSE OF MISCARRIAGE - ANATOMICAL ABNORMALITIES OF THE UTERUS
Abnormalities of the uterus usually are a cause of miscarriage after the twelve week of gestation. Unfortunately this is also when they are usually diagnosed.
CAUSE OF MISCARRIAGE - ANATOMICAL ABNORMALITIES OF THE UTERUS #1 - Congenital abnormalities such as bicornuate uterus, septate uterus, and unicornuate uterus. These abnormalities are developed when the woman is a fetus herself and the uterus either fuses abnormally, a wall divides the uterine cavity, or only develops one half of the uterus. Majority of women do not know that they have this congential abnormality until it is the cause of miscarriage.
CAUSE OF MISCARRIAGE - ANATOMICAL ABNORMALITIES OF THE UTERUS #2 - Uterine fibroids which are abnormal growth of smooth muscle within the wall of the uterus. Majority of these do not affect a pregnancy, however, if the fibroid is submucousal it can affect the implantation of the fetus and be the cause of miscarriage.
CAUSE OF MISCARRIAGE - ANATOMICAL ABNORMALITIES OF THE UTERUS #3 - Incompetent cervix is when the cervix can not stay closed during the pregnancy and is the cause of miscarriage. Usually an incompetent cervix is not identified until the fetus is large enough to add pressure to the cervix. This added pressure will dialate the cervix and cause pre-mature labor. Once this condition is diagnosed it can be easily treated with a cerclage (a stitch is placed into the cervix to prevent dilatation) which is a surgical procedure.
CAUSE OF MISCARRIAGE - SYSTEMIC ILLNESSES
Conditions that require daily medications or daily evaluation can cause significant problems during pregnancy. Therefore, these conditions must be closely followed and medications adjusted accordingly so they do not become the cause of miscarriage.
CAUSE OF MISCARRIAGE - SYSTEMIC ILLNESSES #1 -Thyroid disease especially when it is hypothyroidism can be the cause of miscarriage. Therefore it is essential that the woman who is hypothyroid monitor their TSH, T4 and T3 levels regularly because the fetus does not have a fully functional thyroid and relies on the mother for its source.
CAUSE OF MISCARRIAGE - SYSTEMIC ILLNESSES #2 - Polycystic ovary disease (PCOD) can be the cause of miscarriage due to several different reasons. Due to several hormonal abnormalities associated with PCOD the egg is usually of poor quality. However, there has been some recent breakthroughs which have allowed many women with PCOD to have healthy babies.
CAUSE OF MISCARRIAGE - SYSTEMIC ILLNESSES #3 - Diabetes if not followed closely and changes with medications are not made it also can be a cause of miscarriage. During pregnancy the demand of insulin will increase and will change from one stage of pregnancy to the next. This is because during pregnancy there are hormones released that aid in the growth of the fetus but these hormones block the effectiveness of insulin. Therefore, most diabetic women who become pregnant are followed by maternal fetal medicine physicians.
CAUSE OF MISCARRIAGE - HORMONAL ABNORMALITIES
The most common hormonal abnormality identified during pregnancy is a low level of progesterone which is a cause of miscarriage. Progesterone is produced by the ovary until the placenta matures and then it will produce the progesterone that is needed. Progesterone is a hormone that is required to maintain a healthy pregnancy.
CAUSE OF MISCARRIAGE - HORMONAL ABNORMALITIES #1 - Luteal phase defect is the term given to the decreased progesterone level during pregnancy and has been associated as a cause of miscarriage. A luteal phase defect is suspected especially if the luteal phase of the menstrual cycle is shorten. The luteal phase is after ovulation and prior to menstruation.
CAUSE OF MISCARRIAGE - SUBSTANCE ABUSE
Tobacco use, alcohol use, and illicit drugs especially cocaine and heroin have been found to be a cause of miscarriage.
