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Miscarriage, also called spontaneous or habitual abortion, is defined as the loss of a pregnancy before 20 weeks or with a fetal weight of less than 500 grams by the American College of Obstetricians and Gynecologists (ACOG). Since human reproduction is a very inefficient process it is estimated that early pregnancy loss occurs in approximately 75% of women trying to conceive. These losses often go undetected because they happen before or with the next expected menstrual cycle. In women with a confirmed pregnancy 10-15% will result in miscarriage and most of these miscarriages occur in the first three months (trimester) of pregnancy.

Recurrent miscarriage, defined as three or more pregnancy losses in a row, occurs in 3-5% in women trying to conceive. Studies indicate that less than 5% of women will experience two losses in a row and only 1% will experience three or more. However the likelihood for another spontaneous loss increases with each successive miscarriage especially for women who have not had at least one live born infant. For example, the chances a woman with two losses who had at least one live born infant will miscarry in her next pregnancy is approximately 26% compared to 40-45% for a woman with two losses and no live born infant.

There are many reasons for recurrent miscarriage. (See Fertility Basics November 2007) In about half of the women who experience repeated losses no cause is identified despite exhaustive testing. This can be very distressing for both the woman and the clinician trying to help her. But even though a woman has had recurrent losses she still has a good chance to have a healthy baby.

The American College of Obstetricians and Gynecologists (ACOG) recommends taking the following steps if you have had repeated miscarriages and want to try again:

• Have a complete medical work-up before trying to get pregnant again.
• Consult with your doctor as soon as possible if you think you might be pregnant.
• Follow your doctor’s recommendations.
• Be sure to maintain a healthy lifestyle by eating right and exercising appropriately and avoid alcohol, tobacco and recreational drugs.
• Talk to your doctor about any special care you may need as the pregnancy progresses and the baby grows.

Coping with pregnancy loss, no matter when in the pregnancy the loss occurred, for most people requires a period of mourning and grieving for the unborn child. It is common for women with a history of repeated losses to feel anxious, angry and depressed. It is important to remember that men and women may experience the grief and mourn the loss differently. Each person grieves in their own time and for some that may be a month or two and for others it may be considerably longer. If you’re feeling overwhelmed or your symptoms persist without any improvement seeing a counselor can be helpful. Another option is joining a peri-natal loss support group where you can share your feelings of loss during this difficult time with others who will understand.

For additional information on this topic visit these websites:
American College of Obstetricians and Gynecologists (ACOG) Patient Fact Sheet: Repeated Miscarriage. Available at: http://acog.org/publications/patient_education/bp100.cfm

American Society for Reproductive Medicine Patient Fact Sheet: Recurrent Pregnancy Loss. Available at: http://www.asrm.org/Patients/FactSheets/recurrent_preg_loss.pdf

Resolve: http://www.resolve.org/site/PageServer?pagename=lrn_wii_um

References:
Benfield D, Leib S, Vollman J. Grief response of parents to neonatal death and parent participation in deciding care. Pediatrics 1978; 62: 171-7

Brigham S, Conlon C, Farquharson R. A longitudinal study of pregnancy outcome following idiopathic recurrent miscarriage. Human Reproduction 1999; 14: 2868-71.

Gervaize P. The psychological aspects of recurrent miscarriage. Infertility and Reproductive Medicine Clinics of North America 1996; 7: 807-23

Petrozza J, Robertson A. Early pregnancy loss. Emedicine online. Available at: http://www.emedicine.com/med/topic3241.htm

Poland B, Miller J, Jones D, Trimble BK: Reproductive counseling in patients who have had a spontaneous abortion. Am J Obstet Gynecol 1977 Apr 1; 127(7): 685-91

Quenby S, Farquharson R. Predicting recurring miscarriage-what is important? Obstet Gynaecol 1993; 82: 132-8

Warburton D, Fraser F: Spontaneous abortion risks in man: data from reproductive histories collected in a medical genetics unit. Am J Hum Genet 1964 Mar; 16: 1-25

Wilson A, Fenton L, Stevens D, Soule D. The death of a newborn twin: An analysis of parental bereavement. Pediatrics 1982; 70; 587-91