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Early miscarriages

by Dr Howard Lee

question
After two early miscarriages, I'm really worried that I'll never be able to have a baby. Please tell me what causes a miscarriage, and if it is something that I'm doing wrong?

answer
First of all, don't worry about fault. It's very unlikely that the problems you have experienced are in any way related to your actions. A miscarriage (the word usually associated with a spontaneous event, and almost synonymous with 'abortion') can occur due to a variety of known reasons, and possibly from reasons as yet unknown. One in every six pregnancies in Britain fails to go to full term - the most likely stage being between six to ten weeks of pregnancy (within the first Trimester).

Embryonic abnormalities where chromosomal defects occur are very common. In this group splitting and rejoining of genetic material at the time of fertilisation may be at fault. The new foetus contains material genetically foreign to the mother. In any other area of the body this would cause a rejection of such foreign material - a normal immune reaction. However, in most, but not all, cases the foetus is not rejected and the baby continues to grow and develop. It's thought, therefore, that sometimes the usual 'protection' of a newly formed foetus is not present, causing miscarriage. Up to 30% of spontaneous miscarriages have been attributed to this reason.

Some spontaneous miscarriages at a later stage are caused by an insufficiency in the placental bed where poor structure and function prevents proper development of the foetus. Similarly, if the maternal uterus (womb) has a minor fault that has been present since the time of its own development, this could contribute to the non-support of an early pregnancy. The cervix, or neck of the womb, may also have a structural weakness. This could be congenital (from birth) leading to recurrent miscarriages, or it may be acquired. In the latter case it could follow a previous over-stretching of the cervix at a dilatation and curettage procedure (a 'D&C' operation) In either of these two cases the miscarriage is normally at a much later stage of pregnancy - say 12 weeks.

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