- MEDICINE ATHENS MED4WOMAN ATHENS
- MEDICINE VOLOS MED4WOMAN VOLOS
- 2103390838
- 2421022988
Obstetrician Gynaecologist
Doctor of Medicine, University of Athens Medical School
Panagiotis Polyzos, Gynaecologist Obstetrician, is active at the Institute of Life - IVF Unit of Iaso Maternity Hospital.
Pregnancy loss causes physical and emotional distress for couples, especially when it occurs repeatedly (recurrent miscarriages), and they certainly need support and psychological assistance from their environment (family, friends), as well as from the medical and nursing staff responsible for their care.
Spontaneous pregnancy loss is unfortunately a common phenomenon. Approximately 15% of clinically recognized pregnancies end in miscarriage, while a fairly large number of pregnancies are lost before they even become clinically detectable.
Historically, the term recurrent miscarriages refers to 2–3 consecutive pregnancy losses before 20 weeks, with a frequency of 1 in 300 pregnancies and affecting 1%–2% of women of reproductive age. Although the guideline suggests performing the relevant evaluation after the third miscarriage, in practice it is often necessary even after the first one, depending on the case.
The evaluation for recurrent miscarriages includes a detailed medical history, clinical and ultrasound examination, as well as chromosomal and specific histopathological examination of the miscarriage tissue, which may reveal findings associated with specific causes of miscarriages.
(e.g., immunological, thrombophilic) and guide further laboratory testing.
The etiology of recurrent miscarriages is usually multifactorial and includes genetic causes, anatomical abnormalities of the uterus, endocrine disorders, immune causes, thrombophilic disorders, infections, environmental factors, and unknown causes.
Approximately 2%–4% of recurrent miscarriages are associated with balanced chromosomal abnormalities in the parents. Depending on the specific diagnosis (parental karyotype), the treatment/management may include in vitro fertilization (IVF) with preimplantation genetic testing.
10%–15% of recurrent miscarriages are linked to uterine anatomical abnormalities, diagnosed through hysterosalpingography or hysteroscopy, and the treatment/management is surgical.
Approximately 17%–20% of recurrent miscarriages are associated with endocrine factors (e.g., diabetes mellitus, thyroid disorders, etc.), diagnosed through specific laboratory tests, and managed with medication.
Pregnancy represents an “immunological paradox,” since although the fetus is not genetically identical to the mother, she does not reject it but protects it through complex immunological mechanisms. Possible abnormalities in these mechanisms are related to single or recurrent miscarriages. Diagnosis is carried out with blood tests and specific examination of the miscarriage tissue, many of which are treatable, improving the live birth outcomes.
Thrombophilia is classified into inherited (15% of the population) and acquired, or a combination of both.
Diagnosis is performed through specialized blood tests, and treatment is pharmacological.
Certain infections (toxoplasmosis, rubella, etc.) have been associated with single miscarriages and essentially not with recurrent miscarriages (0.2%–0.5%).
At times, single or recurrent miscarriages have been linked to exposure to various harmful factors. In any case, pregnant women should avoid smoking, alcohol, and caffeine.
20%–30% of recurrent miscarriages remain unexplained and are treated empirically.
Η prognosis for recurrent miscarriages is individualized and depends on the causes and the number of miscarriages. Overall, it is encouraging, considering that even after four consecutive miscarriages, the probability of a successful pregnancy is 60%–65%.
It is also worth noting that several causes of recurrent miscarriages — particularly those related to early miscarriage — may be associated with infertility and failed assisted reproduction attempts. In the context of investigating and treating infertility, histopathological examination of an endometrial biopsy, collected during diagnostic hysteroscopy, can play an important role.
Finally, it should be emphasized that both recurrent miscarriage cases and infertility cases involve multiple medical specialties, with one sole purpose, to help these truly burdened couples achieve a healthy baby!
