Treatments
Screening and treatment for genetic problems
You and your partner will be offered a blood test to check for chromosome
abnormalities; the test is known as karyotyping. If either or both of you turn out to have an abnormality you will be offered the chance to see a specialist clinical geneticist. They will tell you what your chances are for future pregnancies and will explain what your choices are (including IVF treatment with pre-implantation genetic diagnosis).
It can help you decide what you want to do for the future. If it seems likely that other members of your family could be affected by the same problem, they too may be offered genetic counselling.
Screening for abnormalities in the embryo
If you have a history of recurrent pregnancy loss and you lose your next baby, your doctors may suggest checking for abnormalities in the embryo or the placenta afterwards. They will do this by checking the chromosomes of the embryo through karyotyping, although it may not always possible to get a result depending on the stage at which miscarriage happened. They may also request examination of the placenta through a microscope. The results of these tests will help identify any abnormalities and the appropriate next management steps.
Treatment for anti-phospholipid antibodies
There is evidence that if you have anti-phospholipid antibodies and a history of
recurrent pregnancy loss, treatment with low-dose aspirin tablets and low-dose
heparin injections in the early part of your pregnancy may improve your chances of a live birth up to about seven in ten (compared to around four in ten if you take aspirin alone and just one in ten if you have no treatment).
Even with treatment, you will have a slightly increased risk of some problems during
pregnancy (including pre-eclampsia, restriction in the baby’s growth and premature
birth). You will need to be carefully monitored during pregnancy so that you can be
offered appropriate treatment for any problems that arise.
Screening and treatment for abnormalities in the structure of your womb
You will be offered a pelvic ultrasound scan to check for and assess any
abnormalities in the structure of your womb or scarring inside the womb cavity, so
that they can be surgically treated if necessary, using a technique called
hysteroscopy.
Treatment for a weak cervix
If you have a weak cervix, a vaginal ultrasound scan to measure the shape and
length of the neck of the womb during your pregnancy may indicate whether you are
likely to miscarry.
If you have a weak cervix you may be offered an operation to put a stitch in your
cervix, to make sure it stays closed. It is usually done through the vagina, but
occasionally it may be done through a ‘bikini line’ cut in your abdomen, just above
the line of the pubic hair. Because all operations involve some risk, the doctors will
only suggest this if you and your baby are likely to benefit. They will discuss the risks
and benefits with you.
Screening and treatment for vaginal infections
If you have had pregnancy loss in the fourth to sixth month of pregnancy or if you
have a history of going into labour prematurely, you will be offered tests (and
treatment if necessary) for an infection known as bacterial vaginosis (BV).
If you have BV, treatment with antibiotics may help to reduce the risks of losing your
baby or of premature birth.
Treatment for thrombophilia/blood clotting problems.
Treatment for thrombophilia/blood clotting problems
Treatment for thrombophilia/blood clotting problems
A combination of low-dose aspirin tablets plus low molecular weight heparin injections is used to treat the inherited thrombophilias. The therapy starts as soon as pregnancy occurs and continues four to six weeks after birth. High dose folic acid supplementation is recommended to patients with MTHFR gene mutations.
Hormone Treatments
We certainly recommend empirical progesterone treatment in early pregnancy as
there is some evidence that it could help prevent a pregnancy loss. Although evidence is conflicting, metformin may be continued throughout the first trimester of pregnancy in women with PCOS who have experienced previous miscarriage. It is also very important that your thyroid hormone levels are optimized during pregnancy. We may suggest that you take a small dose of thyroxine to reduce your risk of miscarriage based on your blood test results.