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What causes Early Miscarriages at 6-8 weeks?

Miscarriages are common and often, unpreventable. Loss of pregnancy before 12 weeks is an early miscarriage and it happens in around 10% of all pregnancies. If you’ve experienced multiple miscarriages soon after conceiving without any logical explanation, it must be very frustrating. So, what causes early miscarriages at 6-8 weeks?

Normally, the early miscarriages are blamed on chromosomal abnormalities that result in the arrest of embryo growth and while that may be correct in some situations, it is not so for all. Miscarriages are caused by various factors at different times in the pregnancy and not knowing the reason can be frustrating.

To check the embryos for any aneuploidy (chromosomal imbalance), the doctors recommend preimplantation genetic testing for aneuploidy (PGT-A) before embryo implantation. While it has proven highly useful, this technique is not always accurate because the cells that are tested do not always represent the whole embryo.

The placenta and its precursor (the trophectoderm) tend to have more aneuploid cells and those are the ones tested with PGT-A.  So, sometimes, despite being declared aneuploid by PGS testing, an embryo turns into a perfectly normal baby.

Chromosomal abnormalities of the embryo remain the most common cost of pregnancy losses in women but what else could be the reason of early miscarriages? Read below:

Less common reason for early miscarriages at 6-8 weeks:

Hyperactive immune system

An embryo comprises genetic material from both the father and the mother, which means that genetically it is always 50% foreign to the mother’s body and her immune system. In normal situations, during a pregnancy the immune system is reprogrammed to accept this embryo.

However, if your immune system is hyper-active or you have auto-immune diseases, the body may perceive the embryo as a foreign entity and the attack it. This results in embryo implantation problems, clinical pregnancies, and early miscarriages.

Maternal immunity problems are the most common cause of early miscarriages, after chromosomal abnormalities in the embryo.

Other causes of early miscarriages at 6 weeks to 8 weeks

Other than chromosomal and immunologic reasons, there are also other causes of early miscarriages including:

1.     Anatomical abnormalities of the uterus

Uterine malformations can cause recurrent miscarriages if they remain undetected. A study published in the Journal Human Reproduction found that more than 65% of the women with septate uterus ended up having a miscarriage. Similarly, a bicornuate, unicornuate, didelphic, T-shaped, or tipped uterus can all cause early miscarriages. If you have large fibroids, your doctor may recommend removing them to allow for a safe pregnancy.

Not all fibroids need removal. A fibroid’s potential of causing miscarriage depends upon its location within your uterus.

2.     Infections

Around 15% of all early miscarriages are caused by infections of some kind. Bacterial vaginosis (imbalance of vagina’s normal bacteria), HIV (human immunodeficiency virus), Gonorrhea, and cytomegalovirus (CMV) were all found to increase the risk of miscarriage.

3.     Uncontrolled diabetes or high blood pressure

1,228 women with at least one previous miscarriage were examined. During the study, 797 women became pregnant and 188 or about 24 percent again suffered loss of pregnancy.

Even if they achieved normal blood pressure before the pregnancy, each 10 mm increase in systolic blood pressure was found to cause an 8 percent higher risk of miscarriage and each 10mm increase in diastolic blood pressure showed an 18 percent increased risk of miscarriage.

4.     Thyroid disease

Hypothyroidism and raised TSH levels increase the chances of miscarriage in early pregnancy. TSH levels higher than 4.5 mU/L are associated with a greater risk of early miscarriage.

5.     Blood clotting

Having genetic or hereditary thrombophilia raises your predisposition to blood clotting. Blood clots that develop in the placenta increase the risk of miscarriage and fetal loss. Some doctors advise all patients seeking IVF to test for “antiphospholipid syndrome,” so in case, it exists, it can be managed with medications for better chances of a successful pregnancy.

6.     Medications

Medicines like Misoprostol, Methotrexate, retinoids, and some NSAIDS are harmful to pregnancy and may cause an early miscarriage. Never take any over-the-counter medication without your doctor’s advice during pregnancy.

7.     Food poisoning

It will not always be the reason for miscarriage but some cases of food poisoning may be lethal for the growing embryo. Listeria, a bacteria that is sometimes found in soft, unpasteurized cheeses and other uncooked foods may cause miscarriage. Besides, undercooked eggs, raw meat may cause Salmonella, Toxoplasmosis, which can result in a miscarriage.

8.     Environmental causes

Excessive exposure to harmful chemicals such as Lead, Arsenic, Mercury, pesticides, etc. may raise your risk of miscarriage. Be sure to discuss with your doctor to understand if your environment may be responsible for miscarriages.

While any of the above may be responsible for an early miscarriage at 6-8 weeks, the most common reasons for miscarriages are either chromosomal abnormalities in the embryo or immunologic problems in the mother.

If miscarriage is a concern, the doctors usually advise to do Karyotype testing in both parents to check the size, shape, and number of your chromosomes. If it comes out normal [normal female (45, XX) and normal male (46, XY)], the mother must be evaluated for immunological issues.

After a miscarriage happens, the doctor may also advise to test the products of conception (the fetus, placenta, and other pregnancy tissues) to check for chromosomal abnormalities.

If everything is normal, the maternal immune response and other causes must be evaluated before attempting a pregnancy again.

If you find the reason for your early miscarriage, it may be avoided. Consult with our top fertility specialists for early miscarriages and pregnancy problems.

Resources:

Gleicher, N., Vidali, A., Braverman, J., Kushnir, V. A., Barad, D. H., Hudson, C., Wu, Y. G., Wang, Q., Zhang, L., Albertini, D. F., & International PGS Consortium Study Group (2016). Accuracy of preimplantation genetic screening (PGS) is compromised by degree of mosaicism of human embryos. Reproductive biology and endocrinology: RB&E, 14(1), 54. https://doi.org/10.1186/s12958-016-0193-6

Tullio Ghi, Francesca De Musso, Elisa Maroni, Aly Youssef, Luca Savelli, Antonio Farina, Paolo Casadio, Marco Filicori, Gianluigi Pilu, Nicola Rizzo, The pregnancy outcome in women with incidental diagnosis of septate uterus at first trimester scan, Human Reproduction, Volume 27, Issue 9, September 2012, Pages 2671–2675, https://doi. org/10.1093/humrep/des215

Sevi Giakoumelou, Nick Wheelhouse, Kate Cuschieri, Gary Entrican, Sarah E.M. Howie, Andrew W. Horne, The role of infection in miscarriage, Human Reproduction Update, Volume 22, Issue 1, January/February 2016, Pages 116–133, https://doi.org/10.1093/humupd/dmv041

Preconception Blood Pressure Levels and Reproductive Outcomes in a Prospective Cohort of Women Attempting Pregnancy https://doi.org/10.1161/HYPERTENSIONAHA.117.10705

Thyroid Status and Risk of Miscarriage: https://www.thyroid.org/patient-thyroid-information/ct-for-patients/volume-7-issue-12/vol-7-issue-12-p-3

Miscarriage, how to avoid - Planning and management of pregnancy in the gynecology of the Literary Fund polyclinic after a miscarriage

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A miscarriage is always associated with severe consequences for the whole body of a woman and for her reproductive organs in particular, it also affects the family situation, disrupts the woman's work schedule. An unfavorable outcome of pregnancy requires great mental and physical costs on the part of parents. Therefore, contacting doctors to find out the causes of the problem is the very first and correct step towards the birth of a child.

Any competent gynecologist will tell you that the problem of miscarriage can be solved. With proper preparation for pregnancy and its management, the next time you will have a successful pregnancy. Most girls after a miscarriage go to extremes: they try to get pregnant again as soon as possible. And if this succeeds, then the miscarriage is very often repeated. And you need to give the body a rest for 2-3 months, then identify and eliminate the cause. And only then try.

Causes of miscarriage

Many are convinced that miscarriages are due to a fall, bruise, or some other physical shock. Any woman who has had a miscarriage can remember that not long before she either fell or lifted something heavy. And I am sure that she lost her unborn child precisely because of this. However, those women whose pregnancy was normal also fall and lift heavy things. Most sudden miscarriages do not occur for this reason. The reason is in violations of the pregnancy itself. Approximately half of miscarriages are due to abnormal genetic development of the fetus, which can be hereditary or accidental. Merciful nature, following the principles of natural selection in everything, destroys the defective and unviable fetus. But you should not be afraid of this. The fact that there is a defect in one embryo does not mean at all that all the others will be the same.

The woman's body is almost always to blame for the other half of miscarriages. They are caused by various known and unknown factors, such as: acute infectious diseases suffered in the first trimester of pregnancy, poor environment or difficult working conditions, excessive psychological or physical stress, abnormal development of the uterus, radiation, alcohol, smoking and certain types of drugs.

The causes of early and late miscarriage may differ, although they may overlap. The most important thing is to find out and eliminate or compensate for your own cause of miscarriage. Having discovered the cause, the gynecologist will tell you how to avoid another loss.

Miscarriage

Miscarriage statistics also include “missed pregnancy”. Sometimes it happens that the embryo dies and lingers in the uterine cavity. Most often, this fact is detected by ultrasound. The dead fetus may begin to decompose, and this, thereby, will lead to poisoning of the mother's body.

Doctors resort to surgical curettage, which is associated with a risk of inflammation and complications. With such a miscarriage, the next pregnancy is planned after the body is fully restored - not earlier than a year. During this year, you will have to find out the cause of the missed pregnancy and treat it.

Miscarriage up to 6 weeks

The main causes of miscarriage on this line are malformations of the embryo itself. Statistics say that from 70-90% of embryos had chromosomal abnormalities: they are random and will not occur in other pregnancies. You may have been ill, taken medication, or were under the influence of other harmful factors. Fate saved you from a child with malformations.

The human body is perfect and finds a way to correct the situation by miscarriage. Today is a tragedy for you. The real tragedy would be the preservation and birth of a sick, non-viable child. So don’t cry and understand: everything is for the best, you won’t help grief with tears ... And after three months, try again - it will almost certainly turn out to be successful.

It should also be noted that the fact of a miscarriage does not mean that you have lost something. So for a period of 7-8 weeks, the absence of an embryo in the fetal egg is found - "anembryony". It is believed that in 80-90% of cases, miscarriages are undiagnosed non-developing pregnancies.

Miscarriage between 6 and 12 weeks

Miscarriage in this period is also considered early. Its most common causes are:

Endocrine disorders

Endocrine disorders, when the ovaries do not synthesize enough hormones to keep the fetus in the womb, or the amount of male sex hormones is increased, is one of the most common causes of miscarriage and miscarriage.

Imbalance of hormones in a woman's body is very likely to lead to an early termination of pregnancy. With a lack of the main hormone progesterone produced by the ovaries, this happens most often. Another hormonal problem is an increase in the tone of the uterus, which provokes the expulsion of the fetus.

Progesterone prepares the uterine mucosa for implantation and is the hormone for maintaining pregnancy in the first months. If conception occurs, the fetus cannot properly establish itself in the uterus. As a result, the fertilized egg is rejected. But pregnancy can be saved with the help of progesterone preparations if this problem is detected in time.

An excess of male sex hormones that suppress the production of estrogen and progesterone can also be the cause of an early miscarriage. Often, the cause of recurrent miscarriages are androgens that affect the formation and development of pregnancy; as well as thyroid and adrenal hormones. Therefore, a change in the function of these glands can lead to miscarriage.

Undertreated sexual infections

This problem must be solved before conception. Often the cause of miscarriage is sexually transmitted infections: syphilis, trichomoniasis, toxoplasmosis, chlamydia, cytomegalovirus and herpetic infections. Their effect on the fetus and the course of pregnancy is different for each woman and depends on the timing of infection, the activity of the microorganism, the degree of immune protection and the presence of other adverse factors. Depending on the situation, they can lead to the formation of fetal malformations, intrauterine infection, feto-placental insufficiency, early miscarriage or premature birth. Infection of the fetus and damage to the membrane of the fetus leads to miscarriage. To avoid this, infections should be treated before pregnancy. The use of therapy is possible during pregnancy as prescribed by a doctor.

Viral infections and other diseases

Any disease accompanied by intoxication and fever above 38 ^about C can lead to a miscarriage. Rubella, influenza and viral hepatitis occupy a leading position in this list. At a period of 4-10 weeks for pregnancy, ordinary tonsillitis can also become tragic, pneumonia carries a more serious risk. Pyelonephritis and appendicitis can cause early labor. When planning a pregnancy, it is imperative to undergo a medical examination in order to identify and treat foci of infections.

Extremely dangerous during pregnancy rubella - it leads to severe fetal malformations, so infection during pregnancy is an indication for medical abortion.

Any disease during pregnancy can lead to non-viability of the fetus. And the body, through a miscarriage, insures you against unwanted offspring. With such a miscarriage, the next pregnancy has every chance of going well.

Immune causes of miscarriage

Sometimes antibodies that are hostile to the fetus are formed in the blood of a pregnant woman. This cause can be predicted and eliminated in advance. Most often, the conflict occurs when the embryo inherits the positive Rh factor of the father, and the negative Rh factor, the mother's body rejects the embryonic tissues that are alien to it. Constant monitoring of antibody titer and the introduction of anti-Rhesus immunoglobulins allows you to maintain and maintain pregnancy. In case of an immune conflict, progesterone preparations are also used to prevent miscarriage, which in this case has an immunomodulatory effect.

Reduced immunity

Reduced immunity during pregnancy also refers to immune causes. The body is simply not able to grow a new life in itself. You need to take care of yourself and recover before the next conception.

Anatomical causes of miscarriage

Anatomical causes of miscarriage are the most intractable. Malformations of the uterus are a serious reason for miscarriage. Sometimes you just have to deal with it.

Miscarriage between 12 and 22 weeks

Such a miscarriage is considered late. Its causes coincide with the causes of miscarriages in the early stages (anatomical, immune, infectious, endocrine).

At this time, miscarriage also occurs due to isthmic-cervical insufficiency - a weak cervix cannot hold the fetus and opens. For this reason, a miscarriage can occur in the 2nd or 3rd trimester. Isthmic-cervical insufficiency is observed in 15.0-42.7% of women suffering from miscarriage. Careful monitoring of the pregnant woman allows you to identify the problem in time and make surgical correction of the cervix before the onset of childbirth.

In isthmic-cervical insufficiency, there is only one method of treatment - mechanical narrowing of the cervical canal. To do this, the neck is either sewn up or a special ring is put on it. However, the latter method is less efficient, because the ring can easily slide off the neck, then it will no longer hold back the process of opening it.

After suturing, if necessary, it is possible to use antibiotics and drugs that normalize the microflora of the vagina. The treatment of the vagina and the control of the state of the seams are carried out daily for 5 days. Stitches are removed at 37-38 weeks and with premature onset of labor.

Isthmic-cervical insufficiency may be primary (for no apparent reason), may be the result of abortion or hormonal disorders (increased levels of androgens - male sex hormones or their precursors).

Miscarriage after 22 weeks

Such a loss is hard to forget. Obstetricians talk about premature birth after the 28th week of pregnancy. Traditionally, a child born after this period is considered viable. But medicine knows many cases when it was possible to save the life of earlier children.

We recommend that you be carefully examined for miscarriage, check the above factors. In addition to them, the cause of a miscarriage can be antiphospholipid syndrome, while the woman's body perceives the child as something alien and rejects it. This disease, like the others listed, can be corrected; you have a very real chance of bearing a child.

Miscarriages due to hemostasis disorders

All of the above causes account for only 30-40%. Up to 70% of miscarriages are caused by disorders in the blood coagulation system (hemostasis).

Blood coagulation disorders leading to pregnancy loss can be divided into thrombophilic (increased clotting) and hemorrhagic (bleeding tendencies). Both of these extremes are dangerous to the fetus. Various disorders leading to the formation of small blood clots lead to the fact that the fetus loses sufficient blood supply, development is disturbed and the fetus is rejected.

The main hemorrhagic changes can appear even in childhood in the form of increased bleeding during cuts, tooth extractions, the onset of menstruation. But sometimes they declare themselves only during pregnancy and are the cause of a miscarriage. Bleeding in the early stages and detachment of the chorion is difficult to stop.

You may not guess, but incomprehensible headaches, weakness, fatigue, temporary loss of smell or hearing may be symptoms of disorders in the blood coagulation system.

When planning a pregnancy, a genetic examination should be carried out and, if necessary, treatment should be started.

It is advisable to be examined for hidden hemostasis defects even for those who consider themselves healthy. This will allow you to predict the occurrence of complications and prevent loss. Early therapy can prevent miscarriage at 98% of cases. If defects in hemostasis are already detected during pregnancy, it can be difficult to maintain it.

What to do after a miscarriage?

Find the cause! The ideal option is to be examined by future parents: it is much more reasonable to postpone conception and spend two or three months to identify the causes than to risk getting pregnant again, spend two months waiting, and then lose everything again and still go to the doctors.

Until you understand the reason, it will not evaporate. In most cases, the answers lie on the surface. Take care of your health and your future baby.

Sign up for a consultation with an obstetrician-gynecologist by phone +7 (495) 150-60-01

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Spontaneous miscarriage and miscarriage

Over the past 10 years, the number of spontaneous miscarriages has been growing rapidly. The International Histological Classification Organization (FIGO) has declared an epidemic of the situation with an increase in the frequency of miscarriages.

Spontaneous miscarriage is the termination of pregnancy before the fetus reaches a viable term (up to 22 weeks of pregnancy and fetal weight 500g.).
Most miscarriages (about 80%) occur before 12 weeks of gestation. Moreover, in the early stages up to 8 weeks of pregnancy, the cause of miscarriage is chromosomal abnormalities in 50% of cases. It turns out that nature eliminates the defective product of conception. And these causes are difficult to prevent, especially in the presence of hereditary diseases. Fortunately, accidental breakdowns are much more common than genetically determined ones. Therefore, subsequent pregnancies usually end happily. But the remaining 50% of miscarriages have completely real and removable causes. They can be easily identified at the stage of preparation for pregnancy by a gynecologist.

What are the reasons?

- chronic diseases: inflammatory diseases of the uterus and appendages, polycystic ovary syndrome, uterine fibroids, endometriosis, malformations of the genital organs.
- infections: toxoplasmosis, listeriosis, genital tuberculosis, sexual infections - chlamydia, mycoplasma, ureaplasma, syphilis.
- antiphospholipid syndrome.
- endocrine diseases: diabetes, thyroid disease.
- metabolic disorders in the body: obesity, folic acid deficiency, iron deficiency, vitamin D deficiency.
- male factor.
Of course, these causes are identified and eliminated before the planned conception.

There are harmful factors that can affect the development of the fetus in the early stages of pregnancy and lead to miscarriage:

- alcohol consumption.
- use of caffeine (4-5 cups of coffee per day).
- smoking (more than 10 cigarettes per day).
- drug use.
- taking medications with a teratogenic effect (for example: aspirin, nise and others from this group of drugs; antifungals; antidepressants; some antibiotics and a number of other drugs).
- toxins and occupational hazards: ionizing radiation, pesticides, inhalation of anesthetic gases.

What are the signs of possible pregnancy loss?

These are complaints of pain in the lower abdomen and lower back, bloody discharge from the genital tract. It is necessary to consult a doctor to rule out an ectopic pregnancy and conduct an additional examination (hCG test, blood test for progesterone, ultrasound).
In early pregnancy, with dubious ultrasound data or suspected non-developing (missing) pregnancy, expectant management is chosen with a repetition of a gynecologist's examination, ultrasound, tests after 7-10 days. If a the diagnosis was made and the fact of uterine pregnancy was confirmed, with a threatened miscarriage, preservation therapy is carried out in an outpatient day hospital. A miscarriage that has begun requires hospitalization in the gynecological department. In the case of a non-developing pregnancy, an abortion is performed.

In accordance with the clinical treatment protocol approved by the Ministry of Health of the Russian Federation dated 07.06.2016. Preference is given to drug therapy aimed at terminating pregnancy with prostaglandin analogues (misoprostol) with or without prior use of an antiprogestin (mifepristone). In case of need for surgical treatment (with incomplete miscarriage with infected miscarriage), it is recommended to use aspiration curettage (with an electric vacuum source or a manual vacuum aspirator). What has a significant advantage over curettage of the uterine cavity because it is less traumatic and can be performed on an outpatient basis.

All women who have had a miscarriage need treatment to prevent complications and prevent recurrent miscarriages. Why is rehabilitation therapy necessary?

According to the decision of the XVIII World Congress of Obstetricians and Gynecologists , the diagnosis of chronic endometritis should be made to absolutely all women who have had an undeveloped pregnancy. Two out of three miscarriages according to Professor V.E. Radzinsky are caused by this disease. When examining the material from the uterine cavity, infectious pathogens were isolated: ureaplasmas, mycoplasmas, streptococci, staphylococci, Escherichia coli, viruses (herpes, HPV). Therefore, it is very important to carry out treatment immediately after the termination of pregnancy.
If time is lost, it is necessary to carry out additional diagnostics: a pipel biopsy of the endometrium with a histological examination and a study for infections, including tuberculosis. Then, taking into account the results obtained, symptomatic anti-inflammatory therapy is carried out (immunomodulators, antibacterial drugs, physiotherapy, gynecological massage, mud therapy). In parallel, an examination is prescribed to identify other causes of miscarriage (male factor, chronic maternal diseases, genital infections, antiphospholipid syndrome).
In the medical center "Mifra-Med" at the level of modern requirements of medicine, all the possibilities of a complete adequate examination have been created: all types of tests, ultrasound, hysteroscopy, aspiration biopsy, consultations of narrow specialists (endocrinologist, therapist, neurologist, urologist).

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