Question

I am 29 years old and have had 4 miscarriages. I first got pregnant right off of the pill and carried until week 13.5 in April 2007. In September 2007 I was pregnant again, on baby aspirin, and m/c at 7.5 weeks. In December 2007 I was pregnant again and m/c at 5 weeks. Then I had an hsg and everything was normal. All the babies were normal. I have seen a specialist who did every blood test including fasting insulin, thyroid, lupus, antiphospolid, etc. and I am normal. The specialist then put me on estridol and progesterone right when I ovulated and I was monitered the first week of pregnancy June 2008. I m/c again at 7.5 weeks July 2008.

Each time I miscarried I had a D&C. Why did I carry the first one so much longer than the other 3? Was it due to coming off of birth control? Could I have a scarred uterus? The Dr. wants me on Heparin next time. Your suggestions and thoughts would be most appreciated.

Keri

Answer

Dear Keri,

It sounds like you have had a relatively complete evaluation. Heparin would be used if your doctor suspected the antiphospholipid syndrome.

In general, the antiphospholipid syndrome causes miscarriage after 10 weeks of gestation. This and the fact that your blood tests are negative make it less likely a diagnosis in your case. It is important to note that the blood tests can be normal when a woman is not pregnant and be abnormal when she is pregnant.

I think you need further evaluation. You should see a doctor familiar with NaProTechnology. This provider can do a full cycle hormone evaluation. It may be that you have a luteal phase progesterone defect that could be treated before you conceive the next time. See www.naprotechnology.com for more information.

Another thing you might consider if you miscarry again is to avoid a D&C. Multiple D&Cs can lead to cervical damage which can lead to preterm births in subsequent pregnancies. Alternatives to D&C are expectant management and medical management with misoprostol.

Wishing you the best,

George Delgado, M.D., F.A.A.F.P.
Culture of Life Family Health Care
Voluntary Associate Clinical Professor
Department of Family and Preventive Medicine
School of Medicine, University of California, San Diego

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