Miscarriage: Why does it happen and how to avoid it?

Many gynecologists say that the number of miscarriages among Armenians has recently increased. The correspondent of NEWS.am Medicine tried to find out the most common causes of miscarriages and learn how to avoid them.

The head of the women's consultation in the medical center "Malatia", gynecologist, PhD Inna Persoyan thinks that it is not the number of miscarriages that has increased, but the number of women who inform the doctors on this issue. Not so long ago, miscarriages took place at home, and women applied to doctors only in case of severe bleedings; now they visit doctors more frequently.

The most common causes of miscarriages

According to Inna Persoyan, Armenian doctors are now able to diagnose more causes of miscarriages than before. Several years ago the emphasis was made on sexually transmitted infections only, while now much attention is paid to many other causes, including genetic problems like genetic thrombophilia. Thanks to correctly defined causes of miscarriages, appropriate treatment is carried out and the following pregnancies are full-term.

According to doctor Persoyan, the causes of miscarriage can be different:

1. Sexually transmitted diseases (STD)

STD are rather widespread in Armenia and are among the main causes of miscarriages or infertility. It is interesting that, according to doctor Persoyan, several years ago most infertile women had chlamydial infections, but now ureaplasma, human papillomavirus, herpes and cytomegalovirus are more common.

“Cytomegalovirus is also transmitted through the air, and it is especially dangerous when a woman gets it during pregnancy. If she gets infected in the first trimester of pregnancy, the virus can heavily harm the child (fetal deformity can develop),” Persoyan said.

2. Genetic thrombophilia

According to Persoyan, genetic thrombophilia is quite common in Armenia and can also cause a miscarriage.

“Pregnant women have stronger blood clotting, which achieves its peak at the end of pregnancy, so that the woman does not die from bleeding during labor,” doctor Persoyan says. “To explain everything in simple and comprehensible language, there are gene mutations, which are responsible for blood clotting. In women with such genes the clotting increases in the very beginning of pregnancy, forming microtrombs in vessels and blocking the blood supply to fetus, and the fetus dies.”

Doctors find such a problem in most women with a history of more than one miscarriages and stillborn fetuses.

3. Anatomical defects of genitals

Any abnormal development of the genital organs (like intrauterine septum) can also cause miscarriages.

4. Small intervals between two pregnancies 

Some doctors believe that the extremely small interval between two pregnancies (less than two years) can also cause a miscarriage. Inna Persoyan said that may be true, but she saw many women who became pregnant soon after the birth of the first child and had a normal, full-term pregnancy.

5. Physical overload and stress

This factor must also be taken into consideration, since many miscarriages happen after stress and physical overload. But the thing is – this does not happen to everyone.

Inna Persoyan said that even if a woman thinks that her miscarriage was due to stress or physical overload, she still needs to undergo medical examination and find out if she has any other problems, too.

6. Rhesus conflict

The majority of people (about 85%) have rhesus-positive blood. This means, that it contains Rh protein on the surface of erythrocytes. Its presence is inherited genetically. This protein is absent in a small part of the population, which is called rhesus-negative. The absence of the rhesus factor does not influence on people's health. But the incompatibility of Rh-negative mother's blood type and Rh-positive fetal blood (child can inherit the Rh factor from the father) may lead to Rh conflict.

7. Unhealthy lifestyle

“Smoking, drugs and alcohol are also risk factors, so pregnant women should stop using these things. However, I believe that it is necessary to lead a healthy lifestyle even before pregnancy, too,” doctor Persoyan said.

According to her, her smoking patients quit smoking when they learn about their pregnancy, but the problem is that the child is conceived long before the woman becomes aware of her pregnancy. “Moreover, the egg cell that has become fertilized this month was founded in the ovaries of the woman when she was still in the womb of her mother,” doctor Persoyan said and then explained that for this reason, an unhealthy lifestyle, even if it was in the past, can affect the health of women and their unborn children.

8. Hormonal problems

Miscarriages may have also hormonal causes: for example, if there’s a lack of progesterone, the pregnant woman has intake progesterone so not to face a miscarriage.

High levels of male sex hormones are also possible, which is quite widespread among Armenian women.

9. Unknown reasons

According to Inna Persoyan, sometimes a woman who had misscarriage is fully examined but the cause of her miscarriage is not found.

How to avoid miscarriages?

“It is necessary to take the pregnancy and parenthood seriously. I always tell my patients that they should not just become pregnant –  such an important event should be approached seriously,” Inna Persoyan said.

3-4 months prior to conception, it is desirable to be tested for all possible infections and get treatment if necessary. It is also advisable to take vitamins and keep the right lifestyle, giving up smoking and alcohol.

If a woman has a genetic predisposition to thrombophilia, as was described above, it is necessary to obtain appropriate treatment both before pregnancy and during it. The father of the unborn child should also be treated, since half of his/her genes the child gets from the father. “Against the background of this treatment and thanks to this knowledge, we successfully completed a lot of pregnancies,” doctor Persoyan said.

The only problem is that screening and tests are very expensive, and not everyone can afford them. In addition, medications for the treatment are often also rather expensive for Armenian people and their prices continue to rise. However, this is a separate issue, and we will discuss it later.

Amalya Gabrielyan

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