Recurrent Pregnancy Loss > Cause > Anatomic

Uterine Anomalies

Abnormalities in the shape of the uterus must be excluded. This is the most commonly identified cause of recurrent pregnancy loss. When the uterus is abnormal, the chances of miscarriage are significantly increased. Much of this is probably due to the fact that there is not a good blood supply to the abnormal uterine tissue. If the placenta begins to grow on this tissue, it cannot get the blood supply it needs to survive. Uterine anomalies can be diagnosed by a hystero-salpingogram or by hysteroscopy. Surgical correction of a uterine abnormality dramatically improves the chances of a successful pregnancy.

Another type of anatomic problem that can result in recurrent loss is an incompetent cervix. It is the responsibility of the cervix to stay shut and hold the pregnancy in the uterus until it is time to deliver. In some individuals, the cervix just does not form quite properly, and in others it malfunctions as a result of prior surgery or manipulation. An incompetent cervix usually presents with a relatively painless dilation of the cervix and premature delivery in the second trimester. An incompetent cervix can be diagnosed by history, X-ray and other simple procedures.

Incompetent cervix can be treated with a minor surgical procedure called a cervical cerclage. In this procedure a "purse-string" suture is placed around the cervix, in essence, sewing it shut. We do two stitch cervical cerclages, placing two seperate sutures around the cervix rather than just one. Cerclages can be placed once we have reasonable assurance that the pregnancy is normal. In the past, teaching was that we should wait until about fourteen weeks of pregnancy to place the cerclage. However, with the use of ultrasound and the ability to document normlacy of the pregnancy at a much earlier stage, cerclages can be placed at about nine to ten weeks of gestation. The cervix is typically long at this point, allowing easier placement of the cerclage sutures.

© 2005 Jarrett Fertility Group