Does a mmc have different causes?

[escapeartist]

I had a mmc in my 9th week (first pregnancy) earlier this week. I have been up and down and still feeling really raw - in fact I think I might be feeling worse now than I did when I found out...

Anyway, I guess as part of the healing process I have been trying to find out why this has happened. Of course, getting answers is not easy and I don't expect anyone on MN to be able to tell me... BUT MN seems to have a lot of very knowledgable people, most of whom have learned the very hard way.

Would it make sense that a mmc is more likely caused by chromosomal abnormalities rather than an immune reaction? Does the fact that my body retained the tissue/did not expel mean that it's not likely a uterus abnormality or hormonal?

Any ideas much welcome. Thanks for taking time to read and sending lots of strength to all of you.

Hello,
I am intrigued to see the answers to this as I am waiting/trying to miscarry as I have a 6 week sac instead of a 10 week baby. I don't have any answers......

I like to think the fact that I still haven't miscarried does have some positives - firstly I could get pregnant and secondly my body can hold on to it. (At the moment, I wish my body would let it go, so I can start to move on.)

I too am going through the up's and down's that you are. I am just hoping that the up's will increase with time and the down's will get let frequent. Having said that I saw to the MIL yesterday who miscarried a few times before she had my lovely DH and I think it is one of those things that stays with you forever but the pain gets less. x x

escapeartist so sorry for your loss. I am also tyring to negotiate the minefiled that is working out whatever it is that is going on.

Sadly I've had three miscarriages - one pregnancy which didn't progress and which didn't bleed out, the second a MMC and a third a very early MMC. I am intrigued to find out if there are particulare reasons for MMC, but no-one seems to know :(

I'm kind of assuming MMC is more likely to be due to clotting (have assumed not enough oxygen in the womb) whereas the body might expel a chromosomally abnormal fetus itself? not sure really

I was told when I had a MMC last year that the causes are various and often can't be determined. I had an ERPC and an examination of what was removed, but there wasn't any reason for the MMC that they could detect and I was just told to and try again. I'm now 35 weeks pg with my 2nd DC.

congratulations juneau I've been told most likely chromosomes and very bad luck that it's three in a row, and the consultant has said less likely to be chromosomals or age when it's three in a row

Sorry, that wasn't clear.

The GP says it could be chromosomes (at my age fetuses with chromosome issues are more prevalent)

But Consultant says less likely to be chromosomes as it was three in a row (recurrent mc more likely to be other causes)

all very confusing.

I have been asking around/looking at medical journals (I am a geek...) and this is what I have found so far.

My close friend who is a medical examiner (pathologist) told me that a mmc is more likely to be chromosomal - the embryo stops developing yet the body does not expel it. She also mentioned that 8-10 weeks seems to be the time that it all happens, as it is the embryo that makes the placenta, if that makes sense... and if the embryo has a chromosomal anomaly the placenta does not develop. Not sure how correct that is, or even if I understood it correctly...

Secondly I have come across this: humrep.oxfordjournals.org/content/18/8/1724.full

I am not an MD, though I have studied both physiology and anatomy at Uni so have some understanding. To summarise the paper, again if I understand correctly, 93% of missed abortions looked at in this study (of 233 missed miscarriages) shows that there was a chromosomal abnormality. This is higher than the often quoted 60 to 70% for first trimester miscarriages. I guess... this suggests that mmc is more likely to be due to chromosomal abnormalities?! Anyone with more understanding/knowledge please correct me/confirm if you can.

Not to say that these chromosomal abnormalities are always a chance occurance - they are linked to advanced maternal age... (and in fact also paternal age, though less significantly so) as well as incompatible karyotypes in the couple.

Dizzy yet?? I am :)

hairylights I am sorry for your losses - it sounds like you have a team of professionals who will help you achieve a full term, happy pregnancy and I wish you best of luck in your quest for maternity :)

juneau your story and ones like yours bring a smile to my face. It is def hard going through a loss, but I'm sure it has made you appreciate your pg so much more. I hope you hold a happy and healthy baby in your arms soon. Thank you for sharing.

That's useful info.

Actually I'm afraid that I feel like the so called specialists are not on my side (I feel like my GP is doing the best she can) but would rather just fob me off - or that they actually are incapable of offering answers because they can't afford to do the testing I need :(

According to the study above, as I am 'advanced' in age and have had three recurrent MMCs essentially, I am guessing that it's chromosomal. But my consultant thinks not, and said that for it to be three in a row is unusual as it's only 1 in forty for all chromosomal defects at my age (and one in 60 for trisomy 21).

Thank you for that escape, that is very interesting. I had a mmc at 11 weeks but baby stopped developing at 8, plus I've had 1 successful pg so that all fits...thank you.

Hi
You might have already read it or seen it recommended by others, but I found Lesley Regan's book helpful -she goes thro the causes of mc and recurrent mc. To my knowledge, the causes aren't necessarily different for a spontaneous or complete mc compared to a mmc. I've had one of each, and it looks from tests that clotting is my problem, although of course that doesn't mean that there couldn't have been or continue to be other causes too (like chromosomal abnormalities etc.).

That's interesting escape. And I'm sorry for your loss. It sucks doesn't it

I hope you're able to try again and that your story has a happy ending soon.

After my mmc I wondered how common they were and it got me thinking about the difference between a spontaneous mc and a mmc. In part the difference is just timing of discovery. For example, my mmc was discovered by a scan at 10+5, the baby having passed around 9 weeks - making it a mmc. The mc itself happened at 11 weeks, and so if I hadn't been scanned that day, I would have had a mc not a mmc (I would never have known the baby had died 2 weeks before).

Its not relevant to the op question about what causes mmc, but I'd be interested to know if any research about the prevalence of the different types of mc has been done. The number of mmc would surely be highest in countries where they scan most often?

I found trying to understand the statistics was a big part of the healing process. For me personally I didn't need to know 'why' it had happened, I did believe that my body knew best, but more like what were the chances of it happening.

I have conceived after a mmc and very concerned as I have calculated my luteal phase as 9 days. Which is short of what it should be. (Should be 10-14 days)
Normally ladies with a short luteal phase battle ttc but i have luckily overcome that hurdle but now concerned as they say this can be a reason for a early mc / mmc as there is not enough progesterone to allow the baby to grow. Anyone heard of that? or checked up?

Reading this thread with interest, I have been thinking about this a lot too escape.
I have 2 DCs and have just had my 3rd consecutive MMC. I found out about these at 17 weeks, 12 weeks and 13+ weeks, but each time the babies measured around 12 weeks. I think that this must be more than coincidence, but G.P's and consultants have all said, 'bad luck', 'it just happens', 'you will probably never know why'.
I am not 'advanced' in age (obviously advancing all the time though!), and wonder if a clotting issue is the problem.
I hope that things get easier soon escape.

Thank you all for adding your experiences here. It's good to know we are not alone and the ONE thing that seems to help me at this stage is to hear stories like yours Supersunnyday where people have a successful pregnancy after one or more mc's. It's the one thing that keeps me going - I know the statistics, but I am terrified I will never be able to hold a baby in my arms... but your stories bring a smile to my face and some hope in my days :)

I have found some journals on miscarriage which might be helpful. The first one seems to indicate a huge percentage of mmc being chromosomal (more than the 60-70% associated with miscarriage) though note the relative small sample number (still, results are apparently statistically significant so...) Second one is about, statistically, the numbers being on your side after week 8 of a pregnancy. I know anecdotally we read about many women losing their babies after week 9, 10 etc, but it can help to know that the numbers are on our side.

humrep.oxfordjournals.org/content/18/8/1724.full
humrep.oxfordjournals.org/content/14/11/2868.full

Anyway, I am just one of those people who needs to find out as much as possible about anything that happens to me. Any more information, anecdotal or studies much welcome. And of course good news of pregnancies going well, despite of past mc. :D

escapeartist as you asked for positive stories of pregnancy after mmc, I thought i would add that i conceived 3 cycles after mine and am now 33 weeks with a wriggly little girl. It's definitely possible, and you've no higher chance of a mc just because you had one already.

Look after yourself and take your time revovering. You will get there.

Hello escapeartist.
I have been reading this post with interest and also just spent the last half hour looking at the scan report from last week and comparing it with ultrasound images.

Like you I am trying to believe the positive statistics but it is difficult at the moment. Also, since I have been going onto MN and talking to close friends and family it seems like miscarriage is alot more common than I ever thought. I have also spent alot of time reading about it but I seem to have lost my brain at the moment and cannot concentrate enough to read a proper paper!! I have to stick to reading blogs for the moment or summaries when someone else has read the paper. Thanks for reading them for me! x

crochetcircle thanks for your positive story. It feels so unlikely at the moment that I will ever reach the stage that you are at, or in fact hold a little baby in my arms, yet I know I need to keep trying if I ever want to make the family that me and my DH have dreamed of. Thanks for sharing your positive experience, it means more than you can think to me!

LIG wanting answers is natural, having answers is not always possible. But for me, I always want to know as much as I can... I will share more as I come across it. Thanks for reading.

Another interesting bit of information. Seems that:
"Causes of missed abortion generally are the same as those causing spontaneous abortion or early pregnancy failure. Causes include anembryonic gestation (blighted ovum), fetal chromosomal abnormalities, maternal disease, embryonic anomalies, placental abnormalities, and uterine anomalies. Virtually all spontaneous abortions are preceded by missed abortion. A rare exception is expulsion of a normal pregnancy because of a uterine abnormality."

www1.cgmh.org.tw/intr/intr5/c6700/OBGYN/f/web/Miss%20abortion/index.htm

Hi i had two mmc in a row before having my gorgeous dd (9mths on Tuesday.) I was told it was just bad luck but pushed and pushed for testing which i finally had, had two blood tests to check thyroid function and the other was to check for something else will have to look up what it was phlos something... they also scanned me to check my ovaries. I had to beg my gp to put me for the tests, he insisted all along that we didn't need them but finally relented and ref us to a private clinic where again the man just laughed at us an said two mmc in a row with no children was nothing to worry about. I think haing some form of testing done made me relax more about trying again and we also gave ourselves a break of 5 mths before trying again when we did i fell first time and now she's upstairs. I have no idea why i lost my precious two children and i often think about them and blame myself for not being able to keep them. I too took heart in the fact that my body hung on to them even though they could not survive, one of the nurses at a&e when i had my 2nd one commented on the fact that my body obviously wanted to be pregnant too. I guess sometimes things just happen and we can't know why. I wish you all the luck in the world x

Thanks for the input picklebum and so sorry for your losses. Enjoy your gorgeous dd - I live for the day when I can hold my baby in my arms! If I may ask, when were your mmc at/which week?

first one started having a brown loss at 9 wks an 2 days scan showed baby had stopped growing at 6-7 weeks. 2nd one more tricky as we had a so called reassurance scan at 6 weeks and 3 days whiCH showed a slow heartbeat sonographer said it didn't look good,we then had a scan booked for two weeks later, later on i started bleeding so had scan five days later where sac had grown!!! Got hopeful then more bleeing an a scan 5 days later no heartbeat. I know how you feel about wanting answers, when my dd was born they said the placenta was very old and worn looing that has haunted me too. Will keep everything crossed that your day with your dc will come too x

Mmc's are so cruel :( I had one in 2008 at 13 weeks and it broke my heart This book was useful afterwards and it helped me sort my head out.

I have had 2 8 week natural miscarriages before my first child too and I have to say the mmc was so much worse, even though I kind of thought something wasnt right with the pregnancy.

I conceived my ds 5 months after the erpc and although the pregnancy was fraught it healed me a lot.

Good luck next time x

Thanks Worzsel (great name by the way) your story gives me hope again! DH and I have decided we are not actuvely ttc and that we will let nature take its course. It took us over a year the first time, so not holding our (collective) breath...