What is the cause for recurrent pregnancy losses?

Q: My products of conception showed grade 1 gestational trophoblastic disease (partial mole) with decidual endometritis. This was my fourth blighted ovum & the D&AC was performed all the times. It was only third time, pregnancy carried upto 14th week with normal fetal node. All tests performed so far are normal, including karyotyping. Is the above biopsy report of concern, and what is the remedy? Can I conceive again?

A:You have a condition of recurrent pregnancy losses but the cause seems to be different in all the four episodes. You can certainly conceive again and try once more if your age is less than 40 years, only you will need to consult a gynaecologist from very early in the pregnancy - preferably some one who has training and specialisation in this area. If all your tests including karyotype are normal, then when you get pregnant, you may need early testing to confirm pregnancy and certain general precautions to avoid miscarriage such as avoiding constipation, avoiding sex, not lifting heavy objects and getting plenty of rest. You will need to be investigated for a loose cervix since one of the pregnancy went upto 14 weeks and treated by a stitch in case it is present. Certain other treatment regimens such as injection progesterone may also be required in the first four months of pregnancy.