The Medical Minute: After miscarriage, finding answers and a path forward

HERSHEY, Pa. — Two lines, a plus sign: Pregnant. For hopeful parents, these first indicators of new life are the happiest moments they can imagine. But for many families, that joy is cut short by an unexpected loss. Nearly a quarter of pregnancies in the United States end in miscarriage before 20 weeks.

Jaimey Pauli, chief of maternal-fetal medicine at Penn State Health, said miscarriages happen when a pregnancy unexpectedly ends before 20 weeks of gestation. Many women may experience one miscarriage and go on to have normal pregnancies without any other treatment, but some may experience recurrent pregnancy loss.

For Makenzie Stauch of Hershey, a miscarriage came after a healthy first pregnancy. She welcomed her daughter without complications, but said her second pregnancy felt different from the beginning.

“We had just had our anatomy scan, and we were two days away from 20 weeks,” Stauch said. “I went into pre-term labor, and the cord prolapsed. We lost him.”

A cord prolapse occurs when the umbilical cord drops into the vaginal canal, cutting off oxygen and nutrition to the baby.

Understanding the causes of miscarriage

In Stauch’s case, her doctors didn’t know exactly why the pregnancy ended, even after genetic testing — a common outcome. Pauli said miscarriages can happen for many different reasons, including genetic anomalies, a weakened or insufficient cervix, uterine shape irregularities and an autoimmune disease called antiphospholipid antibody syndrome. In some cases, patients have completely normal blood work and no identifiable risk factors, but still have pregnancies that end in miscarriages.

“Some patients have no known reason for miscarrying, but often that’s caused by a genetic issue called aneuploidy, which is extra chromosomes or not enough chromosomes,” Pauli said. “Some patients carry a genetic deletion, translocation or difference that, when passed down in combination with their partner, creates a genetic issue that causes the miscarriage. Both parents are completely fine, but together, the child has two copies of something genetically unsustainable.”

While maternal age can play a factor in miscarriage rate, Pauli said miscarriages can happen at any age, and also older mothers can have completely healthy pregnancies. She also emphasized that miscarriage is a traumatic but natural occurrence, and mothers should not blame themselves.

“Every patient I’ve ever met who's experienced this kind of loss immediately starts thinking about what she did to cause it,” Pauli said. “Was it something she ate or drank? Something she did? This is not your fault. You did not make this happen.”

Treatment options after recurrent pregnancy loss

Since miscarriage has many possible causes, creating a prevention plan can be challenging unless physicians can identify the underlying cause. However, for women with cervical abnormalities, some treatment options may improve their pregnancy outcomes, according to Kristin Riley, chief of minimally invasive gynecologic surgery at Penn State Health.

Riley said one option is a cervical cerclage — a procedure that places a suture around the cervix to help it stay closed during pregnancy.

Stauch, after waiting several months to try again, became pregnant and received a cervical cerclage. Her son, Andrew, was born at 31 weeks at Penn State Health Golisano Children’s Hospital. After a few weeks in the neonatal intensive care unit, he is now healthy and thriving.

Traditional cervical cerclage is performed through the vagina, but Riley also offers robotic transabdominal cerclage, a minimally invasive procedure in which the stitch is placed at the top of the cervix. She said the procedure is ideal for patients who have experienced multiple second-trimester losses due to cervical insufficiency or patients who have experienced miscarriage with a vaginal cerclage in place.

“Traditional cerclage is more accessible to place — you put a speculum in, and you can see where to place the suture,” Riley said. “Transabdominal cerclage uses laparoscopic abdominal surgery to place the suture so it’s higher on the cervix.”

Transabdominal cerclage is ideally placed before a patient conceives and can remain for multiple pregnancies. Once it is in place, Riley said, the mother must deliver via C-section.

Healing after pregnancy loss

While miscarriage is a physical experience, it can also take a heavy emotional toll. Stauch said she found the support she needed at the Penn State Pregnancy After Loss (PAL) Collaborative Center, a multidisciplinary center offered by Penn State at Milton S. Hershey Medical Center.

Led by Serena Wu, a maternal and fetal medicine specialist and Michael Belmonte, a complex family planning specialist, the center brings together experts in maternal-fetal medicine, behavioral health, complex family planning, reproductive endocrinology, internal medicine and social work.

Wu said the PAL team supports the complex needs of individuals coping with pregnancy loss and creates a personalized plan for their path forward.

“We’re creating a safe space for women to navigate their ‘rainbow’ pregnancies, offering parental and group support, as well as complementary therapies,” Wu said.

For families facing miscarriage, answers aren’t always easy to find. But with specialized care, emotional support and advances in treatment, many parents can find hope — and a way ahead.

Related content:

• The Medical Minute: Family on your timeline: Latest trends in family planning, fertility treatments and preservation
• The Medical Minute: What a fertility specialist can do for you
• The Medical Minute: Pulling back the curtain on infertility
• Learn more about Penn State Health’s high-risk pregnancy care
• Explore pregnancy and women’s health clinical trials at Penn State College of Medicine

The Medical Minute is a health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.