Miscarriage and Chinese Medicine

Miscarriage is a common event.  One in seven of known pregnancies miscarries in the first 3 months, and probably twice as many miscarry before the woman knows she is pregnant, when the development of the embryo stops and the woman has a “silent abortion' that is indistinguishable from the normal menstrual bleed. About 1% of women miscarry in the second trimester, and a similar proportion of women have an ectopic pregnancy.

Causes of miscarriage

Most first-trimester miscarriages occur because of foetal abnormalities.  In most cases there in no recurrent aetiological factor and, reassuringly, the outlook for the next pregnancy is not worse than for any other pregnancy.

However, the risk of foetal abnormality increases with age of the parents.  The relationship between maternal age and miscarriage has been frequently documented (see Table below).  Recent studies also begin to suggest that the age of the father and thus the quality of his sperm also plays a significant role in the outcome of a viable pregnancy.  A study has shown that the miscarriage rate in younger women with male partners aged 35 or more is double that of women with younger husbands (Ford et al 1994).  A similar effect was seen on conception rates.

In later stages of the pregnancy (week 11-22) maternal factors such as the presence of a systemic disease, uterine abnormalities (e.g. the presence of uterine fibroids), or cervical incompetence become more common causes of miscarriage.

Relationship between maternal age and miscarriage

What does Chinese medicine say causes miscarriage?

The concept of age affecting fertility is well discussed in Chinese medicine.  Aging leads to a decline of reproductive function, meaning that the building blocks that will later constitutes a foetus (sperm and egg cells) decline in their quality and are thus less likely to mature into a healthy embryo.  Thus the rate of infertility and miscarriage increases.

Increasing the health of both parents before conception will ensure that both the sperm and the egg, as well the foetus' environment, are all optimised so that the best possible conditions are created for a healthy pregnancy.  Thus preventative treatment for the gametes (sperm and egg) is important to lower the chances of abnormalities.  This is easier to achieve in males, as sperm is constantly reproduced and thus can be influenced.  However, the nourishment and development of the female follicle can be influenced by Chinese herbal medicine and acupuncture, so that a more mature egg is released.

Types of miscarriages

It is convenient to divide miscarriage into three main types:

(1) Threatened miscarriage
A threatened miscarriage is diagnosed when there is bleeding from the vagina before the 24th week of pregnancy, and as long as no products of conception have been passed and the cervix remains undilated. Three out of four threatened miscarriages settle down, and when this happens there is no increased risk of foetal abnormality.  A good indicator for the outcome is the foetal heart beat.  If it is still detectable (usually possible from week 7), only about 2% of women will miscarry.

(2) Inevitable miscarriage
A miscarriage becomes inevitable when the cervix dilates significantly or products of conceptions are passed. Most inevitable miscarriages are accompanied by a considerable amount of clotted vaginal bleeding and lower abdominal pain, which can be severe.  Upon completion of the miscarriage, which can take several hours, the pain should subside, and vaginal bleeding should be mild.  On examination, the lower abdomen is not tender, and the uterus has returned to its normal size.

If bleeding or pain continues over several days, an ultrasound should be performed to see if the uterus has been completely emptied. If more than 10% of tissue has remained in the uterus, a D&C is usually performed to avoid the risk of infection.

(3) Recurrent miscarriage
Few women (less than 1%) miscarry successively.  If a woman has miscarried three times, her chance of another miscarriage is increased to 30%, as well as the risk that she will deliver a preterm baby.
A recurrent miscarriage may be caused by the following:

• hormonal dysfunction (ovary, placenta, thyroid) (30%);
• uterine or cervical abnormalities such as fibroids or congenital abnormality of the uterus (10%);
• endometrial infections (10%);
• chromosome abnormalities of either parent (3%);
• sperm factors (2%)
• presence of a serious chronic illness such as renal disease or SLE (1%)

In many cases (about 60% of miscarriages below 12 weeks, and 35% of miscarriages above 12 weeks), no physical causes can be established.  The mainstay of treatment is generally tender loving care and rest.  In such a case Chinese medicine can diagnose and treat the perhaps more subtle but nevertheless important reasons for a recurrent miscarriage.

Chinese medicine treatment of miscarriage

Threatened miscarriage
A threatened miscarriage is inevitable in severe foetal abnormalities, and no treatment can change the outcome.  In a minority of women however the reason for the threatened abortion lies within the physiology of the mother, and timely treatment with Chinese medicine may save the pregnancy.  If there is any doubt as to the nature of the miscarriage, or if the woman had a history of infertility or miscarriage (see below), treatment should be applied.

Inevitable miscarriage and its sequelae
Similar to orthodox medicine Chinese Medicine places a great emphasis on removing all tissues still residue in the uterus after a miscarriage.  Several days of Blood moving herbs as well as acupuncture will ensure that the uterus is cleaned to allow restoration of the menstrual cycle.  Subsequent treatment addresses weakness in the mother due to blood loss and physiological and psychological stress or pre-existing physiological imbalances.

Recurrent miscarriage
Chinese medicine can have a very useful role in the treatment of recurrent miscarriages as it detects any possible weaknesses in either one or both partners and, by correcting them, can ensure that conditions for a future pregnancy are optimised.  This is particularly the case if underlying menstrual conditions are present that need to be regulated, such as the existence of polycystic ovaries or endometriosis, where a weak hormonal output from the ovaries during pregnancy might endanger the development of a foetus.

Studies now support practitioner's experience that Chinese medicine can play a significant role in the prevention of recurrent miscarriages.  Women whose recurrent miscarriages are immune-related benefit from Chinese herbal medicine prior to their next pregnancy, a research from Japan shows.  A study from Shanghai indicates that, in a large percentage of women with a history of recurrent miscarriage who again show signs of a threatened miscarriage, the pregnancy can be saved with correct treatment.

In pregnancies at risk (history of infertility or previous miscarriages), women may be asked to continue taking their basal body temperature (BBT) readings for the first few weeks into the pregnancy: valuable information regarding the hormone regulation is thus obtained, and the vigour of what we call Kidney Yang (stable maintenance of a raised temperature), an important indicator of the stability of the pregnancy, is thus monitored.  If there is a drop in temperature, herbs need to be administered to support ovarian functions.

Failure of Implantation & the Role of TCM

Conditions of the tubes or uterus affect implantation and the early growth of the foetus. The tube or the uterus might have excess fluid or mucus on the surface that makes it difficult for the embryo to transverse, implant, or flourish.  This excess fluid is called dampness in Chinese medicine, and aim of treatment is to clear any excess fluid with herbs or acupuncture.

The endometrial lining might not provide an even surface with appropriate sites for attachment, implantation, and growth. In Chinese medicine this is often diagnosed as Blood stagnation (poor microcirculation in the uterus).  Blood stagnation is best treated during the menstruation to ensure a thorough discharge of the old endometrium and smooth remodelling of fresh endometrial tissue.  Some women have too thin an endometrial lining that cannot sustain a growing foetus. Here, herbs and acupuncture are given particularly after the period to aid the rebuilding of a thick uterine lining.