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Methods of research on miscarriage of pregnancy
Last reviewed: 04.07.2025
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It should be noted that in the literature there is often an opinion that it is not necessary to conduct an examination in connection with habitual miscarriage, since with each pregnancy a married couple has a 60% chance of carrying the pregnancy to term without examination and treatment, and only a 40% chance of losing it again. And if the financial resources of the family are limited, then the examination may not be carried out, considering miscarriage as a manifestation of natural selection. Considering the material condition of our society as unsatisfactory, and most methods of examination in connection with miscarriage are expensive studies, for many families this issue is resolved in this way.
For those who want to know the cause of miscarriage and seek help outside of pregnancy, we believe that the examination should be carried out in full, but without unnecessary costs for unjustified research for this patient.
Taking into account the polyetiological nature of habitual miscarriage, we conduct examination of patients with this pathology in 2 stages. At stage 1, the state of the reproductive system and the most common causes of embryo development disorders are assessed.
At stage II, the pathogenetic mechanism of habitual pregnancy loss and more rarely encountered disorders are clarified.
Hysterosalpingography is the first, necessary link in the examination. This method reveals malformations of the uterus, the presence of intrauterine adhesions, isthmic-cervical insufficiency, and uterine hypoplasia. In case of miscarriage, hysterosalpingography should be performed on the 18th-22nd day of the menstrual cycle in the absence of signs of infection, changes in blood, urine, and vaginal smears.
Studies in the second phase of the cycle allow us to identify not only anatomical changes, but also a number of functional disorders. The isthmic section of the cervix in the second phase of the cycle is narrowed due to the action of progesterone and increased tone of the sympathetic nervous system. Expansion of the isthmus can be caused by isthmic-cervical insufficiency, as well as an incomplete second phase of the cycle, and a decrease in the progesterone level. These conditions can be differentiated using an adrenaline-progesterone test.
An alternative method of examination is hysteroscopy, which allows more accurate determination of the nature of the uterine cavity lesion, spatial relationship in case of uterine malformations, and the extent of intrauterine adhesions. Hysteroscopy has fewer false-positive and false-negative examination results than hysterosalpingography due to possible artifacts.
However, both of these methods, while providing very valuable information about the condition of the uterine cavity, do not allow for a clear differential diagnosis of uterine malformation: bicornuate or intrauterine septum.
Considering that for habitual miscarriage, an intrauterine septum is a more severe pathology than a bicornuate uterus, laparoscopy is often necessary to clarify the nature of the uterine malformation. However, due to possible complications and the high cost of the method, the study is rarely used for these purposes, only if there is a need for intervention in concomitant gynecological pathology.
An alternative method to laparoscopy may be resonance tomography. In recent years, data on the use of sonohysterosalpingography have appeared in the press. Under ultrasound control, an echo-negative substance is introduced into the uterine cavity and the ultrasound method monitors not only the state of the uterine cavity, but also the dynamics of tube contractions and their patency.
When performing hysterosalpingography, we recommend taking doxycycline 100 mg 2 times a day, trichopol 0.25 mg 3 times a day, nystatin 0.5 4 times a day for 5-6 days after the procedure the day before the start of the study. To ensure the procedure itself and reduce discomfort after it, we can recommend taking antiprostaglandin drugs: indomethacin, voltaren, ibuprofen in therapeutic doses for 1-2 days.
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