Anatomic causes that may lead to recurrent miscarriage include congenital uterine abnormalities such as didelphis and unicornuate uterus, fibroids or endometrial adhesions that are mostly related to endometritis.
In addition, part of the anatomical cause is cervical insufficiency. The cervix is the anatomical boundary between the vagina and the uterus and I often describe it as the “door” that holds the pregnancy inside the uterus. The cervix, quite often from its construction or due to previous uterine surgery, like scratching, is dysfunctional and opens up easily. This could lead to a silent miscarriage in the second trimester. Such miscarriages are prevented by regular ultrasound monitoring of its length during the pregnancy and a surgery called Cervical Cerclage, which places of a stitch around the cervix in order to keep it shut throughout pregnancy.
