Miscarriage is the loss of a pregnancy prior to 20 weeks gestation and approximately one in four of us will experience it at some point during our reproductive years. If not, we’ll almost certainly know of someone who’s been through it.
The fact it is so common does not make the experience any less intense but it sometimes helps to know you’re not alone out there.
Most pregnancy losses occur before 13 weeks The highest risk period is between 4 and 6 weeks. These are the first trimester miscarriages and are the most common. Often they occur about the time the period is due and may be mistaken for a heavier than usual menstrual loss (but obviously don’t assume every heavy period is a miscarriage).
Pregnancy losses after 13 weeks are in the second trimester of pregnancy, are less common, and have different causes from those of the pre-13 week losses. Three or more consecutive losses is termed ‘recurrent miscarriage’.
There are five different types of miscarriage:
- Missed miscarriage: this is usually discovered during a routine scan when no heartbeat can be found or there is an empty sac (blighted ovum).
- Threatening miscarriage: this can be experienced for days or even weeks with light bleeding, period-like pain and nausea. Sometimes there is spotting around the time of your normal period and the pregnancy can continue as normal without harming the baby.
- Inevitable miscarriage: the pain is stronger, bleeding is heavier and often with clots.
- Incomplete miscarriage: this is usually at 6 to 12 weeks after bleeding has occurred and some pregnancy tissue still remains.
- Complete miscarriage: this is when the baby has completely passed and the uterus is empty. The pain stops, the cervix closes, bleeding slows down and ends after about 7 to 12 days.
why does miscarriage happen?
The eggs you use to get pregnant are the same eggs you were born with and, like supermarket eggs, they have an expiry date. The closer you get to that date, the less fresh they are and the more your eggs’ DNA deteriorates.
Around sixty percent of first trimester miscarriages occur because the DNA blueprint just doesn’t make sense and is therefore unable to develop properly. The pregnancy is rejected, gets discarded and miscarriage results. The older you are, the poorer the egg quality, the higher the chance of miscarriage, and for those pregnancies that continue successfully, there is a higher incidence of chromosomal abnormalities such as Downs Syndrome.
minimising the risk of miscarriage
Uterine abnormalities, including getting pregnant when using an IUCD and some medical conditions, may increase the chance of having a miscarriage either in the first or second trimester. In some cases the risk can be minimised by optimising conditions before you try to get pregnant. Seek advice from your doctor regarding pre-pregnancy counselling. Diabetes is a good example of this and pre-pregnancy counselling is essential before thinking about getting pregnant.
signs and symptoms of miscarriage
Crampy, lower abdominal pains and vaginal bleeding are the most common symptoms. The bleeding is often light to start with. While the bleeding is light and the cervix is still closed this is termed a ‘threatened miscarriage’. (In some cases, the bleeding will settle and a healthy pregnancy will continue but any bleeding in pregnancy should be treated as abnormal until proven otherwise.)
As the process of miscarrying continues, the bleeding gets heavier and the abdominal cramps get stronger as the cervix opens up. This is an incomplete miscarriage. Blood clots may be passed along with the pregnancy tissue, which has a whitish/grey appearance. Once the pregnancy tissue has been passed, the bleeding and the cramps should settle down. The cervix closes. This is now a complete miscarriage. It is helpful to keep any tissue that does not look like a blood clot to show to your doctor.
Some pregnancy failures are diagnosed on ultrasound scan, with no preceding symptoms at all. This is a missed miscarriage.
what will the doctor do?
Your doctor will establish how many weeks pregnant you are based on the first day of your last period. An internal examination may be done to see how big the womb feels and to see if the cervix is open or closed. An ultrasound scan will then be arranged to confirm the pregnancy is still viable (alive). You may also have some blood tests and swabs taken.
treatments for miscarriage
Once a miscarriage has started, it cannot be stopped and the bleeding and cramps will continue until the uterus is empty. The uterus can be emptied conservatively, medically or surgically and your doctor will discuss the options with you. Not all methods are appropriate for all situations.
Conservative
Most failed pregnancies will spontaneously miscarry if left alone. For some, it will just be like a heavy period. For others, the blood loss and abdominal cramps may be quite severe. In the case of a missed abortion, the process of miscarrying may occur hours, days or weeks after the scan diagnosis has been made.
Medical
Dependent on the size of the failed pregnancy (and not necessarily on the number of weeks pregnant you are), it may be possible to empty the uterus without requiring surgery. The doctors at the hospital will discuss this with you if appropriate.
Surgical
The operation to clean the womb is called an ERPC (Evacuation of Retained Products of Conception). This is usually a quick and easy procedure done under general anaesthetic. The cervix is gently dilated (opened up) and the uterine contents removed with a combination of suction and a metal instrument called a curette.
post miscarriage
Once the uterus is empty, the pain should stop. You may be a little uncomfortable after an ERPC but this should settle after a few hours. The bleeding will take a little longer to stop completely but no more than a week and should be light spotting only. If the bleeding persists, or becomes heavier again, see your doctor as this can be a sign of infection. Similarly any temperature, offensive vaginal discharge or abdominal pain should be reported to your doctor. You may also feel quite tired, not to mention emotionally exhausted. Take it easy for a while and enjoy a little self indulgence.
when can I get pregnant again?
You are physically able to get pregnant again straightaway - your ovary is capable of producing an egg within two weeks of a miscarriage so use contraception if you are not ready for this. Some women like to experience a few normal cycles before trying again but there are no hard and fast rules.
will a miscarriage happen again?
It may but if that was your first miscarriage, your chance of miscarrying again is pretty much the same as someone who hasn’t miscarried before. After two miscarriages, the chance of having another is less than 0.5%.
recurrent miscarriage
When three or more consecutive losses occur, it is called ‘recurrent miscarriage’ and warrants medical investigation. National Women’s Hospital in Auckland runs a recurrent miscarriage clinic, offering investigation, treatment and support.
for further information
www.miscarriagesupport.org.nz for contact details of support networks around the country.
