We have been receiving a lot of questions in regards to miscarriages so I’ve created this video series:
Part 1 – Reasons and Causes for Miscarriage
Part 2 – Frequently Asked Questions
Part 2 – Frequently Asked Questions
What is a miscarriage?
A miscarriage is the spontaneous loss of a pregnancy before the fetus is able to survive outside the monther’s womb. I know this can be a very sad and distressing experience as I’ve been through this myself. You may feel as though your hopes for the future have been taken from you. These feelings can be very real even if the pregnancy is only a few weeks along.
There’s no set of rules about what you will or will not feel after a pregnancy loss. You may simply feel numb for awhile. Allow yourself the time to work through these feelings.
Grieving a pregnancy loss takes time. Some couples may think that they must try to conceive again right away in order to replace the pain.
Unfortunately it is unlikely that a subsequent pregnancy will carry the same joy, because a new pregnancy after a loss can be fraught with anxiety and fear that something may go wrong.
I want to stress that although a pregnancy loss can be extremely difficult it doesn’t mean you won’t be able to have another baby. In most cases your chances of having a successful future pregnancy is still very good even if you have suffered several pregnancy losses.
I suffered three miscarriages and one ectopic pregnancy but have also given birth to 6 healthy children…all adults now!
Miscarriage is not uncommon. It is estimated that up to 20% of pregnancies end in miscarriage.
The information I am about to share with you is designed to help you cope with the loss of your pregnancy. I will try to provide answers to some of the questions we have been receiving.
So, you may wonder what happens next?
Well, this depends on what type of miscarriage you have had. It is quite possible that the doctor / sonographer has diagnosed that your miscarriage is complete which means that most of the pregnancy has passed and that there is no need for further treatment. You may still experience blood loss which can go on for up to two weeks.
If your miscarriage has been diagnosed as being a missed or incomplete that means that there is some pregnancy tissue retained within the womb. Depending on your own individual circumstances there are some incomplete miscarriages which are best treated surgically with dilation and curettage also known as ‘D&C’. A D&C is a procedure that opens up the cervix and remove the contents of the uterus.
Other miscarriages may be treated either with no treatment or occasionally using tablets to expel the remaining pregnancy tissue. You will be advised as to which approach is best for your situation by your health care provider. Often it is appropriate to discuss the different approaches.
The three ways of dealing with a pregnancy that is not progressing are as follows:
1. Wait and see approach (leaving things to nature).
In the past an operation was nearly always performed in cases of miscarriage, however, with the use of ultrasound we can reasonably confidently predict those miscarriages that do not require any treatment. If you have had no bleeding it may take up to 3 weeks for you to start miscarrying. The bleeding may be heavier than a normal period and you may experience strong period like pains in your lower abdomen as the womb contracts in an attempt to expel the pregnancy tissue. If the bleeding is very heavy, the pain very severe, or you feel unwell you should attend the hospital for review. In a small number of cases an operation may still be necessary should there be some tissue left within the womb or if the bleeding becomes too heavy.
The 2nd is the medical approach:
Medicines may be used to start a miscarriage if you prefer not to wait. Misoprostol is a medicine that you can take by mouth (or occasionally by placing the tablets in the vagina). You may need to take a few doses before bleeding commences (as described above). The advantages of this approach is that you avoid a hospital admission, an anaesthetic and a surgical procedure. In about 10% of cases an operation may still be necessary should there be some tissue left within the womb or if the bleeding becomes too heavy. This medication can only be prescribed by your doctor or hospital.
The third approach is Surgery (D & C).
D and C, dilation and curettage. The cervix (neck of the womb) is dilated by using either plastic or metal instruments and then the pregnancy tissue is removed from the womb. It is correctly called an ERPC (evacuation of retained products of pregnancy).
This is done under general anesthesia through the vagina and you will not have any cuts/stitches. As with all operations there are small risks such as infection or injury to the womb and cervix. The advantage of this approach is that it clears out the womb quicker than the above approaches.
Generally your chances of having successful pregnancy in the future are just as good irrespective of which approach you choose.
Following any of the above approaches, you may have a period like bleeding for up to 14 days which is quite normal and should gradually diminish with time.
What is a Threatened Miscarriage:
A threatened miscarriage is a pregnancy where the vaginal bleeding has taken place but an ultrasound has shown a healthy fetus and fetal heartbeat. The bleeding can be very varied and can occur at any time after a missing period. It can range from being a smear of pink, brown or red loss on the toilet paper to heavy vaginal bleeding similar or even heavier than a period.
The diagnosis of a threatened miscarriage is made when you attend for an ultrasound scan. As long as you are at least 6 weeks pregnant the ultrasound should be able to visualise your tiny embryo and show a healthy heartbeat. It may be necessary to demonstrate by performing an internal vaginal scan.
Sometimes the scan may demonstrate a small haematoma (blood clot) around the pregnancy sac but very often nothing abnormal is seen and it is difficult to explain why the bleeding has occurred. The bleeding may have come from the implantation site which is when the placenta of your baby burrows itself into the lining of the womb. This process may cause some bleeding. If we can see a baby’s heartbeat on ultrasound it is very likely your pregnancy will continue with success rates exceeding 95%.
It is very uncommon to miscarry after 12 weeks gestation and affects only 1 to 2 perenct of pregnancies.
If there is a collection of blood around the pregnancy sac and the bleeding continues, it may be appropriate to repeat an ultrasound scan in 1-2 weeks. In any case the heartbeat will be checked at your first booking visit.
If the bleeding settles down there is probably no need for a further scan unless you have further anxieties. Traditionally bed rest has been advised for mothers with threatened miscarriage but all the evidence would suggest that this does not prevent miscarriage. It may help some patients psychologically to rest in bed but it is not necessary.
Unfortunately there is no specific treatment to stop the bleeding and if you do adopt bed rest there is a possibility that on standing up bleeding may become heavier due to pooling of blood in the vagina that results from lying down.
With regard to work, our advice will depend on the nature of work, your history and the nature of bleeding, but it is probably prudent to stop work if you are having significant bleeding.
If you have further heavy bright red bleeding, particularly if this is associated with crampy abdominal pains, it is appropriate to get in touch with the early pregnancy assessment unit for advice.
There is no evidence that having intercourse at any stage in pregnancy causes miscarriage or pregnancy loss though again it seems sensible to avoid intercourse until the bleeding has completely stopped.
What Does an Inconclusive Scan Result Mean?
Sometimes, following a visit to an early pregnancy unit, it may not have been possible to confirm whether your pregnancy is going to continue or not. It can be difficult to take in all the facts when you are anxious.
There are three main reasons for uncertainty during an ultrasound to determine whether or not you are having a miscarriage;
1) It is possible that a fetus and fetal heartbeat is not seen because you are too early in the pregnancy. A repeat scan in 7 to 10 days should clarify whether the pregnancy is healthy or not.
2) It is also possible that the pregnancy is not growing as it should and the bleeding may be a sign of an impending miscarriage. Similarly, a repeat scan will clarify the situation.
3) There is also the outside possibility that the pregnancy is outside the womb. This is unlikely but it cannot be excluded at this stage as it is too early to diagnose.
If an ectopic is suspected it may be suggested that you follow up with your doctor or hospital to perform a blood test called Beta HCG (Human Chorionic gonadatrophin). It is a hormone produced by the placental tissue and its levels roughly double every two days in a normally growing early pregnancy. They may also repeat the scan in a few days. It is quite possible that you will have further bleeding if you have bled already and as long as it is not too heavy you may stay at home and wait for the follow-up scan in 7-10 days which should clarify the situation for you. However, if you develop sharp pain or are aware of increasing crampy abdominal pains, it is reasonable to take paracetamol tablets. If the pain becomes too severe or the bleeding becomes too heavy, or indeed if you are anxious about your situation, please do not hesitate to get in touch with your doctor.
Frequently Asked Questions about Miscarriage:
Why did I miscarry?
Miscarriage is a process, not a single event. Approximately 1 in 5 pregnancies end in a miscarriage. It is often very difficult to give a definitive answer as to why you had a miscarriage. Many studies have shown that approximately 2 out of every 3 miscarriages are explained by a chromosome problem. This means that when the egg was fertilized by the sperm the process of fusing together was somewhat faulty and in many cases gave rise to one extra chromosome. A normal embryo has 23 from the mother and 23 from the father. Where there is a problem at conception this may give rise to a total of 45 or 47 chromosomes. Very often these chromosome problems are not compatible with life and nature will determine that these pregnancies do not progress and they will then end in miscarriage.
Occasionally you may have a miscarriage because of an infection associated with a high temperature / fever, though this is unusual.
Occasionally there may be a problem with the cervix and or uterus (womb). An irregularly shaped womb or the presence of fibroids encroaching into the cavity of the womb are associated with a higher chance of miscarriage.
Unfortunately, in many cases we are unable to give a definitive cause.
Will this happen again?
If you have had one miscarriage it is extremely likely you will be able to go on and have a normal pregnancy. It is important to say that the risk of miscarriage increases as maternal age increases and also if a woman has had other miscarriages.
Even after several miscarriages though there is a good chance of a successful pregnancy.
Is there anything I can do to prevent a miscarriage?
In truth the answer to this question is almost certainly no. If we assume that 2 out of every 3 miscarriages occur because of a chromosome problem then no amount of rest or medication will make any difference to a pregnancy that might already be faulty. There is very little evidence that bed rest reduces the chance of miscarriage.
How long should I wait before trying again?
There is no perfect time to aim for another pregnancy. This may depend on many different circumstances such as your age, co-existing health problems etc. It is certainly wise to wait until you have at least one normal period, which usually occurs about 3-6 weeks after a miscarriage. Some people would advise waiting until you have had a few periods to allow your cycle to go back to being regular, if indeed they were regular before.
Do I need a follow-up appointment in the hospital?
In general, most hospitals do not have specific clinics for early miscarriage follow-up. It is probably more appropriate for you to see your family doctor who will probably know better and who can help you through this difficult time.
It may help to talk things over with your partner, friends and other members of the family. It is quite normal to be tearful and feel low from time to time but, if you feel that you are getting depressed and unable to cope it is important to alert your family doctor, or indeed the bereavement counseling service at your local hospital.
Recurrent miscarriage which is usually defined as more than 3 consecutive pregnancy losses is uncommon and affects only 1 percent of couples. Most couples in this situation will likely want to undergo investigations sooner rather than later in order to establish whether or not they have an underlying cause for their repeated miscarriages.
A referral to a hospital or clinic that has an interest in miscarriages is very valuable since they these centers offer the most recent investigations and treatment trials. Also, those in this situation will benefit from knowing they have done everything possible to prevent miscarriage from recurring.
* All women have a right to grieve whether they lose their babies through early or late miscarriage. Losing a baby at any stage can be a devastating experience. The stages of loss can be a lengthy process as one moves through the stages of acute greif, mourning and healing.
* Not every woman grieves following a miscarriage and some recover quite quickly emotionally and physically.
* For others, losing their baby can leave them feeling shocked, angry, empty and depressed
* It is generally assumed that men will take care of their partners. Sadly, it is often forgotten that they have suffered a loss too. Their hopes and dreams for the future have also been shattered.
* Your grief may manifest itself in a physical way and the depth of your feelings can be very frightening. If you are worried, maybe talking to your doctor would help.
* Try not to rush the “back to normal” routine. Take things slowly and allow yourself the time to grieve for your baby.
* Physically, you may recover quickly from your miscarriage while emotionally, it may take weeks or even months to come to terms with your loss.
* You may have no mementos if you lost your baby in early pregnancy and this can be heartbreaking. It may be important to make your baby tangible in some way for you.
* It is never too late to acknowledge your baby.
Eventually you will become resigned and accepting of what happened and although this never completely takes away the emotional pain you will be able to deal with it in a more controlled way.
I understand that this can be a very difficult time so if you have any questions please join us in the forums at pregnancychat.com
Thanks for watching, I’m Monica Healy.