What Is Miscarriage?
Miscarriage is mostly described as losing an early pregnancy. Miscarriages mostly occur within the first three months of pregnancy. Some occur later on, but in the second half of pregnancy when the fetus (unborn baby) begins to have a chance of survival, the description 'premature labour' starts to be used.
What Are The Signs And Symptoms Of Miscarriage?
Names are given for the different ways miscarriage can happen. Below is a list of these terms with a brief description of their meanings:
• Threatened miscarriage: Any bleeding from the vagina during early pregnancy, whether or not there is pain, is a threatened miscarriage. Most cases settle and the pregnancy carries on.
• Inevitable miscarriage: usually where there is vaginal bleeding and pain and where your doctor can feel internally that the cervix or neck of the womb is open. The cervix would normally stay shut all through pregnancy until labour begins.
• Complete Miscarriage: The complete expulsion of the pregnancy from the womb. If nothing is left inside the womb, pain and bleeding stop and physical healing can begin.
• Incomplete Miscarriage: This describes the situation where a miscarriage is happening but not all the tissues have been expelled. Usually your doctor would advise a short operation to 'evacuate the womb' under an anaesthetic. If tissue remains in the womb it can cause continued bleeding and can lead to infection.
• Blighted Ovum: An old-fashioned sounding term used when a pregnancy appears to be progressing but a scan shows that the fetus (developing baby) has not formed. In this situation, even if you feel fine and even if your pregnancy test is still positive, your doctor will have to tell you that the pregnancy is not destined to result in a baby. The only thing your doctor will want to sure about is if it may be possible that you are not as far on as you thought and the fetus is too small to be seen on the scan. If this is a possibility a repeat scan a week or two later will give the answer.
• Missed Miscarriage: A pregnancy that has started but the fetus has no heartbeat and has died. Often it is only discovered when you go for a scan. Sometimes it may be suspected if your womb is 'small for your dates'. If the fetus is very small and there is a possibility that you are not as far on as you thought a repeat scan may be offered a week or two later to be sure. Fetal heartbeats in very early pregnancy are tiny and can be hard to see on a scan.
• Recurrent Miscarriage: Definitions vary but most would agree it describes a situation where you have had four or possibly three consecutive miscarriages. The chance for any one pregnancy to miscarry is one in six, for two it is one in thirty-six. It can be tempting to rush into having detailed tests after two miscarriages, especially if you have not had any pregnancies that have resulted in a healthy baby. However the chance that a cause will be found is remote and the chance of a treatment being effective is even more remote. Many hospitals now run a recurrent miscarriage clinic. A figure often quoted is that if you have had four pregnancies and all have miscarried, you are still more likely to have a baby at term in the fifth pregnancy than another miscarriage.
• Septic Miscarriage: Miscarriage can occasionally be caused by infection or sometimes followed by infection. These are termed 'septic'.
• Chemical Pregnancy: A curious term usually used when a woman has had a positive pregnancy test only to have a late heavy period. It is presumed that a very early miscarriage has taken place. A spark that has failed to catch fire.
• Tubal Miscarriage: Pregnancies outside the womb are called ectopic. They can cause serious complications. Occasionally however they suffer the same fate as pregnancies in the womb and stop growing. They can cause pain and some vaginal bleeding. This form of miscarriage is uncommon.
• The 'Vanishing Twin': High resolution scanning in very early pregnancy not infrequently shows twins. To everyone's surprise, scanning a few weeks later sometimes finds only one fetus. Nothing may have happened to suggest a problem. Occasionally there may have been some tummy pains or light vaginal bleeding. It is thought that one fetus has stopped growing and been absorbed or disappeared. It does not seem to be a problem for the surviving fetus.
• Molar Pregnancy: A problem with the placenta or afterbirth. There are a range of conditions ranging from minor abnormalities (only discovered after childbirth) through to a form of miscarriage and very rarely indeed a placental tumour or cancer. Special pregnancy tests and ultrasound scans show this up. These are rare.
• Iatrogenic Miscarriage: Iatrogenic means 'caused by the doctor'. This is not common. Miscarriage can occasionally follow special tests on the womb like amniocentesis.
Sadly miscarriage is common, 15% of pregnancies miscarry. In most cases it is thought that the development and growth of the embryo goes wrong. The pregnancy will not produce a healthy baby and nature steps in to end it. Because it is common and because a treatable cause is rarely found it is not usual to perform many tests. The priority is to help you through it as sensitively and safely as possible so that your health can be restored, and if you wish, so that you can soon start trying to become pregnant again.
Studies have shown a number of reasons why miscarriage occurs. Sometimes the embryo cells just fail to grow. Sometimes the baby's chromosomes are not able to produce a healthy child. Sometimes the placenta, or afterbirth, which nourishes the baby has not formed properly or, perhaps, clots have formed in its blood vessels. In some cases there is a problem with the shape of the womb. Fibroids can sometimes cause problems. If the placenta is situated over a large fibroid its blood supply can be reduced. Occasionally this can cause miscarriage.
Infection is not a common cause of miscarriage. New born lambs can carry a bacteria that causes miscarriage and pregnant women should keep away from sheep at lambing time. The bacteria Listeria which can contaminate food can cause miscarriage too. This normally produces a flu-like illness in the mother which is followed by a late miscarriage. It is rare.
Women with true 'recurrent miscarriage' will be offered a variety of investigations. Very uncommon conditions where there are abnormal antibodies in your blood can be detected using sensitive blood tests. Some women have slight abnormalities of their blood clotting systems. These can affect the developing placenta and cause miscarriage as well as problems with the nutrition of the unborn babies where the pregnancy continues.
It is important to say what does not cause miscarriage as well. This is because you will almost certainly be searching for things you have done (or not done) that might have caused it. Physical exercise does not cause miscarriage. Neither does sexual intercourse. It is important for you to know this as it is so easy to feel guilty when, in fact, the miscarriage was not your fault. If you were asked to make yourself miscarry you would be unable to do it. There is scientific evidence using hormone measurements to show that pregnancies destined to miscarry have started to go wrong before you even missed that first period.
Will I Have Any Tests Or Investigations?
The two most common tests you may be offered are an examination of the tummy and womb and an ultrasound scan. The doctor's examination assesses the cervix or neck of the womb and allows an estimation of the size of the womb to be made. The scan gives a great deal of information about the pregnancy. For example is the fetus alive? Or has the miscarriage been complete?
It is important that your blood group is known. Women who are Rhesus negative should have an injection of Anti-D Immunoglobulin. (The only exception to this is when the miscarriage is early and complete, and where operation has not been necessary to empty the womb). If the pregnancy was a Rhesus positive one then without this injection a Rhesus negative woman could make antibodies that could damage any subsequent Rhesus positive babies.
You may be offered a blood count, especially if you have bled significantly. Sometimes samples are taken to look for infection and occasionally samples are taken to test for chromosome abnormalities. These tests are done to gather information for the future as much as to account for why you have miscarried now.
What Treatment Might I Need?
This depends on what is happening. In a complete miscarriage no specific treatment may be needed. But if you are in a lot of pain or bleeding significantly it is usual to empty the womb under anaesthetic. A similar procedure is often advised if the miscarriage has been incomplete. If a blighted ovum or missed miscarriage has been diagnosed it is possible to wait for nature to take its course. However most women will want to end a fruitless pregnancy. This can be done under anaesthetic by 'evacuating' the womb. It can also be brought about using drugs that bring on a miscarriage. This involves taking some anti-progesterone pills and a day or two later taking pills that cause the womb contractions of miscarriage to begin.
What Course Will The Miscarriage Follow
What you have read above will have described the various events that may have happened to you. The treatment of a miscarriage is usually straightforward from the physical point of view. Your doctor will want you to safely and cleanly progress through the miscarriage so that you can begin to recover. Miscarriage rarely has any physical after-effects and future pregnancies are almost never affected by a previous miscarriage. The most important part of your recovery is from the emotional trauma of miscarrying.
Miscarriage involves losing something in exactly the same way as with the death of a member of the family or a friend. However with miscarriage you are grieving for what might have been, for a history that never happened. Your hopes and expectations have been ruined and you have to grieve. Grief is a painful process but without it we can find we do not get over things as well as we might have expected. After the initial shock you can find yourself experiencing feelings of guilt or perhaps anger. This is part of the process of coming to terms with your loss. Eventually your life will get back to normal and although you will never forget the miscarriage and it may always cause you to feel sad, you should re-engage with life.
Every person will have a different story to tell about their coming to terms with miscarriage. For some people it may not be very traumatic, for others it can be devastating.
Can I Do Anything To Help Myself?
Physically, most women make a quick and full recovery. Emotionally, things can be a problem. How can you come through this? The answer is to talk.
Talk about how you feel. Choose someone with whom you feel comfortable sharing your feelings. Many women are astounded to discover how many of their friends and work colleagues have also had miscarriages. You have joined a big club. If you do not feel comfortable sharing your feelings with people you know you can speak to someone from a miscarriage support group. Your local hospital should have information on this and a phone number. Your library may have information and The Samaritans have lists of contacts and are great listeners. Your own GP and midwife will be sad to hear your news. Why not go along for a chat. Your doctor may have suggestions about the future. Certainly contraception should be considered.
When you are better, remember that you have had an experience that others will have. Do not be surprised if, in the future, you come across a friend or relative in the same situation. You may be able to help them from your own experiences. Don't forget your pregnancy. It happened. Many women mark this significant event in some way. Maybe a buying special piece of jewellery or writing a short story or a poem may be a 'rite of passage' for you. So, if you wish, do something in your own way to mark the event.
Tell Your Doctor
1. Ongoing symptoms: Let your doctor know if you are having any problems. Bleeding, discharge, pain and breast symptoms, as well as how you are in your spirits
2. Work: If you work out of the house deciding when to go back needs consideration. You need time and space to come to terms with your loss. So rushing back as if nothing has happened is not wise. You do have to get back into the swing sometime but it should not be too rushed. Many women have a week or two off to come to terms with things.
3. Family: While everyone rallies to comfort you, your partner is liable to be overlooked. He has lost something too, but is probably doing his best to be strong for you. He has lost his baby too and your own parents may feel that they have lost a potential grandchild. Every family is different.
4. Contraception: probably not what you want to be thinking about but important nevertheless. Even if you want another pregnancy as soon as possible it is wise to let your womb settle down so that it provides the healthiest environment. That takes time. Perhaps a couple of periods should be allowed to go before you try again. You also have to recover from the emotional loss too. Talk about this with your doctor.
5. Whether or not you are rhesus negative: Your doctors may well already know but it does no harm to be sure and remind them.
Ask Your Doctor Five Things
1. Are there any support groups for people like me? Yes. Information can be obtained from your doctor, midwife or hospital clinic.
2. How soon after miscarriage can we try for another pregnancy? Most people wait two or three months so that the womb is back to normal. Many women want to feel in their minds that they have finished one pregnancy before starting another. If you should conceive earlier then do not worry. It happens and your doctor will be delighted to see you. Most women have their first period about six weeks after miscarrying. It can come earlier or later however.
3. Will I be able to carry a baby all right? Your doctor should be able to reassure you to that, in general, the only significance of having had a miscarriage is that you are fertile. Having a miscarriage usually has no meaning other than your bad luck or misfortune.
The Miscarriage Association
Address: 17 Wentworth Terrace, Wakefield WF1 3QW
Phone: 01924 200799
Email: info [at] miscarriageassociation.org.uk