EVERYTHING YOU NEED TO KNOW ABOUT MISCARRIAGE

WHAT ARE THE SYMPTOMS? 

Let’s start simple. What is a miscarriage? A miscarriage is the loss of a pregnancy during the first 23 weeks. The main sign is vaginal bleeding, which may be followed by cramping and pain in your lower abdomen. This can vary from light spotting or brownish discharge to heavy bleeding and bright-red blood or clots. The bleeding may come and go over several days. If you have vaginal bleeding, contact a GP or your midwife. Most GPs can refer you to an early pregnancy unit at your local hospital straight away if necessary. But bear in mind that light vaginal bleeding is relatively common during the first trimester (first 3 months) of pregnancy and does not necessarily mean you're having a miscarriage.

Other symptoms of a miscarriage include:

• Cramping and pain in your lower tummy.
• Discharge of fluid from your vagina.
• Discharge of tissue from your vagina.
• No longer experiencing the symptoms of pregnancy, such as feeling sick and breast tenderness.

 

  

WHAT ARE THE CAUSES?

Discovering an exact cause for a miscarriage is difficult. In most cases, the cause is something you couldn’t have prevented, meaning you couldn’t have prevented the miscarriage, either. Rarely, doctors are able to find an issue that increases the risk for a miscarriage. In that case, treating the issue may help prevent a future miscarriage.

First trimester

Around 80% of miscarriages occur in the first trimester. The first trimester refers to the time between weeks 1 and 13. Common causes of miscarriage in the first trimester include:

• Genetic abnormalities. More than half of all first trimester miscarriages are the result of problems with the fetus' chromosomes. If your body detects the fetus has damage or missing chromosomes, it will end the pregnancy.
• Blood clots. A condition called antiphospholipid syndrome (APS) causes blood clots that can end a pregnancy. This condition can be treated with medications to prevent a miscarriage.
• Ectopic pregnancy. This potentially serious but rare type of pregnancy occurs when the fetus begins developing outside the womb. Ectopic pregnancies cannot be saved and are a medical emergency requiring immediate treatment.
• Placental problems. If the fetus and placenta are not compatible, the pregnancy may be lost. Likewise, uterine defects, including an abnormal shape, may also cause the sudden end of a pregnancy.

Second trimester 

A miscarriage in this later stage of pregnancy, weeks 13 to 24, is much less common. If it does occur, the cause is likely related to external health conditions, or problems with the mother’s health. These second trimester issues that may lead to pregnancy loss include:

• Infection. Infections within the uterus or cervix can lead to a miscarriage. Likewise, food-borne illnesses may put a woman at risk for a miscarriage.
• Chronic conditions. Chronic conditions like diabetes or high blood pressure increase a woman’s risk of having a miscarriage. The risk is higher if the condition isn’t properly treated or managed.
• Thyroid disease. Untreated thyroid conditions increase risk of miscarriage.
• Autoimmune conditions. Lupus, as well as other autoimmune conditions, can lead to a miscarriage.
• Problems with the uterus or cervix. Fibroids or an abnormally shaped womb may cause a miscarriage.
• Lifestyle factors. Smoking, second-hand smoke, consuming alcohol, and drug use can interfere with a fetus’s development. High caffeine consumption may also be problematic.
• Environmental factors. Exposure to certain chemicals or hazards can cause a miscarriage. These include mercury, solvents, paint thinners, pesticides, and heavy metals. Air pollutants have also been linked to an increased risk of miscarriage.

Third trimester

At this late stage of a pregnancy, a miscarriage is more commonly called stillbirth. The same issues that can cause a miscarriage in the first two trimesters of a pregnancy can also be responsible for a pregnancy loss in the third trimester. But, understanding the exact cause is often difficult. These issues may include:

• Pregnancy complications. This includes preterm labor or the separation of the placenta from the womb.
• Birth defects. One in 10 stillbirths are the result of a genetic or structural birth defect.
• High blood pressure. Preeclampsia occurs in 5-8% of all pregnancies. While the greatest risks of this condition are to the mother, preeclampsia can cut off the supply of oxygen and nutrients to the fetus. Preeclampsia can also progress to eclampsia, a very serious condition that can be fatal to the fetus and woman.
• Uncontrolled diabetes.
• Infection. An infection in the placenta or in the fetus can cause the end of the pregnancy.
• Problems with the umbilical cord. If this cord is knotted or squeezed, it can cut off the flow of blood and oxygen to the fetus.
• Problems with the placenta. Insufficient blood flow to the placenta can end in a miscarriage.

 

  

IS THERE A WAY TO TEST IT?

The hospital can carry out tests to confirm whether you're having a miscarriage. The tests can also confirm whether there's still some pregnancy tissue left in your womb (an incomplete or delayed miscarriage) or if all the pregnancy tissue has been passed out of your womb (a complete miscarriage).

The first test used is usually an ultrasound scan to check the development of your baby and look for a heartbeat. In most cases, this is usually carried out using a small probe inserted into the vagina (transvaginal ultrasound). This can feel a little uncomfortable but is not painful.

You may be able to have an external scan of your tummy if you prefer, although this method reduces the accuracy of the scan. Neither type of scan is dangerous to the baby and they do not increase your risk of miscarriage. 
You may also be offered blood tests to measure hormones associated with pregnancy. You usually need to have 2 blood tests 48 hours apart to see if your hormone levels go up or down. Sometimes a miscarriage cannot be confirmed immediately using ultrasound or blood testing. If this is the case, you may be advised to have the tests again in 1 or 2 weeks.
If there's no pregnancy tissue left in your womb, no treatment is required.

However, if there's still some pregnancy tissue in your womb, your options are:

• Expectant management – wait for the tissue to pass out of your womb naturally.
• Medical management – take medicine that causes the tissue to pass out of your womb.
• Surgical management – have the tissue surgically removed.

The risk of complications is very small for all these options. It's important to discuss them all with the doctor in charge of your care.

 

 

WHAT HAPPENS IF I HAVE IT?

If you have a miscarriage in your first trimester, you may choose to wait 7 to 14 days after a miscarriage for the tissue to pass out naturally. This is called expectant management.

If the pain and bleeding have lessened or stopped completely during this time, this usually means the miscarriage has finished. You should be advised to take a home pregnancy test after 3 weeks. If the test shows you're still pregnant, you may need to have further tests.

If the pain and bleeding have not started within 7 to 14 days or are continuing or getting worse, this could mean the miscarriage has not begun or has not finished. In this case, you should be offered another scan.

After this scan, you may decide to either continue waiting for the miscarriage to occur naturally, or have drug treatment or surgery. If you choose to continue to wait, your healthcare professional should check your condition again up to 14 days later.

Contact your hospital immediately if the bleeding becomes particularly heavy, you develop a high temperature (fever) or you experience severe pain.

Medicine

You may choose to have medicine to remove the tissue if you do not want to wait, or if it does not pass out naturally within 2 weeks. This involves taking tablets that cause the cervix to open, allowing the tissue to pass out. In most cases, you'll be offered tablets called pessaries that are inserted directly into your vagina, where they dissolve. The tablets usually begin to work within a few hours. You'll experience symptoms similar to a heavy period, such as cramping and heavy vaginal bleeding. You may also experience vaginal bleeding for up to 3 weeks. In most units, you'll be sent home for the miscarriage to complete. This is safe, but ring your hospital if the bleeding becomes very heavy.

You should be advised to take a home pregnancy test 3 weeks after taking this medicine. If the pregnancy test shows you're still pregnant, you may need to have further tests. You may be advised to contact your healthcare professional to discuss your options if bleeding has not started within 24 hours of taking the medicine.

Surgery

In some cases, surgery is used to remove any remaining pregnancy tissue. You may be advised to have immediate surgery if:

• You experience continuous heavy bleeding.
• There's evidence the pregnancy tissue has become infected.
• Medicine or waiting for the tissue to pass out naturally has been unsuccessful.

Surgery involves removing any remaining tissue in your womb with a suction device. You should be offered a choice of general anaesthetic or local anaesthetic if both are suitable.

 

After a miscarriage

A miscarriage can be very upsetting, and you and your partner may need counseling or support. You may also have questions about trying for another baby and what happens to the miscarried fetus. A miscarriage can have a profound emotional impact on you and also on your partner, friends and family.

Remembrance

It's usually possible to arrange a memorial and burial service if you want one. In some hospitals or clinics it may be possible to arrange a burial within the grounds. You can also arrange to have a burial at home, although you may need to consult your local authority before doing so. Cremation is an alternative to burial and can be performed at either the hospital or a local crematorium. However, not all crematoriums provide this service and there will not be any ashes for you to scatter afterwards. You do not need to formally register a miscarriage. However, some hospitals can provide a certificate to mark what has happened if you want one.

Emotional impact

Sometimes the emotional impact is felt immediately after the miscarriage, whereas in other cases it can take several weeks. Many people affected by a miscarriage go through a bereavement period. It's common to feel tired, lose your appetite and have difficulty sleeping after a miscarriage. You may also feel a sense of guilt, shock, sadness and anger – sometimes at a partner, or at friends or family members who have had successful pregnancies.

Different people grieve in different ways. Some people find it comforting to talk about their feelings, while others find the subject too painful to discuss. Some people come to terms with their grief after a few weeks of having a miscarriage and start planning for their next pregnancy. For others, the thought of planning another pregnancy is too traumatic, at least in the short term.

If you're in a relationship, it can help to make sure you're both open about how you are feeling. Your partner may also be affected by the loss. Men sometimes find it harder to express their feelings, particularly if they feel their main role is to support the mother and not the other way round. Miscarriage can also cause feelings of anxiety or depression, and can lead to relationship problems.

 

  

CAN I PREVENT IT?

Most miscarriages are caused by genetic abnormalities in the fetus. Unfortunately, there is nothing that can be done to prevent miscarriages caused by genetic abnormalities.

However, not all miscarriages are caused by genetic abnormalities. If you have had a miscarriage, work with your health care provider to determine the reason for your miscarriage, if possible, and to plan a future pregnancy. A healthy lifestyle before and during pregnancy may help.

Here are some tips that may help prevent miscarriage:

• Be sure to take at least 400 mcg of folic acid every day, beginning at least one to two months before conception, if possible.
•  Exercise regularly.
• Eat healthy, well-balanced meals.
• Manage stress.
• Keep your weight within normal limits.
• Don't smoke and stay away from secondhand smoke.
• Don't drink alcohol or have more than one to two cups of a caffeinated beverage like coffee a day.
• Avoid illicit drugs.
• Make sure you are up to date on immunizations.

These steps may help to prevent miscarriage, too:

• Avoid radiation and poisons such as arsenic, lead, formaldehyde, benzene, and ethylene oxide.
• Take special care to keep your abdomen safe while pregnant. Avoid sports that carry a higher risk for injury, such as contact sports and skiing, and always wear your seat belt.
• Check with your health care provider before taking any medication including over-the-counter drugs during pregnancy.
• Avoid environmental hazards such as X-rays and infectious diseases.

You can also help ensure a healthy baby by finding out about and treating any health conditions you have before you try to conceive. If, for example, you know a previous miscarriage was due to an autoimmune response or a hormonal imbalance, seek treatment for this underlying condition. Once you become pregnant, get early, comprehensive prenatal care to improve your chances of a healthy pregnancy.