Miscarriage

A miscarriage is the spontaneous natural termination of a pregnancy before fetal development has reached viability. Miscarriages occur in less than 20% of known pregnancies. Most miscarriages happen in the first 12 weeks of pregnancy.

Symptoms for miscarriage may include:

  • Vaginal spotting or bleeding
  • Pain or cramping in your abdomen or lower back
  • Or most commonly fluid or tissue passing from the vagina.

Occasionally women do not experience any symptoms and their miscarriage is only diagnosed via an ultrasound.

If you are bleeding heavily, that is changing a sanitary pad every hour, feeling dizzy, or experiencing severe stomach pain contact your health care provider to exclude an ectopic pregnancy. If you have a fever, constant shivering or have vaginal discharge with a strong odour, have your doctor check for infection.

Most of the time a miscarriage is an incidental occurrence. Most commonly there was a chromosomal abnormality of the baby which caused the miscarriage. Very rarely uterine abnormalities or malformation can cause a miscarriage.

Other causes of miscarriage:

  • Responses by the immune system that can result in a disruption to the implantation of the embryo.
  • Hormone imbalances at the time of conception or early on in the pregnancy.
  • Blood clotting problems
  • Smoking, both active and passive, can cause miscarriages.
  • Consumption of any amount of alcohol and recreational drugs may affect the pregnancy
  • An increase in maternal age can cause an increase in the risk of a spontaneous miscarriage.
  • The use of anti-inflammatory drugs early in the pregnancy
  • Fever and infections

The health conditions of the mother can also affect the risk of a miscarriage, maternal conditions such as uncontrolled diabetes, or thyroid disease could lead to a miscarriage.

Routine activities such as exercise, working, and sexual intercourse, as well as stress do not increase the risk of pregnancy loss in routine or uncomplicated pregnancies.

If you’re concerned about early miscarriage, concentrate on taking good care of yourself and your baby. Seek regular prenatal care, manage any chronic conditions and avoid known risk factors for miscarriage.

Factors that may increase the risk of miscarriage include:

  • Age: As a woman’s age increases, her risk of miscarriage does as well. Some research also suggests that paternal age can also be a factor.
    • Women who are 35 have a 20-25% risk
    • Women who are 40 have a 40-50% risk
    • Women who are 45 or older have an 80% risk
  • Previous miscarriages: Women with two or more miscarriages are at a higher risk.
  • Diabetes or other chronic conditions
  • Uterine or cervical malformations or conditions
  • Ingestion or inhalation of cigarette smoke, alcohol or illicit drugs
  • Weight: The risk of miscarriage is increased if the mother is under or over-weight.
  • Invasive prenatal tests: Tests such as amniocentesis or chorionic villus sampling increase the risk of miscarriage.

In a small percentage of women a miscarriage can cause a uterine infection, also known as a septic miscarriage. Which can cause fever, chills, tenderness and soreness in the lower abdomen, and vaginal discharge with a strong unpleasant odour.

Very rarely women can haemorrhage with their miscarriage, hence it is important to see a doctor if you are bleeding very heavily.

Diagnosis can be through pelvic examinations, blood tests, or ultrasounds.

If the pregnancy is continuing

If you’re experiencing a threatened miscarriage, which is the signs of a miscarriage without the loss of the pregnancy, it is best not to do anything strenuous, like work, exercise, or engage in sexual intercourse until the bleeding stops. However bed rest is not shown to reduce the risk of miscarrying.

If the pregnancy is not continuing

If you have had an incomplete miscarriage, or there is still tissue remaining in your uterus, you have three options to consider.

  1. Conservative Management: The “wait and see” method is the first method suggested to women who have shown no signs of damage or infection. This includes resting at home and monitoring any output to see if you pass the tissue without any medical intervention. This will often occur within four weeks of the determined ‘loss’ of the pregnancy. This can be an emotionally difficult time and it is advisable to have a support person in case of heavy bleeding followed by fainting, this will result in a need for immediate medical attention.
  2. Medical Management: This may require hospital admission and medication. Vaginal tablets are used to soften the cervix and cause contraction of the uterus which will potentially expel the tissue. For 70-90% of women, this medication will work within 24 hours, if the medication does not work surgery may be needed.
  3. Surgical Management: This involves a small operation, called suction dilation and curettage, which involves the dilation of the cervix and the removal of any placental and fetal tissue remaining in the uterus. Surgical management is only needed if the other treatments have failed, or miscarriage is initially accompanied by severe bleeding or signs of infection.

After the loss of a pregnancy, you may experience a range of emotions, including:

  • Denial: You may find yourself in shock or disbelief.
  • Anger: You may be angry at yourself, your partner or a higher power for letting this happen.
  • Guilt: You may wonder if you could have done anything to avoid the pregnancy loss.
  • Depression: Your pain and sorrow may lead to feelings of inadequacy and self-pity.
  • Acceptance: Each step in the grieving process brings you closer to acceptance, which may help ease your pain.

If you experience three or more miscarriages in a row, which is known as a recurrent miscarriage, you should see a specialist gynaecology clinic for investigations.