Miscarriage

What is a 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

If you notice any of these symptoms, contact your health care provider immediately. Symptoms of a miscarriage may include:

  • Vaginal bleeding or spotting
  • Pain or cramping in your abdomen or lower back
  • 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, contact your healthcare provider to exclude an ectopic pregnancy. Signs of an infection include: fever, constant shivering or odorous vaginal discharge. If you are experiencing any of these, arrange to see your doctor as soon as possible.

Risk Factors

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 recurrent 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 overweight.
  • Invasive prenatal tests – tests such as amniocentesis or chorionic villus sampling carry a risk of miscarriage.

Causes

Most of the time a miscarriage is an incidental occurrence. Most commonly, there might be a chromosomal abnormality of the baby which can cause a spontaneous natural termination. Very rarely, uterine abnormalities or malformation can cause a miscarriage.

Other causes of miscarriage:

  • Immune system responses that can result in a disruption to the implantation of the embryo
  • Hormone imbalances at the time of conception or early 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 natural termination
  • The use of anti-inflammatory medication early in the pregnancy
  • Fever and infections

Existing or developed health conditions can also affect the risk of a miscarriage. Maternal conditions such as uncontrolled diabetes, or thyroid disease could potentially lead to a miscarriage. Routine activities such as exercise, working, and sexual intercourse do not increase the risk of pregnancy loss in uncomplicated pregnancies.

Treatment

Recognising the signs can help you to prevent a miscarriage from occurring.

A threatened miscarriage is when you are experiencing the signs of a miscarriage without the loss of the pregnancy. If you are experiencing a threatened miscarriage, it is best not to participate in anything strenuous. Work, exercise, or sexual intercourse should be ceased until the bleeding stops. It is possible to experience a successful pregnancy once the threat of a potential miscarriage has subsided.

If you have had an incomplete miscarriage, you have three treatment options to consider.

Conservative Management

This is commonly referred to as the “wait and see” method. It is usually suggested to women who have shown no signs of damage or infection. This includes resting at home and monitoring any output to see if your pregnancy tissue will pass naturally. This is often expected to occur within four weeks of the determined ‘loss’ of the pregnancy.

Medical Management

This may require admission to hospital and medication. Specific medication is used to soften the cervix and cause contractions of the uterus which will potentially expel the tissue.

Surgical Management

This involves a small operation to dilate the cervix and remove any remaining placental or fetal tissue. Surgical management is only required if the other treatments have been attempted and have failed.

If you experience three or more consecutive miscarriages, you should see a specialist gynaecology clinic for further investigation.

After a Miscarriage

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 allowing this loss to occur
  • 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-loathing
  • Acceptance – each step in the grieving process brings you closer to acceptance, which may help to ease your pain

It is important to understand that it is completely normal to experience some or all of the emotions mentioned above. Many women and couples seek emotional support through family, friends or obtain professional assistance following the loss of a pregnancy.