Early Pregnancy Loss or Miscarriage

A miscarriage, sometimes called a spontaneous abortion, is any pregnancy that ends spontaneously before the fetus can survive outside the womb, usually at less than 20 weeks. Miscarriage occurs in about 15-20% of all recognized pregnancies, and most often occurs before the 13th week of pregnancy.  Some miscarriages happen before a woman knows that she is pregnant.  About 15% of fertilized eggs are lost before the egg even has a chance to implant (embed itself) in the wall of the uterus. A woman would not generally identify this type of miscarriage.  Another 15% of conceptions are lost before eight weeks' gestation, often before a woman skips a menstrual period.  Often, the cause of a miscarriage cannot be determined. The most common known causes of miscarriage in the first trimester are:

• Chromosome problems with the fetus.  These problems probably account for more than half of all early miscarriages.  Chromosomes are the microscopic components of every cell in the body that carry all of the genetic material that determine hair color, eye color, and our overall appearance and body chemistry.  Chromosomes duplicate and divide many times during the process of development, and there are numerous points along the way where a problem can occur.  Over 50% of tissue samples obtained from first trimester miscarriages contain faulty chromosomes.  The potential for chromosome problems increases as a woman ages, and women over 35 have a higher rate of miscarriage than those under 35.
• The medical condition of the mother.  Immune system diseases (such as lupus), insufficiently controlled diabetes, hormonal conditions and some infections can increase a woman’s risk of miscarriages.
• Congenital (present at birth) problems with the mother’s uterus or cervix.  Abnormal anatomy of the uterus can also cause miscarriages. In some women there can be a tissue bridge (septum) that acts like a partial wall dividing the uterine cavity into sections. The septum usually has a very poor blood supply, and is not well suited for placental attachment and growth. Therefore, an embryo implanting on the tissue bridge would be at increased risk of miscarriage. 

The Signs of Miscarriage

One or more of the following symptoms may appear during a miscarriage, but none of these mean that a miscarriage has definitely occurred.  Tell your physician immediately if any of these occur:

• Vaginal bleeding that may be preceded by a brownish discharge
• Cramps in the pelvic area
• Tissue or blood clots passing from the vagina
• A decrease in the usual signs of early pregnancy, such as nausea and breast tenderness
• Pain in the lower back or abdomen

 What the Physician Can Do

The physician may order a blood test or ultrasound based on your symptoms.  He or she may do a pelvic exam to see if your cervix has opened.  If the physician does not think a miscarriage has occurred, you will probably be advised to rest and avoid having sex.  If a miscarriage has occurred, you may need medication to help empty your uterus or a D&C (dilation and curettage) procedure to remove any tissue that may remain in your uterus in order to avoid infection.A D&C is usually a minor 10 to 15 minute operation, usually performed under a general or local anesthetic.  It involves dilating (opening) your cervix, or neck of the uterus (womb), and gently scraping it with a curette (an instrument with a long handle, the end shaped like the rim of a hollow spoon). Any pregnancy tissue that is left is removed which is done to prevent infection and excessive bleeding.   Some women experience some cramping and period-like pain after the D&C. Your physician will want to schedule a follow-up visit to check on your progress.  If you experience heavy bleeding, severe pain, fever or chills, it is best to call your physician immediately.

Your Emotional Health

The unexpected and unwanted termination of a pregnancy can result in intense feelings of loss.   Those who have recently experienced a miscarriage may find it difficult to go to work, see friends, or just get out of bed in the mornings.  Shock, grief, anger and guilt are all a natural part of the coping process.  You and your partner may respond differently to the grieving process.  Although your partner may be having the same reactions, he may express his in an entirely different way.  You may find that your relationship becomes strained as both of you come to terms with your grief, so it is important to stay close and connected. It’s sometimes a good idea to set aside some quiet time for just the two of you to help you to stay connected during the grieving process.

Remember

You need to know that the great majority of miscarriages are not a result of a woman’s actions; rather, they are nature’s way of ending a pregnancy that would not have produced a healthy baby.  There is no proof that exercising, having sex, overexertion, or having used birth control pills in the past have any effect on a woman’s risk of miscarriage.  Over 95% of women who have experienced a miscarriage become pregnant again and deliver healthy babies.

If you or your partner find you are having real difficulty in coping with the loss, you can always talk to your physician or midwife.