Understanding Miscarriage

 It is estimated that one in four pregnancies end in miscarriage. Many miscarriages are unreported, or go unrecognised, because they occur very early in the pregnancy. 

Spontaneous miscarriage is defined as the loss of a pregnancy before 20 weeks’ gestation. Most spontaneous miscarriages (75 to 80 per cent) occur in the first 12 weeks of pregnancy. It is estimated that one in four pregnancies end in miscarriage. Many miscarriages are unreported, or go unrecognised, because they occur very early in the pregnancy.

The types of miscarriage that can occur include:

  • Missed abortion: occurs when the pregnancy has failed, although there has not been any bleeding or other signs. Occasionally, the aborted pregnancy may remain in the uterus for weeks, or even months, until bleeding commences. Missed abortion is suspected when pregnancy symptoms disappear and the uterus stops growing. It is diagnosed by an ultrasound examination.
  • Blighted ovum: this occurs when a pregnancy sac is formed but there is no developing baby within the sac. This is diagnosed by ultrasound, usually after some bleeding.
  • Ectopic pregnancy: this occurs when the developing pregnancy implants in the fallopian tubes rather than in the uterus. One to two per cent of all pregnancies are ectopic and without treatment, an ectopic pregnancy can seriously impact on your health and fertility.

What Causes a Miscarriage?

Usually there is no treatable cause found for a miscarriage. Research tells us that about half of all miscarriages happen because the chromosomes in the embryo are abnormal and the pregnancy doesn’t develop properly from the start. In this case, miscarriage is nature’s way of dealing with an abnormal embryo.

Nothing can be done to prevent miscarriage from occurring if a pregnancy is developing abnormally. However, there may be reasons why some women are at higher risk of experiencing a miscarriage:

Age

Miscarriages are more common in older women than younger women, largely because chromosomal abnormalities are more common with increasing age.

 

Lifestyle

Miscarriages are also more common in women who smoke and in women who drink more than three alcoholic drinks per week in the first 12 weeks of pregnancy. Research suggests that miscarriage is also more common in women who drink more than 500mg of caffeine per day; this is about three to five cups of coffee.

 

Medical Conditions

Some medical conditions in the mother, such as uncontrolled diabetes, fibroids, or thyroid problems, can lead to miscarriage. Rare medical conditions that affect blood clotting can also cause miscarriage. Women who have three or more subsequent miscarriages should be tested for these conditions.

 

Diagnostic Procedures

Early tests in pregnancy, such as Chorionic Villi Sampling (CVS) and Amniocentesis, carry a small risk of miscarriage. These are tests that involve passing a needle into the uterus. These tests are only carried out in women of increased maternal age, or to detect particular abnormalities more accurately.

 

Uterine and Cervical Abnormalities

Abnormalities in the shape of the uterus can lead to miscarriage. This tends to occur after 12 weeks and is due to a weakness in the neck of the uterus, or due to implantation on a septum (divide of the uterus). Appropriate blood supply may not occur to these abnormal areas to support the growing fetus, therefore resulting in miscarriage of the pregnancy.

 

Symptoms of a Miscarriage

Pain and bleeding in early pregnancy can mean that you are having a miscarriage, but not always. Bleeding is very common in early pregnancy, affecting about one in four women, many of whom will go on to have a healthy baby. Early bleeding that does not lead to miscarriage will not have caused your baby any harm.

If the bleeding is being caused by a miscarriage, there is no treatment or therapy that can stop the miscarriage from occurring. However, it is still very important that you see a health professional.

 

What can you do to Prevent Miscarriage?

Look after your general health; decrease or eliminate smoking, modify caffeine intake, avoid alcohol and where possible avoid contact with others who have a serious infectious illness. Usually the next pregnancy will be normal, but if you have three miscarriages in a row further tests are recommended. Such testing would include investigation of parental chromosomes, excluding diabetes and thyroid disease, and/or hysteroscopy if miscarriages occur after 12 weeks’ gestation, to name a few.

For lesbian couples experiencing recurrent miscarriages (or failed IVF attempts and specific genetic disorders), Advanced Embryo Selection (AES) using Comparative Genomic Hybridisation (CGH) is an option – this is an advanced technique used to test for genetic disorders.

 

How is a Miscarriage Diagnosed?

Women seek medical care at different stages of a miscarriage; sometimes the miscarriage has already happened and sometimes it has only just begun. A combination of symptoms (such as pain and bleeding), examination findings, ultrasound and blood tests will confirm whether you have had, or you are having, a miscarriage.

A miscarriage is usually diagnosed as complete, incomplete or missed:

  • Complete: is when all the pregnancy tissue has passed.
  • Incomplete: when some of the pregnancy tissue has passed, but some is still inside the uterus.
  • Missed: miscarriage is when the pregnancy has stopped growing but the tissue has not passed and there is still a “sac” in the uterus.

 

When Should you Attempt to Conceive Again?

You should only attempt another pregnancy when you feel both physically and emotionally ready and have undergone any necessary investigations to determine the cause of miscarriage if possible. Most clinicians will recommend having a normal menstrual cycle prior to attempting a subsequent pregnancy.

 

Coping with Miscarriage

How you cope with miscarriage depends very much on your personality and your situation. Every person is different, and the way that each individual deals with her own emotions is unique.

Coping with miscarriage involves finding the strength within yourself and within your relationship to get through this difficult period. It also involves asking for help when you need it.

While the medical focus may be on treating the physical causes of miscarriage, it’s equally important to take care of your emotional well-being. Rainbow Fertility has a team of counsellors and other trained staff to help you deal with the stress and emotions involved in miscarriage and resolving fertility problems.

 

 

Current as at 01.02.2016

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