Miscarriage
What is Miscarriage?
Miscarriage refers to the unexpected loss of a pregnancy from
the time of conception up to 5 months of pregnancy. After this
time the term stillbirth is used.
How do I know if a Miscarriage is
happening?
Miscarriage usually starts with bleeding from the vagina,
crampy abdominal pain or both. The pain and bleeding increase,
the cervix (neck of the womb) opens and the placenta, fluid
and embryo are passed through the vagina. In most cases this
happens in early pregnancy and you will not recognize the
embryo or placenta as both are very small. The most you will
note is blood loss possibly with 'stringy material' which
is the placenta. The blood loss is usually equivalent to a
heavy period.
Not all patients however with pain and bleeding in early
pregnancy progress to miscarriage and pregnancy loss. In fact,
bleeding or spotting along with, crampy lower abdominal pains
are quite common symptoms in early pregnancy and most settle
with time. In only a few cases do the symptoms worsen and
lead to miscarriage.
What Causes Miscarriage?
Up to 15% of pregnancies are lost as a result of miscarriage.
Some pregnancies are lost before you miss your period and
therefore go unnoticed, but most are lost at 5-12 weeks of
pregnancy. Most miscarriages occur as a result of a chromosomal
or genetic problems in the developing embryo. In a sense they
are nature's way of dealing with a pregnancy where the baby
is likely to be born with serious physical or mental handicap.
The earlier the miscarriage occurs the more likely there is
a serious genetic or chromosomal problem. For example at 5-6
weeks of pregnancy approximately 60-70% of miscarriages are
due to chromosomal or genetic abnormalities such as Down Syndrome.
The Grief of Miscarriage
Pregnancy loss is a sad and upsetting time for both you and
your partner. Most patients before they present with signs
of miscarriage have begun to think ahead in pregnancy and
about the end result of a healthy baby. The news of miscarriage
therefore comes as a great shock. Experiencing grief and sadness
is however a normal and important response in these circumstances
and helps in the long run with the emotional healing process
which follows with time.
What Happens Next?
Most patients require a curettage following miscarriage. This
is a procedure which involves a brief hospital admission,
a light anaesthetic, dilatation of the cervix (opening of
the neck of the womb) and removal of the remaining tissue
from within the uterine cavity. Dilatation and curettage,
or "D&C" brings an end to the pain and bleeding and reduces
the risk of pelvic infection particularly with late miscarriages.
Many patients find this procedure helpful in that it helps
to recover more speedily with the grief of the situation and
enables them to start thinking more positively and possibly
about the next pregnancy.
In some patients, particularly those who miscarry in early
pregnancy, when only a tiny amount of remaining tissue is
present in the uterus, a D&C is not necessary. The small volume
of remaining tissue is either reabsorbed back into the body
or passed through the vagina.
When will I be able to get pregnant
again?
It is generally advised that you should wait for at least
the return of a normal period. This allows regeneration of
the lining of the uterus and creates a more favorable environment
for implantation of the next pregnancy.
Will this happen to me again?
For most patients there is no significant increased risk of
miscarriage in the next pregnancy. Your miscarriage risk with
the next pregnancy is therefore similar to the background
risk i.e. as though you are on a fresh starting block. Investigations
for miscarriage are generally arranged only if you have had
the misfortune of having 3 or more consecutive miscarriages.
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