A Complete Introduction to Pregnancy & Miscarriage.
A miscarriage is the loss of a fetus before the 20th week (140 days) of pregnancy. The medical term for a miscarriage is spontaneous abortion, but “spontaneous” is the key word here because the condition is not an abortion in the common definition of the term.
According to the March of the Dimes, as many as 50 percents of all pregnancies end in miscarriage, most often before a woman misses a menstrual period or even knows she is pregnant. About 15 to 25 percent of recognized pregnancies will end in a miscarriage. Probably, more than 80 percent of miscarriages occur within the first three months of pregnancy. Miscarriages are less likely to occur after 20 weeks (140 days) gestation; these are termed late miscarriages.
What are the major causes of Miscarriage?
Most miscarriages happen when the unborn baby (in the belly of a mother) has fatal genetic problems. Usually, these problems are unrelated to the mother.
Other causes of miscarriage include:
- Medical conditions in the mother, such as thyroid or diabetes disease
- Hormone problems
- Immune system responses
- Physical problems in the mother
- Uterine abnormalities
A woman has a highest chance of miscarriage if she:
- Is over age 35
- Has certain diseases, such as thyroid or diabetes problems
- Has had three or more miscarriages
Sometimes a miscarriage happens because there is a weakness of the cervix, called an incompetent cervix, which cannot hold the pregnancy. From an incompetent a miscarriage cervix usually occurs in the second trimester.
There are usually several symptoms before a miscarriage caused by cervical insufficiency. A woman may feel sudden pressure, her “water” may break, & tissue from the fetus & placenta may be expelled without much pain. An incompetent cervix can be treated usually with a “circling” stitch in the cervix in the next pregnancy, usually around 12 weeks. The stitch holds the cervix closed even it is pulled out around the time of delivery. The stitch may also be placed until if there has not been a previous miscarriage if cervical insufficiency is discovered early enough before a miscarriage does occur.
How is a Miscarriage Diagnosed & Treated?
Your health care provider will perform a pelvic exam, an ultrasound test & bloodwork to confirm a miscarriage. If the miscarriage is complete & the uterus is empty, then no further treatment is usually required. Occasionally, the uterus is not completely emptied, so a dilation & curettage (D&C) procedure is performed. During this procedure, the cervix is dilated & any remaining fetal or placental tissue is gently removed from the uterus. As an alternative to the D&C, certain medications can be given to cause the body to expel the contents in the uterus. This option may be more ideal in someone who wants to avoid surgery & whose condition is otherwise stable.
Blood work to determine the amount of the pregnancy hormone (hCG) is checked to monitor the progress of the miscarriage. When the bleeding stops, usually you will be able to continue the normal activities. If the cervix is dilated, you may be diagnosed with an incompetent cervix & a procedure to close the cervix (called cerclage) may be performed if the pregnancy is still viable. If your blood type is Rh-negative, then your doctor may give you a blood product called Rh immune globulin (Rhogam). This prevents you from the developing of antibodies that could harm your baby as well as any of your future pregnancies.
Genetic tests, Blood tests, or medication may be necessary if a woman has more than two miscarriages in a row (called recurrent miscarriage). Some diagnostic procedures used to evaluate the reason of the repeated miscarriage include pelvic ultrasound, hysterosalpingogram (an X-ray of the uterus & fallopian tubes), & hysteroscopy (a test in which the doctor views the inside of the uterus with a thin, telescope-like device inserted through the vagina & cervix).
How can I know if I had a Miscarriage?
Bleeding & mild discomfort are common symptoms after a miscarriage. If you have heavy bleeding with fever, chills, or pain, contact your health care provider right away. These may be signs of an infection.
After how much time, I can try again?
Discuss the timing of your next pregnancy (after miscarriage) with your health care provider. Some health care providers recommend waiting a certain amount of time (from one menstrual cycle to 3 months) before trying to conceive again. To prevent another miscarriage, your health care provider may recommend treatment with progesterone, a hormone needed for implantation & early support of a pregnancy in the uterus.
Taking time to heal both physically & emotionally after a miscarriage is important. Above all, don’t blame yourself for the miscarriage. Counseling is available to help you for cope with your loss. Pregnancy loses support groups may also be a valuable resource to you & your partner.
Can a Miscarriage be Prevented?
Usually, a miscarriage cannot be prevented & often occurring because the pregnancy is not normal. If a specific problem is identified with testing, then treatment options may be available.