A miscarriage is the sudden or unplanned loss of a pregnancy within twenty weeks of the last menstrual period. It may also be referred to as a spontaneous abortion.
- A miscarriage is most common during the first 13 weeks of a pregnancy.
- It is estimated that between ten and twenty percent of known pregnancies end in miscarriage. The percentage drops once a heartbeat has been detected.
- Many miscarriages occur before a woman realizes she is pregnant.
A miscarriage can also be described as:
- A complete abortion, when no fetal tissue remains in the body
- An incomplete abortion, when some fetal tissue remains in the body
- An inevitable abortion, when a miscarriage will happen
- An infected abortion, when the uterus and fetal tissue become infected
- A missed abortion, when there is a loss of the fetus - but all fetal tissue remains in the body
Many miscarriages are related to an abnormally developed embryo that could not survive outside the womb.
- The abnormal development is often due to chromosomal problems that are not inherited. This means they will not necessarily occur again in later pregnancies.
- In fact, sixty to seventy percent of women who have a miscarriage for unexplained reasons will go on to deliver healthy babies.
Maternal factors that may be associated with miscarriage include:
- Infections of the uterus
- Hormonal problems
- Uncontrolled diabetes
- High blood pressure
- Problems with the immune system
- Blood clotting disorders
- Problems with the cervix
- Defects in the structure of the uterus or cervix
Exposure before birth to diethylstilbestrol (DES), a synthetic estrogen that was given to some women until the early 1970s, can also increase a women's risk for having a miscarriage.
The risk of miscarriage may also increase if you:
- Use tobacco products, recreational drugs or alcohol
- Are underweight or overweight
- Have been exposed to certain chemicals
- Became pregnant within three months of having a baby
- Became pregnant at an older age
- Have undergone certain procedures during pregnancy (such as an amniocentesis)
The most common symptoms of an impending miscarriage are:
- Vaginal bleeding
- Lower abdominal cramping
- Low back pain
If you are spotting or bleeding, you should report the symptom to your doctor right away.
- Do not assume you are having a miscarriage. Some pregnant women can have a small amount of vaginal bleeding during the first trimester. A small amount of bleeding does not necessarily mean you are having a miscarriage.
- If you do have a miscarriage, you may pass fetal tissue from your vagina. If possible, save the tissue in a clean jar or sealable plastic bag. Bring the sample with you when you see your healthcare provider. He or she can send it for examination.
- Your healthcare provider will want to make sure no tissue remains in your uterus.
You may continue to have vaginal spotting for one to two weeks after a miscarriage. Pregnancy tests may continue to be positive for up to four weeks.
- You may experience very intense, but normal, feelings of grief and loss.
- You may also have physical problems after the miscarriage. This includes loss of appetite, inability to sleep and fatigue.
- It is normal to be unsure of the best way to talk to your friends and loved ones about your miscarriage.
- To begin the healing process, it is important for you and your partner to share your feelings with someone who understands and can provide the support you need.
- You may also find it helpful to talk to your healthcare provider, a counselor or someone who has experienced a similar loss.
After a miscarriage, your healthcare provider may recommend surgery to clean out your uterus. This can help prevent a serious infection or heavy blood loss.
- The procedure is called a D&E&C, or dilatation, evacuation and curettage.
- During the procedure, the lining of the uterus is scraped to remove any remaining fetal tissue.
To keep you comfortable and pain free during the procedure, you will likely receive general anesthesia.
- General anesthesia is when you are put into a deep sleep and are unable to see, hear or feel anything.
- Antibiotics are sometimes prescribed after the procedure.
- If you have Rh-negative blood, you will be given Rh immune globulin. This helps to prevent Rh incompatibility with future pregnancies. Rh immune globulin is not needed if the biological father of the fetus is also Rh negative.
Do not forget to arrange for transportation to and from the facility and help at home while you recover.
What should I ask my healthcare provider if I have symptoms of a miscarriage?
- What is my risk of a miscarriage? How can I prevent a miscarriage?
- What symptoms should I watch for and report to you?
- What are my treatment options? Are there any alternatives? Do I need surgery (D&C)?
- If I need surgery, what type of sedation will I have? What are the possible side effects?
- What are the possible risks/complications?
- How will I feel after the surgery? Will I have to modify my activity?
- What type of medication can I take to manage my pain?
- What symptoms might indicate a problem after the surgery?
- When can I return to work and resume sexual activity?
Before you go home, make sure you understand all home care instructions (including medications and side effects) and follow-up plans. Your surgeon should let your primary c0are physician know the details of your surgery and treatment plan.