Miscarriage what is it?

Miscarriage what is it?

Miscarriage
Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist

What is a miscarriage?

A miscarriage is the loss of a pregnancy before 24 weeks, with most miscarriages actually occurring during the first 12 weeks of pregnancy. Unfortunately, miscarriage is very common, affecting one in eight pregnancies.

What causes a miscarriage?

There is seldom an adequate explanation for why a woman experiences a miscarriage. Studies inform us that approximately 50 per cent of lost pregnancies have failed to develop normally, either due to chromosome or genetic problems or because of structural (bodily) problems. There is no apparent explanation for the remaining 50 per cent of cases.

* Certain maternal illnesses are associated with an increased risk of miscarriage, although these are very uncommon.

* Smoking increases the risk of miscarriage.

* There is a gradual increase in the risk of miscarriage as the woman gets older.

It is important to remember that an ordinary lifestyle that includes exercise, going to work, minor falls or taking the Pill before pregnancy does not increase the risk of miscarriage.

What are the symptoms of a miscarriage?

The most common symptom is bleeding from the vagina. Lower abdominal pain is also very common.

Some women have no symptoms at all and the miscarriage is only diagnosed when they are given an ultrasound scan at their antenatal clinic. This is referred to as a 'silent miscarriage', and can be very distressing for the woman and her partner.

What to do if a miscarriage is suspected

If a woman is bleeding from the vagina and feels pain then she must consult her doctor.

When is it necessary to consult a doctor immediately?

* If the woman is bleeding at such a rate that she needs more than one sanitary towel per hour. In this case, too much blood is being lost and the flow must be stopped.

* If the woman feels weak or faint. These are both signs that she is losing too much blood.

* If the woman experiences severe stomach pain, this may be a symptom of an ectopic pregnancy.

* If the woman experiences fever, shivering or a smelly vaginal discharge, this can be a sign of an infection or inflammation.

All these conditions are potentially serious and must be treated immediately.

What does the doctor do?

An abdominal examination is usually combined with an internal (pelvic) examination. In this way, it is possible to determine if the bleeding is a sign of a pregnancy that is destined to miscarry or one that may continue. An ultrasound scan is the most useful investigation. This is performed through the abdomen or through the vagina and gives precise information about whether the pregnancy is continuing or not.

What if my pregnancy is continuing?

Provided the bleeding is not too heavy and the pain is controlled by simple painkillers, then you can go home. As long as the bleeding continues, it is advisable to keep off work. Bed rest is not essential and does not influence whether the bleeding will continue and result in a miscarriage or not. If a pregnancy is destined to miscarry, there is, unfortunately, nothing effective that you or your doctor can do.

What if my pregnancy is not continuing?

Again, depending on the amount of bleeding and discomfort you may be admitted to the hospital or allowed home. If the scan shows that there is no blood clot or tissue in the womb then nothing further needs to be done. If there is more than just a little tissue or a blood clot then a small operation called a uterine evacuation may be recommended.

What happens after a miscarriage?

Following a miscarriage, it is advisable to take it easy and rest for a couple of days. It will help if the woman has someone she trusts with her, so that she can talk openly about her feelings. After a couple of days it is often helpful to return to a normal daily routine.

After a miscarriage a woman might experience headaches or have trouble sleeping. She may also experience lack of appetite and fatigue.

Many women feel anger and sadness after a miscarriage, while many others experience a strong sense of guilt, even though it is not their fault. These are all natural reactions.

A miscarriage can be frightening, confusing and depressing. It is natural to feel grief over the loss of a child. Women should not let people ignore or belittle what they have been through. The people they choose to talk to must be prepared to listen to what they have experienced and deal with the strong emotions involved.

Any woman who finds it too difficult to deal with her grief, or who continues to feel depressed, should consult her doctor for further help.

What if more than one miscarriage is experienced?

If a woman has three miscarriages in a row, this is known as a recurrent spontaneous miscarriage (RSM) and a referral to a gynaecologist for special investigation is recommended. Provided the investigations are negative, a woman's next pregnancy still has a 70 per cent chance of being successful.

When can I try for another baby?

There are no hard-and-fast rules. The right time to try for children again will vary from one couple to another: some will want to start a couple of weeks or months after the bleeding has stopped, others will want to wait longer. It is, of course, advisable to recover from the worst of the emotional upset before starting another pregnancy.

Will my next pregnancy be successful?

Following one miscarriage, the risk of the next pregnancy being a miscarriage is not increased beyond the overall risk of one in eight.

* Remember to keep taking folic acid to reduce the risk of the baby being affected with spina bifida.

* If you smoke, give up.

* Often a woman gains considerable re-assurance by having an early scan. Ask your doctor or gynaecologist about this.

Based on a text by Dr Niels Lund, specialist gynaecologist and obstetrician, Dr Charlotte Floridon, specialist gynaecologist and obstetrician and Christel Bech, nurse