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MISCARRIAGE

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INTRODUCTION

A miscarriage is the loss of a pregnancy during the first 23 weeks.

The main sign of a miscarriage is vaginal bleeding, which may be followed by cramping and pain in your lower abdomen.

If you have vaginal bleeding, contact your GP or midwife. Most GPs can refer you to an early pregnancy unit at your local hospital straight away if necessary. You may be referred to a maternity ward if your pregnancy is at a later stage.

However, bear in mind that light vaginal bleeding is relatively common during the first trimester of pregnancy (the first 12 weeks) and doesn’t necessarily mean you’re having a miscarriage.

 

WHAT IS A MISCARRIAGE?

Miscarriage is the loss of a pregnancy in the first 20 weeks. (In medical articles, you may see the term “spontaneous abortion” used in place of miscarriage.) About 10 to 20 per cent of known pregnancies end in miscarriage, and more than 80 per cent of these losses happen before 12 weeks.

This doesn’t include situations in which you lose a fertilized egg before a pregnancy becomes established. Studies have found that 30 to 50 per cent of fertilized eggs are lost before or during the process of implantation – often so early that a woman goes on to get her period at about the expected time.

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CAN MISCARRIAGES BE PREVENTED?

The majority of miscarriages can’t be prevented. If a woman has suffered from more than three miscarriages, some women can be helped to keep their pregnancy with medication under the care of a specialist.

However, there are some things you can do to reduce the risk of a miscarriage. Avoid smoking, drinking alcohol and using drugs while pregnant. Being a healthy weight before getting pregnant, eating a healthy diet and reducing your risk of infection can also help.

 

WHAT CAUSES MISCARRIAGE?

Most miscarriages happen when the unborn baby has fatal genetic problems. Usually, these problems are unrelated to the mother.

 

Other causes of miscarriage include:

  • Infection
  • Medical conditions in the mother, such as diabetes or thyroid disease
  • Hormone problems
  • Immune system responses
  • Physical problems in the mother
  • Uterine abnormalities

 

A woman has a higher risk of miscarriage if she:

  • Is over age 35
  • Has certain diseases, such as diabetes or thyroid problems
  • Has had three or more miscarriages

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CERVICAL INSUFFICIENCY

A miscarriage sometimes happens because there is a weakness of the cervix, called an incompetent cervix, which cannot hold the pregnancy. A miscarriage from an incompetent cervix usually occurs in the second trimester.

There are usually few symptoms before a miscarriage caused by cervical insufficiency. A woman may feel sudden pressure, her “water” may break, and tissue from the foetus and placenta may be expelled without much pain. An incompetent cervix can usually be treated with a “circling” stitch in the cervix in the next pregnancy, usually around 12 weeks. The stitch holds the cervix closed until it is pulled out around the time of delivery. The stitch may also be placed even if there has not been a previous miscarriage if cervical insufficiency is discovered early enough, before a miscarriage does occur.

 

AFTER A MISCARRIAGE

A miscarriage can be an emotionally and physically draining experience. You may have feelings of guilt, shock and anger.

Advice and support is available at this time from hospital counselling services and charity groups. You may also find it beneficial to have a memorial for your lost baby.

You can try for another baby as soon as your symptoms have settled and you’ve had one period, although you should ensure you’re emotionally and physically ready first.

Having a miscarriage doesn’t necessarily mean you’ll have another if you get pregnant again. Most women are able to have a healthy pregnancy after a miscarriage, even in cases of recurrent miscarriages.

 

HOW COMMON ARE MISCARRIAGES?

Miscarriages are much more common than most people realise. Among women who know they’re pregnant, it’s estimated one in six of these pregnancies will end in miscarriage. Many more miscarriages occur before a woman is even aware she has become pregnant.

Losing three or more pregnancies in a row (recurrent miscarriages) is uncommon and only affects around 1 in 100 women.

A conceptual illustration showing a female right hand holding a fetus in the palm.

SPOTTING THE SIGNS OF A MISCARRIAGE

If you have these signs of miscarriage, call your doctor or midwife right away so she can determine whether you have a problem that needs to be dealt with immediately:

Bleeding or spotting. Vaginal spotting or bleeding is usually the first sign of miscarriage. Keep in mind, though, that up to 1 in 4 pregnant women have some bleeding or spotting (finding spots of blood on your underpants or toilet tissue) in early pregnancy, and most of these pregnancies don’t end in miscarriage.

Abdominal pain. Abdominal pain usually begins after you first have some bleeding. It may feel crampy or persistent, mild or sharp, or may feel more like low back pain or pelvic pressure.

If you have both bleeding and pain, the chances of your pregnancy continuing are much lower. It’s very important to be aware that vaginal bleeding, spotting, or pain in early pregnancy can also signal an ectopic or a molar pregnancy.

Also, if your blood is Rh-negative, you may need a shot of Rh immune globulin within two or three days after you first notice bleeding, unless the baby’s father is Rh-negative as well.

Some miscarriages are first suspected during a routine prenatal visit, when the doctor or midwife can’t hear the baby’s heartbeat or notices that your uterus isn’t growing as it should be. (Often the embryo or foetus stops developing a few weeks before you have symptoms like bleeding or cramping.)

If your practitioner suspects that you’ve had a miscarriage, she’ll order an ultrasound to see what’s going on in your uterus. She may also do a blood test.

 

WHAT PUTS YOU AT A HIGHER RISK FOR MISCARRIAGE?

Though any woman can miscarry, some are more likely to miscarry than others. Here are some risk factors:

AGE: Older women are more likely to conceive a baby with a chromosomal abnormality and to miscarry as a result. In fact, 40-year-olds are about twice as likely to miscarry as 20-year-olds. Your risk of miscarriage also rises with each child you bear.

A history of miscarriages: Women who have had two or more miscarriages in a row are more likely than other women to miscarry again.

Chronic diseases or disorders: Poorly controlled diabetes and certain inherited blood clotting disorders, autoimmune disorders (such as antiphospholipid syndrome or lupus), and hormonal disorders (such as polycystic ovary syndrome) are some of the conditions that could increase the risk of miscarriage.

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UTERINE OR CERVICAL PROBLEMS: Having certain congenital uterine abnormalities, severe uterine adhesions (bands of scar tissue), or a weak or abnormally short cervix (known as cervical insufficiency) up the odds for a miscarriage. The link between uterine fibroids (a common, benign growth) and miscarriage is controversial, but most fibroids don’t cause problems.

A history of birth defects or genetic problems: If you, your partner, or family members have a genetic abnormality, have had one identified in a previous pregnancy, or have given birth to a child with a birth defect, you’re at higher risk for miscarriage.

INFECTIONS: Research has shown a somewhat higher risk for miscarriage if you have listeria, mumps, rubella, measles, cytomegalovirus, parvovirus, gonorrhoea, HIV, and certain other infections.

Smoking, drinking, and using drugs: Smoking, drinking alcohol, and using drugs like cocaine and MDMA (ecstasy) during pregnancy can all increase your risk for miscarriage. Some studies show an association between high levels of caffeine consumption and an increased risk of miscarriage.

Medications: Some medications have been linked to increased risk of miscarriage, so it’s important to ask your caregiver about the safety of any medications you’re taking, even while you’re trying to conceive. This goes for prescription and over-the-counter drugs, including no steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin.

Environmental toxins: Environmental factors that might increase your risk include lead; arsenic; some chemicals, like formaldehyde, benzene, and ethylene oxide; and large doses of radiation or anaesthetic   gases.

 

PATERNAL FACTORS: Little is known about how the father’s condition contributes to a couple’s risk for miscarriage, though the risk does rise with the father’s age. Researchers are studying the extent to which sperm could be damaged by environmental toxins but still manage to fertilize an egg. Some studies have found a greater risk of miscarriage when the father has been exposed to mercury, lead, and some industrial chemicals and pesticides.

Obesity: Some studies show a link between obesity and miscarriage.

Diagnostic procedures: There’s a small increased risk of miscarriage after chorionic villus sampling and amniocentesis, which may be performed for diagnostic genetic testing.

Your risk of miscarriage is also higher if you get pregnant within three months after giving birth.