Miscarriage: What Is It?
Premature pregnancy loss (also called perinatal loss Or miscarriage) occurs when a baby dies before the 20th week of pregnancy (roughly four and a half months into the pregnancy). Even though miscarriages are quite common, people are often taken by surprise if they experience one. Approximately 10% to 15% of pregnant women miscarry before 13 weeks of gestation, meaning that most miscarriages are due to a lack of fetal growth. [1] [2]
What are the possible symptoms of a miscarriage?
Every miscarriage presents differently. It usually depends on how far along you are in your pregnancy and when you were diagnosed whether you have any symptoms. You will generally experience more symptoms as you progress through pregnancy. Also, you can suffer from a lack of symptoms.
The following symptoms may accompany a miscarriage: [3]
- A feeling of cramping or pain in the abdomen
- Back pain
- The discharge of fluids or tissues from the vaginal area
- There is no longer any nausea or breast tenderness associated with pregnancy
- Blood in the vaginal area (spotting can be heavy or mild)
Miscarriages occur most commonly before reaching 13 weeks pregnant, during the first trimester. The higher you are in pregnancy, the higher your chances of experiencing a miscarriage are.
Miscarriage diagnosis
Your medical provider should be consulted if you think you are miscarrying. When you are pregnant, you should let your doctor know about any vaginal bleeding you experience. Blood may be spotting or staining in light red, pink, or dark red. A heavy period of bleeding along with strong cramping increases your chance of miscarriage more so than if your bleeding is light and painless.
You and/or your doctor might perform tests (usually ultrasounds) to ensure that all is well during your pregnancy or to confirm that you are suffering from a pregnancy loss.
You should not panic if you are bleeding regardless of your pregnancy status. A miscarriage does not happen to all women who have bleeding during early pregnancy. Other causes of vaginal bleeding can be ruled out by your doctor, including:
Implantation Bleeding
Bleeding is a common occurrence in early pregnancy as the embryo attaches to the wall of the uterus. Implantation bleeding is what causes this. Bleeding usually occurs without any cramping and is usually associated with light bleeding. [4]
Subchorionic Hemorrhage
Blood can collect or clot under the placenta when implantation bleeding collects. Ultrasound can reveal this and it is called a subchorionic hemorrhage.
You may experience cramping and a little bit of bleeding with this type of bleeding compared to implantation bleeding. A few weeks may pass before you stop bleeding. It is common for your body to re-absorb the blood and the bleeding to stop as soon as you collect it.
Post-Coital Bleeding
Is this the result of recent sex? The bleeding is probably just from your cervix if this is the case. A woman’s cervix changes as she becomes pregnant due to hormonal fluctuations. When you touch your cervix during sex, your cervix bleeds more easily. Bleeding after a sexual encounter is known as post-coital bleeding.
Sexual activity can cause bleeding that may be quite heavy and bright red in color. This is not usually accompanied by cramping in the uterus.
Urinary Tract Infection
It’s possible to get a urinary tract infection (UTI) by noticing light bleeding after you urinate. The symptoms of a UTI aren’t always present in early pregnancy and they are very common. [5]
What causes a miscarriage?
Perhaps you wonder if there is something you did that resulted in your miscarriage. It’s very unlikely, especially if the miscarriage occurred before 13 weeks, as most early miscarriages occur when the embryo isn’t viable (unable to survive to birth). Chromosome abnormalities cause about 50 percent of all early pregnancy deaths.
Many miscarriages occur for unknown reasons as well. Lifestyle choices like cigarette smoking and drug use have been shown to increase the chance of miscarriage. Miscarriages are caused by a variety of less common causes, including:
- Stress that is out of control
- Infection
- Maternal autoimmune diseases
- Thrombophilia in pregnancy
- Uterine or cervical structural problems
What are the risk factors of a miscarriage?
The causes of pregnancy loss can be many, but research shows that miscarriages often happen when there are no known risk factors present-and it’s unknown why some people miscarry while others don’t. What is certain is that your miscarriage risk increases as you get older. [6]
Your age-based risk of miscarriage is calculated as follows by the American College of Obstetricians and Gynecologists (ACOG):
- At ages 20-30, it ranges from 9% to 17%
- By the age of 35, 20%
- In the 40s, 40%
- At age 45, 80%
Other factors that contribute to pregnancy loss, in addition to the mother’s age, include:
- Having miscarried at least twice in the past
- Having an underweight condition
- Paint thinners and other toxic chemicals are common sources of exposure
- Disorders of the hormones, including Polycystic Ovarian Syndrome (PCOS).
- Use of recreational drugs, drinking, smoking, and other lifestyle behaviors
- Obesity
- Diabetes, lupus, high blood pressure, and other pre-existing medical conditions
Recurrent Miscarriages
Having two consecutive miscarriages is not common, even though miscarriages during the first trimester are. If you have an infertility problem after a miscarriage, your chances of having a successful pregnancy are much higher than the chances of having a second (or third or more) miscarriage. A woman who has experienced several miscarriages is more likely to experience a subsequent one-but the risks are still low.
Typically, recurrent miscarriages occur when a pregnancy loss occurs three or more times in one first trimester. The rates of this event increasing with maternal age and number of miscarriages, according to studies, are estimated to be 2% to 5% of pregnant women. However, you still have a greater chance of completing your next pregnancy even if you have recently miscarried more than three times.
Seventy-five percent of women who have experienced recurrent miscarriages will succeed in conceiving.
Treatment
You will need treatment if you have suffered a miscarriage so that all the products of conception can be removed. How you manage your miscarriage will depend on how far along you are in your pregnancy and how much bleeding you have.
You will likely need an emergency dilation and curettage (D&C) procedure if you are bleeding very heavily and you have still not passed all of your pregnancy tissue. The following treatment options may be discussed with you if you are stable upon diagnosis.
Expectant Management
Expedient management simply means waiting for your body to pass the tissue and not intervene. When you are under eight weeks pregnant, this approach can generally be successful, but it is not recommended once you are over 13 weeks pregnant.
Medical Management
You will take misoprostol to attempt to pass the tissue through your uterus with medical management. Following a few hours, the medicine begins to work and results in periods of bleeding and cramping. During the first few weeks after the procedure, there may be some bleeding.
Surgical Management
D&C is a surgical procedure that removes the tissue. A doctor may offer you an aspiration of tissue from your uterus if it is an early miscarriage. As your body sheds the uterine lining and the embryo, you can expect heavy vaginal bleeding and cramping.
Blood Type Complications: How to prevent them
As part of the miscarriage management process, your blood type will be checked in addition to removing fetal tissue. It is possible to prevent a pregnancy complication called hemolytic disease of the newborn that may affect future pregnancies if you are Rh-negative through RhoGAM injections.
Second Trimester Miscarriage
It is similar to the treatment of a miscarriage that occurs after the first trimester. Miscarriages occur further along in pregnancy, however, and you may need surgery since there is more fetal tissue that needs to be safely removed from the uterus at that point.
Depending on your clinical condition and how far along you are in your pregnancy, your doctor may recommend one treatment option over another. A follow-up check may be necessary to ensure that all the tissue has been removed.
Return of Menstruation
Following a loss of pregnancy, you will usually start having your period again after about four weeks – but it may take up to eight weeks. The hormone responsible for causing ovulation to happen in the second half of a cycle must return to normal levels (human chorionic gonadotropin, or hCG). After ovulation, you will have your period about two weeks later.
Coping
Grieve as much as you need to. The importance of this cannot be overstated. You should give yourself time to recover from your miscarriage if you have suffered a miscarriage.
As with any loss of a loved one, losing a pregnancy can be devastating. Despite passing through the stages of grief more quickly, you will have the same emotional reactions. A significant depressive episode can be prevented by learning to process your emotions and seeking psychological support.
You may experience increased anxiety in your next pregnancy once you’ve lost a pregnancy. The pregnancy may even cause you to feel ambivalent. You may find it helpful to talk with your doctor and/or a counselor if you are finding it hard to emotionally attach to your pregnancy after a miscarriage.
Trying Again
It is common for women to wonder “When can I try again?” after suffering a miscarriage. Generally, physicians will recommend that you wait until you have had three regular cycles before you can try again. Essentially, it shouldn’t take so long for the majority of women to become pregnant.
Although we don’t know the appropriate time for trying to become pregnant after a miscarriage, newer studies suggest there is no need to delay getting pregnant and that the first three months after miscarriage are actually the most fertile.
Nevertheless, most doctors recommend waiting at least a few weeks before you have vaginal intercourse after a miscarriage to reduce the chances of infection.
A Word From KidsRush
The pain of miscarriage is unbearable. Do not hold back your grief. When you experience a miscarriage, it can be helpful to remember that the chances of a successful outcome for your next pregnancy are much higher than your previous miscarriage. You can recover physically and emotionally by talking to your doctor about treatment options.
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