A miscarriage is a spontaneous loss of a pregnancy before the 20th week and is often a naturally occurring event.
Why do we miscarry?
A majority of miscarriages occur before the 12th week of pregnancy and maybe because of various reasons.
Some reasons for a miscarriage are:-
Abnormal genes or chromosomes
Most miscarriages occur because a fetus is not developing normally. In about 50% of miscarriages, it is found that there is a missing or an extra chromosome found in the fetus, resulting in the loss. Most often, this missing or extra chromosome occurs by chance when an embryo divides and grows, and is not because of problems inherited by either parent.
Certain maternal health conditions such as uncontrolled diabetes, hyperthyroidism, or autoimmune diseases; Infections such as Rubella or Chickenpox; Hormonal problems such as low blood progesterone (hormonal) levels during an early pregnancy or even uterus and cervix problems may also be a cause for a miscarriage.
Environmental or lifestyle factors such as excessive smoking, inhaling of secondhand smoke, alcohol drinking, drug use, and exposure to high levels of lead, pesticides, or mercury are also high factors for miscarriage.
Age plays a major part because it has been found that women older than the age of 35 have a higher risk of miscarriage than younger women. At age 35, there is about a 20 percent risk, at age 40, the risk is about 40 percent, and at the age of 45, the risk of miscarriage is about 80 percent. The older the woman is, the more vulnerable the pregnancy is, because eggs stored in the ovaries are vulnerable to damage over time.
Different Types of Miscarriages
There are several types of miscarriages - threatened, inevitable, complete, incomplete or missed. Learn about these types below, as well as about other types of pregnancy loss such as ectopic, molar pregnancy, and a blighted ovum.
A ‘threatened miscarriage’ is when your body shows signs that you might miscarry. There may be a little vaginal bleeding or lower abdominal pain and this can last days or weeks.
The pain and bleeding may go away and you can continue to have a healthy pregnancy and baby. Unfortunately, things may also get worse and you may go on to have a miscarriage.
There is rarely anything a doctor or you can do to protect the pregnancy. Sometimes, bed rest is recommended, but there is no scientiﬁc proof that this helps at this stage.
‘Inevitable miscarriages’ can come after a threatened miscarriage or without warning. There is usually a lot more vaginal bleeding and strong lower stomach cramps. During the miscarriage, your cervix opens and the developing fetus will come away in the bleeding.
A ‘complete miscarriage’ is one that has taken place when all the pregnancy tissue has left your uterus. Vaginal bleeding may continue for several days. Cramping pain that feels like a labour or a strong period pain is common – this is the uterus contracting to empty.
If you have miscarried at home or somewhere else with no health workers present, you should have a check-up with your doctor to make sure the miscarriage is complete.
Sometimes, some pregnancy tissue will remain in your uterus. Vaginal bleeding and lower abdominal cramping may continue as the uterus continues trying to empty itself. This is known as an ‘incomplete miscarriage’.
Your doctor will need to assess whether or not a short procedure called a ‘dilatation of the cervix and curettage of the uterus’ (often known as a ‘D&C’) is necessary to remove any remaining pregnancy tissue. This is an important medical procedure done in an operating theatre while you are under general anesthesia.
A missed (or silent) miscarriage is one where your baby has died or has not developed, but has not been physically miscarried. In many cases, a missed miscarriage is often diagnosed at a routine ultrasound scan, whether around 12 weeks or at the 20 week ‘anomaly’ scan. However it might also be seen at a non-routine scan, whether or not there are any symptoms.
Unfortunately, there is usually no sign that anything was wrong, so the news can come as a complete shock to you.
With a missed miscarriage, the scan picture usually shows a pregnancy sac with a baby (or fetus or embryo) inside, but there is no heartbeat and the pregnancy looks smaller than it should be at this stage. The doctor will usually advise you on the next steps.
Other Types of Pregnancy Loss
There are some types of pregnancy losses that also result in a miscarriage.
A chemical pregnancy (sometimes called a biochemical pregnancy) is a very early pregnancy loss which usually happens just after the embryo implants (before or around 5 weeks).
As it happens at such an early stage, you may not have any pregnancy symptoms apart from your positive test and it would be too early to be able to see anything on a scan. Some women may not even realise that they have experienced a chemical pregnancy as they might not have taken a test or have missed their period.
In recent years, pregnancy tests have become much more sensitive and it is possible to detect pregnancy hormones up to 3 days before a period is due. It’s thought that as a result, more women are detecting these very early losses.
An ectopic pregnancy occurs when a fertilised egg implants outside the uterus, such as in the fallopian tube, abdominal cavity, or cervix. A fetus does not usually survive an ectopic pregnancy. An untreated ectopic pregnancy can be a medical emergency. Early detection of an ectopic pregnancy can prevent serious medical complications and may save the fallopian tube from permanent damage
A molar pregnancy is a type of pregnancy that fails to develop properly from conception. It can be either complete or partial and usually needs to be surgically removed.
A blighted ovum also known as an anembryonic pregnancy usually occurs in the first trimester. It occurs when your fertilised egg attaches to the wall of your uterus but doesn’t develop into an embryo. You may feel pregnant, however, the doctor performing your ultrasound will see an empty gestational sac and sadly won’t be able to pick up a heartbeat.
Tests for Men
What options do I have when I miscarry?
After finding out that you have miscarried, your doctor will give you a few options for miscarriage treatments.
Natural / Expectant Miscarriage
A natural miscarriage is one that allows your body to dispel the tissue on its own and without medical intervention. This process will begin naturally, usually within a week to two weeks after a miscarriage. A natural miscarriage is completed at home and generally includes period-like cramping, some of which may be severe, similar to the contractions of labour, as well as heavy bleeding. Once you pass the tissue, you will see a doctor to monitor your hormone levels as they naturally lower to a non-pregnancy level.
The doctor will also monitor your bleeding levels to ensure that your body has dispelled all of the internal tissue appropriately. In the event that this does not happen or you experience excessive bleeding, you may need to undergo D&C procedure to complete the clearing of the uterus.
Many women choose this natural method as a way to have closure of the end of an intended pregnancy. Occasionally, depending on how many weeks into the pregnancy you were when the fetus stopped growing, you will not have the option of a natural miscarriage.
Sometimes, doctors will give you the option to take a medication called misoprostol to start or speed up the process of a delayed or missed miscarriage. Misoprostol works by preparing your cervix and making your womb contract to help push out the pregnancy.
Some women experience severe abdominal cramps as well as heavy bleeding with this option, but they may prefer this to having a surgical procedure. As with natural management, some women say that the process is similar to the contractions of labour and it can be a long and exhausting process. It can help to have pain-killers such as paracetamol on hand, as well as a supply of extra-absorbent pads.
The surgical procedure to remove your fetus is called a D&C (Dilation & Curettage). If you choose to have a D&C procedure or it is medically recommended, you will generally be scheduled very quickly for the procedure. The procedure is done by a medical professional either in their office, or in some cases, in the outpatient surgery center of a hospital. While the procedure is medically coded as minor surgery, it is very common and routine for most OBGYNs doctors.
Patients are given a general anesthesia so that they will comfortably sleep through the procedure. The procedure consists of your doctor using a device to dilate your cervical opening and then using a sharp instrument, such as a scalpel, or suction to clean out the tissue inside of your uterus. The entire process takes under a half an hour and you will be discharged roughly two hours following the procedure.
Typical recovery can include light cramping and bleeding, and you’ll generally follow up with your doctor one to two weeks after the procedure.
You should note that this procedure does carry potential risks including scarring of the uterus that may make future pregnancies more difficult. Even so, many women elect to complete a D&C to provide quicker closure and swifter recovery.
How do I survive my miscarriage?
A miscarriage is often an emotional and traumatic time. You may go through feelings of grief, hopelessness, sadness, guilt, anger, jealousy, and loneliness.
This grief is often too painful to discuss and a lot of women find it hard to digest the emotions that they are feeling. In addition to emotional grief, there are often physical impacts as well.
While nothing can erase the loss that you feel, there are steps you and your partner can take towards healing and recovery.
Initially, it might seem like you’ll never get over the devastating loss of your pregnancy. However, things will eventually get better and you will recover in time.
Give yourself lots of love and care as you cope with miscarriage. Seeking out help and support from others who have gone through miscarriage can help greatly. Pregnancy loss can create a sense of loneliness, but remember that you’re not alone as you cope.
Allow yourself to grieve and express your emotions
A miscarriage is like losing a loved one, and you will feel a roller coaster of emotions ranging from sadness to despair and even anger at why this has happened to you.
Understand that it is normal to feel this way and what you’re feeling is a natural part of the grieving process. Take the time to grieve and don’t feel ashamed about it.
Find a support group
Although miscarriage is often a taboo subject in the Asian culture, they are actually quite common and there are many in person or online support groups available for this type of loss. Although you may have your friends or family to talk to, it sometimes feels better talking to people who have gone through the same loss as you have, and fully understand how you are feeling at the moment.
Seek spiritual guidance
If you are a religious person, it may also help for you to speak to your spiritual leader, or attend group worship sessions.
Seek professional help
Sometimes, it may be hard working through grief yourself. This is where a grief counsellor or therapist can help you and your partner through this difficult time.
Real women say…
“My miscarriage was the single, hardest part of my life. I can recall the moment the doctor told me there was no heartbeat. It took me many months to get over the pain, and even then, I carried the anxiety throughout my pregnancy. Ultimately, I was blessed with two children and I know that my miscarriage made me more appreciative of my children.”
“This is a hard time for the couple. More than just going through the physical impact of the process, their emotional and mental health will need to be taken care of as well. After my miscarriage, I felt devastated. But after finding groups on Facebook about pregnancy loss and talking to people who had gone through the same thing as me, it made me feel so much better.”
“After having a missed miscarriage, it took me a long time to feel alright again. I just felt such sadness and pain over the loss of the baby at 4 months. Till today, a year later, the pain is still there, but I’ve just learned to deal with it. I don’t think it ever goes away”
“Give yourself time to grieve and be sad over what had happened. Many times, there is nothing much you could have done to prevent the loss. Do not blame yourself, give yourself and your spouse space to grieve and get in terms with all that have happened. Different people deal with the situation differently. So if you need someone to talk to, find someone you trust and talk to them.”