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Miscarriage - Better Health Channel

What is a miscarriage?

A miscarriage is defined as the loss of a pregnancy before 20 weeks gestation. Miscarriage happens when a pregnancy stops growing. Eventually, the pregnancy tissue will pass out of the body. Some women will feel crampy, period-like pain and in most cases there will be vaginal bleeding.

Most spontaneous miscarriages (75 to 80 per cent) occur in the first 12 weeks of pregnancy. It is estimated that 1 in 4 pregnancies end in miscarriage. Many miscarriages are unreported or go unrecognised because they occur very early in the pregnancy.

Causes of a miscarriage

A miscarriage usually occurs because the pregnancy is not developing properly. The development of a baby from a female and a male cell is a very complicated process. If something goes wrong with the process, the pregnancy will stop developing. Miscarriages are more common in older women than younger women, largely because chromosomal abnormalities are more common with increasing age.

Another cause of miscarriage may be that the developing pregnancy did not embed itself properly into the lining of the uterus (womb). The natural reaction of the uterus is to expel the non-viable pregnancy.

Symptoms of a miscarriage

Pain and bleeding in early pregnancy can mean that you are having a miscarriage, but not always. Bleeding is very common in early pregnancy, affecting about one in four women, many of whom will go on to have a healthy baby. Early bleeding that does not lead to miscarriage will not have caused your baby any harm.

If the bleeding is being caused by a miscarriage, there is no treatment or therapy that can stop the miscarriage from occurring. However, it is still very important that you see a health professional.

Treatment for a miscarriage

Nothing can be done to stop a miscarriage once it has begun. Treatment is aimed at avoiding heavy bleeding and infection. It is also aimed at looking after you, physically and emotionally.

You may need to wait a short period of time before treatments begin. If you experience heavy bleeding with clots and crampy pain in that time, it is likely that you are passing the pregnancy tissue. The bleeding, clots and pain will usually settle when most of the pregnancy tissue has been passed.

Sometimes, the bleeding will continue to be heavy and you may need further treatment. If you think you are having, or have had, a miscarriage, you should see a doctor or go to an emergency department.

You should go to your nearest emergency department if you have:

• increased bleeding – for instance, soaking 2 pads per hour or passing golf ball-sized clots
• severe abdominal pain or shoulder pain
• fever or chills
• dizziness or fainting
• vaginal discharge that smells unpleasant
• diarrhoea or pain when you open your bowels.

Types of miscarriage

The types of miscarriage that can occur include:

• Missed abortion– occurs when the pregnancy has failed, although there has not been any bleeding or other signs. Occasionally, the aborted pregnancy may remain in the uterus for weeks or even months until bleeding commences. Missed abortion is suspected when pregnancy symptoms disappear and the uterus stops growing. It is diagnosed by an ultrasound examination.
• Blighted ovum– this occurs when a pregnancy sac is formed, but there is no developing baby within the sac. This is diagnosed by ultrasound, usually after some bleeding.
• Ectopic pregnancy– this occurs when the developing pregnancy implants in the fallopian tubes rather than in the uterus. One to two per cent of all pregnancies are ectopic and without treatment, an ectopic pregnancy can seriously impact on your health and fertility.

Reactions to miscarriage

There is no ‘right way’ to feel after a miscarriage. A range of feelings is normal, and they often linger for some time after the miscarriage. Reactions may include feelings of:

• emptiness
• anger and disbelief
• disappointment
• sadness and a sense of isolation.

Some degree of grief is very common, even if the pregnancy wasn’t planned. Partners may react quite differently, just as people can respond differently to a continuing pregnancy. Try to take it a day at a time and acknowledge your feelings and reactions as they arise.

In addition to the grief you may feel, your body will be undergoing many hormonal changes, which may make you feel very emotional. Family or close friends can be a great source of support at these times. Alternatively, you may choose to seek professional support.

Don’t blame yourself for a miscarriage

Pathology tests are sometimes performed after a miscarriage, but usually, no cause can be identified. This can add to feelings of distress and disbelief, and may lead to feelings of guilt. However, doctors agree that a miscarriage is rarely caused by anything the mother did – or didn’t – do (for example, drank a glass of wine, ate a particular food, had sex or did not rest enough). In the majority of cases, the next pregnancy proceeds to full term.

After a miscarriage

Often, some of the pregnancy tissue remains in the uterus after a miscarriage. If it is not removed by scraping the uterus with a curette (a spoon-shaped instrument), you may bleed for a long time or develop an infection. Unless all the pregnancy tissue has been passed, your doctor will usually recommend that a curette (also called a ‘D&C’ – dilation and curettage) be performed. This is done under a light general anaesthetic and you can usually go home later the same day. A sample of tissue is usually sent for pathology tests.

After the curette

Most women bleed for 5 to 10 days following a curette. Contact your doctor if you experience:

• prolonged or heavy bleeding
• blood clots or strong abdominal pain
• changes in your vaginal discharge
• fever or flu-like symptoms.

Your next period after a miscarriage

Your ovaries will usually produce an egg about 2 weeks after your miscarriage. Your first period should occur within 4 to 6 weeks. You should have a check-up with your doctor 6 weeks after your miscarriage to make sure there are no problems and to ensure your uterus has returned to normal size. You can also ask any questions about your miscarriage at this time, including the results of any pathology tests.

The effect of miscarriage on future pregnancies

Most of the problems that cause miscarriage happen by chance and are not likely to happen again. One miscarriage does not significantly increase the risk of the same thing happening with your next pregnancy, as long as no specific cause has been found. Testing is not usually offered to women who have miscarried once or twice because it is very unlikely that anything would be found.

However, women who have had 3 consecutive miscarriages are at risk of miscarrying again. If you fall into this category, you can attend the Recurrent Miscarriage Clinic at The Royal Women’s Hospital for further investigations, counselling and management of future pregnancies.

Trying for another pregnancy after miscarriage

There is no right time to try for another pregnancy. Some people decide they need time to adjust to their loss, while others want to try again right away. It is usually suggested you wait until after your next period before trying again. As it is possible to become pregnant again straight away, it is important to use contraception until you are ready to try again.

If you are Rh (Rhesus) negative

If you have an Rh negative blood group, you will require an injection of anti-D immunoglobulin following a miscarriage. This will prevent problems with the Rh factor in future pregnancies. Your doctor will discuss this with you further.

Preparing for another pregnancy after a miscarriage

Although the common reasons for miscarriage cannot be prevented, you can improve your chances for long-term fertility and a successful pregnancy by:

• stopping smoking
• taking regular exercise and having a balanced diet
• reducing stress
• maintaining your weight within recommended limits.

Take folic acid

It is recommended that all women planning a pregnancy take folic acid as it helps promote the normal development of a baby’s nervous system. You will need to take 0.5 mg per day for one month prior to pregnancy and up to 12 weeks gestation.

Where to get help

• In an emergency, call 000 for an ambulance
• Your GP (doctor)
• The Royal Women’s Hospital Tel. (03) 8345 2000
• Recurrent Miscarriage Clinic, The Royal Women’s Hospital Tel. (03) 8345 2000
• Stillbirth and Neonatal Death Support (SANDS) Tel. (03) 9899 0218

Miscarriage. What to do after a miscarriage?

When a woman finds out about her pregnancy, she changes her rhythm of life, especially if the pregnancy is desired. However, depending on many circumstances, miscarriage , that is, a natural termination of pregnancy, may occur. Statistics say that up to 20 percent of pregnancies end in pathological abortions. Often a woman may not know that she was pregnant, as a miscarriage sometimes occurs at a very early stage and seems to be just a normal delay in menstruation followed by heavy discharge.

If a woman finds out that she is pregnant and wants to become a mother, she should be very attentive to her condition. The threat of miscarriage often occurs in the early stages of pregnancy and therefore it is necessary to know what symptoms and signs precede a sudden miscarriage.

Signs

The main sign of a suspected miscarriage is bleeding from the uterus. They happen not abundant, pale scarlet or gray-brown. The discharge most often gradually increases and is characterized by sudden spasms or pulling pains in the lower abdomen. These symptoms may last for some time.

The pains are often so mild that the woman simply does not pay attention to them. They are able to be interrupted, and the woman simply forgets about them, especially if the discharge also stopped, and before that they were insignificant. Meanwhile, the very first symptoms should alert you and you should urgently go to the gynecologist for examination and consultation. Even if the process has stopped, after a few days you can feel a sharp deterioration in health, and then you can no longer save the life of the unborn child. Be sure to pay attention to what exactly comes out with the discharge, if there are tissue fragments, it means that miscarriage has already occurred. Therefore, one should not hesitate to go to the doctor, the fetus may come out, in whole or in parts, there may be white particles or a round gray bubble. When the body is completely cleansed, the pain will subside, but before that it may continue for some time.

Terms of miscarriages

A miscarriage is classified as early if it occurred before twelve weeks from the onset of pregnancy. Starting from the 22nd week, if a spontaneous miscarriage has occurred, it is considered late. If the termination of pregnancy occurred before thirty-seven weeks, then this is already called premature birth. All subsequent fetal rejections are called term births and are generally considered normal, since during this period, mostly able-to-survive children are born. In modern medicine, children born after 22 weeks are nursed and subsequently do not differ from those born at term with normal weight.

Types of miscarriages

Specialists have identified several types of miscarriages.

1. Complete or inevitable - characterized by pain in the lower back and dilatation of the cervix, hemorrhages from it. The fetal membrane necessarily bursts, and the pregnancy is terminated. The fetus comes out of the uterus, and all discomfort in the form of pain and bleeding stops.
2. Miscarriage is different in that the fetus died, but remained in the mother's body. This can be detected by a doctor when examining a woman and when listening to the fetal heartbeat.
3. Repeated miscarriage is rare, it occurs only some time after the first and can occur up to three times in a row in the early stages.

Causes of spontaneous abortion

The vast majority of women, having learned about their pregnancy, want to give birth to a healthy baby. And if there is a spontaneous miscarriage , then for a failed mother this is a real tragedy. Many, having experienced an abortion, try to conceive a child faster again, but first you need to know the reasons for what happened in order to save the fetus in the future. According to statistics, the largest number of miscarriages occurs precisely in the early stages.

There are several reasons for this:

1. Violations in genetics.

This is the most common cause of miscarriage. This is not due to heredity, it is a consequence of the mutation of parent germ cells, which accidentally ended up in unfavorable conditions. This is also the influence of radiation, poisoning, viruses, that is, temporary situations that affected the quality of germ cells. The body thus gets rid of a weak non-viable fetus. It is impossible and unnecessary to prevent such spontaneous abortion. It is only necessary, having decided to become pregnant, to try to cleanse your body of possible harmful influences.

2. Hormonal disorders

The cause of a miscarriage at a very early stage is also a lack of the hormone progesterone, or the fact that a woman has an excess of male sex hormones that suppress the production of estrogen and progesterone in her body. In this case, the fetus can be saved medically by administering the necessary medicines to the woman. The work of the adrenal glands, as well as the thyroid gland, affects the production of hormones, so a lot depends on the work of these glands throughout the pregnancy process.

3. Immunological causes .

In this case, the vitality of the fetus is directly affected by the Rh conflict. The embryo will inherit the positive Rh of the man, and if the partner has a negative Rh, then her body simply rejects cells that are foreign to him. A similar situation can be prevented by injecting the expectant mother with a variety of progesterone, a process called immunomodulation.

Sexually transmitted infections such as toxoplasmosis, syphilis, trichomoniasis, chlamydia and others are of great danger. External infection: bacteria and viruses infect the fetal membranes, and the body will inevitably reject the embryo. Therefore, before becoming pregnant, you should be examined to know for sure that there are no infections, and if the result is positive, undergo treatment.

In addition, all inflammatory processes, various diseases of the internal organs, which are accompanied by a persistent high temperature, can also lead to unexpected rejection of the fetus. Rubella is especially dangerous, and viral hepatitis is common. But even a sore throat, mild pneumonia, appendicitis sometimes play a key role and lead to a miscarriage, so the expectant mother must undergo a thorough examination even before the child is conceived, and then beware of all kinds of infections and weakening of the body.

4. Medical abortion.

If a woman had an abortion in a hospital and then became pregnant and decided to give birth, there is a danger that she will have a miscarriage. Abortion is a stress factor for the body, ovarian dysfunction is often observed, inflammatory processes in the female genital organs can begin, and all this will lead, at best, to miscarriage and subsequent repeated miscarriages, and at worst, to infertility. Therefore, you need to think very seriously before going for an abortion.

5. Medicines and certain herbs.

It is advisable for a pregnant woman not to take any medication at all, especially during the first three calendar months. Medicines and herbs can cause various defects in the fetus, which in turn will lead to its rejection. Analgesics and uncontrolled hormonal contraceptives are especially dangerous. Parsley and nettle should be eaten with caution - they cause a high tone of the uterus, which in turn can reject the fetus.

6. Stress.

It is no coincidence that in ancient times, pregnant women were protected from unrest, they were created comfortable conditions, and they tried to give as many positive emotions as possible. Now the direct dependence of the health of the unborn baby on the mental state during pregnancy has already been proven. Any stress, fear and overstrain can cause an unexpected termination of pregnancy. If you have a problem (death of a loved one, divorce, etc.), you need to find sedatives with the help of a doctor, they will help you cope with this period.

7. Unhealthy lifestyle.

Of course, the intake of alcoholic beverages, an unhealthy lifestyle, smoking, even coffee consumption in large quantities, improper diet - all this can lead to a transient miscarriage. Therefore, the expectant mother should prioritize and change her rhythm of life in advance in order to give birth to a healthy child.

8. Sexual intercourse, falling, heavy lifting.

All of these factors can affect the fetus, so you should protect yourself and your baby by avoiding these activities.

What to do after a miscarriage?

Having experienced the tragedy of losing a child, parents often intend to immediately conceive a new baby, but they are afraid that everything will happen again. In this case, you do not need to make independent decisions, but consult a doctor. And first of all, it is necessary to identify the cause that led to the miscarriage. For this, the expectant mother needs to undergo as thorough an examination as possible.

If no obvious cause is found, the fetus most likely has a chromosomal abnormality. In this case, you should not worry, since the next conception will occur with a different set of chromosomes, which means that there will be no repeated miscarriage. If the miscarriage was repeated, it is necessary to contact a geneticist and conduct a study of the set of chromosomes of both parents. If it turns out that the cause was an infection, then it is necessary to fully recover. If we are talking about sexual infections, then both parents need to undergo therapy. It is necessary to take tests for hormonal studies, hemostasis systems and determine the immune status.

After a miscarriage, should be treated, if necessary, and pause between conceptions. During pregnancy, you should not take medications to prevent re-spontaneous pathological termination of pregnancy. Therefore, you can become pregnant only after the end of the course of treatment. If the cause was hormonal abnormalities, then the expectant mother should take special drugs to stabilize the background, and at this time she should never become pregnant. During the pause, you need to choose contraceptives with the help of a doctor. You can go to a specialized clinic where you will be prescribed a full course of rehabilitation.

The first week after a miscarriage women often experience pain in the lower abdomen, heavy bleeding, so you should refrain from sexual intercourse with a man. If there is severe bleeding, acute pain in the lower abdomen, convulsions, high fever, palpitations, nausea, vomiting, then you should immediately consult a doctor to identify the cause of this condition. It is necessary to plan a subsequent pregnancy not earlier than three months after this situation, but preferably six months later. Until that time, it is worth reconsidering your outlook on life, giving up hard work, eating right and wisely, taking vitamins, exercising, losing weight if you are overweight, stop smoking, drinking alcohol, think over your daily routine.

It is very important during this recovery period to have a positive attitude and confidence that the next attempt will be successful. This is harder to do than to say, because after a miscarriage the woman is in a depressed state and is afraid of a repetition of the situation. You can’t get hung up on your problem, during this period it’s better to do some favorite thing, relax, change the situation, travel, visit the city more often. The modern ecological situation in cities has a bad effect on women's health, so private trips to nature, a trip to the sea, to friends in another city can distract from painful thoughts. An important role in this case is played by the woman's relatives and, above all, the husband, who can surround her with care and attention, creating peace of mind.

You may need to contact a counseling psychologist or psychotherapist. Yoga classes, self-education, visiting theaters, exhibitions and temples have a very beneficial effect on the psyche of a woman and help to distract from her problems. Helping others who have a difficult life situation, caring for the sick can also have a beneficial psychological effect and help you look at your problems from the outside.

Remember, the human body is a self-healing system, it just needs a little help.

Miscarriage (spontaneous abortion)

• Types of miscarriage
• Causes of miscarriage
• Symptoms of miscarriage
• When to seek immediate medical attention
• Miscarriage research
• Treatment of miscarriage
• Prevention of miscarriage

Miscarriage is a condition in which a pregnancy is terminated before the fetus can survive. Any bleeding from the vagina that is larger than a speck in size during early pregnancy is regarded as a threat of miscarriage. Vaginal bleeding is a fairly common situation during early pregnancy. One in four pregnant women develop spotting during the first months of pregnancy. In half of them, bleeding stops on its own and in the future the pregnancy proceeds without complications. In the medical sense, miscarriage and spontaneous abortion are identical terms.

Varieties of miscarriage

There are such types of miscarriage (spontaneous abortion):

• Threat of miscarriage - no vaginal bleeding. Canal of the cervix during the examination is not opened. There are pulling pains in the lower abdomen and spasms. When conducting ultrasound during pregnancy during the threat of miscarriage, you can see the hypertonicity of the uterus in the form of a thickening of the wall.
• Incipient miscarriage - vaginal bleeding during early pregnancy. The intensity of vaginal bleeding and pain during a threatened miscarriage is usually low and the cervix is ​​usually closed on gynecological examination. At the same time, there are no signs of the release of the tissues of the fetal egg from the cervical canal. When conducting a manual study, the area of ​​\u200b\u200bthe uterus and appendages is sensitive.
• Abortion in progress ( imminent miscarriage ) - there is significant bleeding from the vagina, more intense pain and spasms. A gynecological examination reveals a gaping canal of the cervix, in which parts of the fetal egg are visible.
• Incomplete miscarriage (incomplete abortion) - partial expulsion of parts of the fetus and tissues of the chorion (placenta) before the 22nd week of pregnancy. The intensity of bleeding from the vagina is high, the pain and spasms are quite strong. When conducting an ultrasound, it is possible to visualize the remnants of tissues in the uterine cavity.
• Complete miscarriage (complete abortion) - characterized by the complete exit of all tissues of the fetus and the ovum from the uterus. Bleeding and pain usually stop when all of the tissue is removed from the uterus. When conducting ultrasound in the uterine cavity, it is not possible to detect the fetus and parts of the fetal egg.

Currently, miscarriage occurs in approximately 20% of all pregnancies. However, there is no single obvious reason for the development of such a complication. Stages such as a threatened miscarriage and a miscarriage that has begun (an abortion that has begun) are reversible if the pregnant woman is provided with medical care on time.

Causes of miscarriage

Miscarriage develops due to separation of the placenta and fetus from the uterine wall, and although the exact causes of this condition are unknown, there are several most significant factors in the development of this pregnancy complication:

• Anomalies in the development of the fetus are the most common cause miscarriage during the first three months of pregnancy. Genetic abnormalities in the fetus are found in almost half of the cases. The risk of anomalies and miscarriage increases with a woman's age and becomes maximum after 35 years.
• Miscarriages occurring during the second trimester of pregnancy mostly depend on the health of the woman. The risk factor is diabetes mellitus, arterial hypertension, renal failure, thyroid disease, some infectious diseases (cytomegalovirus infection, mycoplasmosis), emotional upheaval, background gynecological diseases (uterine fibroids, endometriosis, multiple pregnancy, placental abnormalities). Miscarriages can develop with insufficient tone and cicatricial changes in the cervix (isthmic-cervical insufficiency). The negative effects of caffeine, alcohol and tobacco are very strong.

Symptoms of a miscarriage

When a woman has a miscarriage, symptoms such as vaginal bleeding, lower abdominal pain and cramps are common.

• Bleeding can be of varying degrees of intensity. To make it easier for the doctor to assess the severity of this symptom, tell how many pads are changed during the day and if you noticed the presence of blood clots and foreign tissues in the vaginal discharge.
• Pain and cramps usually occur in the lower abdomen. The pain can be one- and two-sided, spread to the back and buttocks, as well as to the genitals.
• Symptoms such as nausea during pregnancy, swelling and hardening of the mammary glands may disappear.

When to seek immediate medical attention

If you are pregnant and experience any of the following symptoms, contact your doctor immediately:

• Vaginal bleeding
• Lower abdominal pain or cramps
• Weakness and/or nausea
• Severe attacks of nausea and vomiting
• Pain and increased frequency when urinating

If you have the following symptoms, you should immediately go to a medical hospital or call an ambulance :

• If you know that you are pregnant and the intensity of vaginal bleeding is such that you have to change more than 1 pad per hour.
• If you experience severe pain and cramps in your lower abdomen
• If you see anything in the discharge that looks like tissue
• If you have had an ectopic pregnancy in the past
• If you experience severe dizziness and fainting
• If you have a high temperature (higher than 37. 5)

Investigations for miscarriage

When you visit your doctor, you will be asked the following questions:

• What is your gestational age?
• When did you last have a normal period?
• How many times have you been pregnant?
• How many live birth pregnancies have you had in your life?
• Have you ever had a miscarriage before?
• Have you had any ectopic pregnancies?
• Have you ever had an abortion?
• What kind of contraception did you use?
• Did you plan this pregnancy?
• Do you want to keep the pregnancy?
• Did you receive any treatment during pregnancy?
• Do you have problems with urination?
• Have you had an ultrasound done to confirm that the pregnancy is proceeding normally?
• Do you know your blood type and Rh factor?
• Do you have any chronic or acute illnesses?
• What medicines do you use?

Do you use any dietary supplements or herbal bioactives?

It is mandatory to assess the condition of the cervix by performing a gynecological examination, which consists in inserting a vaginal speculum and assessing the condition of the cervix. With the onset of a miscarriage, you can see the open external pharynx of the cervical canal with fragments of the fetal egg. Bimanual palpation of the pelvic organs is also performed. With this manipulation, the gynecologist places the fingers of one hand into the vagina, and with the other hand gently presses on the uterus, cervix and ovaries. This technique allows you to assess the sensitivity, size and displacement of the pelvic organs. Also, with the threat of a miscarriage, they collect blood for analysis. In the blood, the level of beta-chorionic gonadotropin, a hormone that increases during pregnancy, is determined. A decrease in the concentration of this hormone may indicate the fading of pregnancy. A general blood test is also performed to determine the degree of blood loss. A blood typing and Rh test may also be done. If there are symptoms that indicate a genitourinary infection, cultures are taken and PCR reactions are performed to diagnose bacteria and viruses. Ultrasound with a suspected threat of miscarriage is one of the main diagnostic procedures. Ultrasound is painless and can be performed through the abdomen or transvaginal ultrasound for more accurate imaging.

Treatment of miscarriage

Threatened miscarriage and incipient miscarriage are reversible conditions. If an abortion is diagnosed in the course or later stages, attempts to maintain the pregnancy do not make sense. Therefore, in case of incomplete abortion, cervical dilatation and curettage of the uterine cavity from residues are used. In cases where there are suggestions that the threat of miscarriage is due to the presence of an infection of the urogenital tract, it is treated. If there is a suspicion of the occurrence of a Rh conflict during pregnancy, an anti-Rhesus serum is administered. In the event that ultrasound does not show placental abruption, the cervical canal is closed, bleeding is insignificant, and blood tests are normal, you can stay at home and follow these instructions:

• Get plenty of rest, trying to stay in bed
• Do not shower
• Do not have sexual contact
• Watch carefully for white or gray pieces of tissue in the vaginal discharge
• Be sure to seek help if your symptoms worsen
• Return visit to the doctor within 48 hours

Prevention of miscarriage

Unfortunately, it is impossible to accurately predict or prevent the development of a miscarriage, but you must adhere to the following principles to increase the chances of a successful pregnancy:

• See your doctor if you become pregnant, perform the necessary tests and follow all his recommendations
• Do not drink alcohol or smoke
• Avoid coffee consumption
• Monitor blood pressure and blood sugar
• Get tested for urinary tract infections before planning a pregnancy and treat them in advance.

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