21 Aug Miscarriage Explained
Miscarriage is very common and thought to affect around 1 in 4 pregnancies.
Some Legal definitions of Miscarriage:
A miscarriage occurs up to 23+6 weeks gestation. A baby born after 24 weeks who has passed away in the uterus is classed a stillbirth. A baby born at any gestation who lives even if it for a very short time and then passes away is classed as a live birth and a neonatal death.
Types of Miscarriage
- Missed or delayed – may not know a problem until you have a first scan and are told the fetus is not growing or no heartbeat can be detected
- Blighted Ovum – the pregnancy sac is seen on scan but no fetus has developed within it.
- Incomplete – bleeding has occurred and some of the pregnancy tissue has passed but some still remains in the uterus.
With all of the above the pregnancy will likely miscarry naturally within its own timescale. Watchful waiting is known as expectant management and is a safe option. You will be discharged home and your HCP will continue to follow you up every 7-14 days if the miscarriage has not started.
The process of a miscarriage can be speeded up with medical or surgical intervention.
Research has shown no differing outcomes with all three; low infection risks, chances of healthy pregnancy following all three are the same but women cope better when given good support, clear information and the option to choose what will be best for them.
Emergency – A quick note about Ectopic Pregnancy
Ectopic Pregnancy is a pregnancy growing outside the uterus. If you experience one sided sharp abdominal pain, pain on opening bowels or pain in your shoulder attend A+E inform them of your symptoms and that you are pregnant so that you can have an early assessment. This can be a serious pregnancy related emergency and you should seek advice early if you have any of these symptoms.
How to know if you’re experiencing a miscarriage?
- Bleeding – The most common sign is vaginal bleeding; it could be spotting, dark red or bright red. It may come and go over a few days or be continuous.However, bleeding in pregnancy is quite common and not always a sign of a miscarriage; any bleeding at any stage of pregnancy should always be checked out be a healthcare professional.
- Pain – like bleeding can vary and is not always a sign of miscarriage. Backache is common in pregnancy as is constipation and low abdominal aches. However, you should always check with your HCP for advice.
- Loss of pregnancy symptoms is not a sign of miscarriage; some women have experienced this when they have suffered a pregnancy loss. However, it is normal for pregnancy symptoms to settle and a pregnancy continues. Some women do not experience any pregnancy symptoms and this is also very normal. Every pregnancy is different.
If you experience any pain or bleeding it is recommended you attend the A+E department for assessment; you will likely be referred to the Early pregnancy Unit of your local hospital. Most women will be offered a scan to assess the pregnancy. In early pregnancy (before 12 weeks) this is likely to be a transvaginal scan (A small probe is inserted into the vagina gently to see inside the uterus). After 12 weeks abdominal scan can be performed to assess the pregnancy.
A note about Covid-19
With the current ongoing health pandemic it is advised that you contact your GP or local hospital prior to attending if it is not an emergency. There may be restrictions in place with regards to walk in appointments and accompanying visitors. Hospitals will also vary with their current protocols as situation continues to change.
However if you require emergency care then you should attend A+E directly for assessment.
You will likely experience heavy vaginal bleeding and period like cramps. These can be quite painful and you may want to have some paracetamol or ibuprofen for pain relief. When the pregnancy tissue passes you may see large clots or something that resembles the pregnancy sac. If you miscarry at home you are likely to miscarry into the toilet. This is very normal and your natural reaction may be to want to flush the toilet. This is absolutely fine. It is also okay if you also want to have a closer look or want to keep what you can visibly see.
You are likely to experience the process that is very similar to labour if you miscarry in the second trimester and will most likely need hospital care with the midwifery team who will ensure you are well cared for.
Why have I experienced a miscarriage?
You may be wondering why your miscarriage occurred. Here are some of the reasons why a miscarriage may occur:
- Genetics: this is when the building blocks of DNA have not developed in the correct way right from the start and the pregnancy was unable to survive. 3 out of 4 miscarriages in the first trimester are caused by this.
- Hormones: women with irregular cycles may find it harder to conceive and when they do may be at higher risk of miscarrying.
- Blood clotting: Any problems with the blood vessels that feed the placenta can lead to miscarriage especially if the blood clots more than it should.
- Infection: coughs and colds are not harmful to your pregnancy but very high temperatures or some illnesses like German Measles may increase the risk of miscarriage.
- Anatomical: if the cervix (the neck of the uterus) is shortened or weak it may start to open as the uterus becomes heavier in later pregnancy which can be a cause of miscarriage. If the uterus is an irregular shape there may not be enough room for the baby to grow. Large fibroids (benign growths in the uterus) may be a cause of miscarriage in later pregnancy.
There are some myths about causes of pregnancy loss which are not true:
The mother being stressed or depressed, working, standing or sitting for long periods of time, travelling by air, having sex, having a scare or a fright, or eating spicy food cannot contribute to a miscarriage. It is highly unlikely that anything ‘you did’ led to your loss.
However, we do know that some controllable factors may mean a pregnancy is at higher risk of miscarriage. These are if the mother is obese, smokes, uses drugs, drinks alcohol or has a lot of caffeine.
Tommy’s: Support After a Miscarriage
Sands: Stillbirth and Neonatal Death Charity