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Information about Miscarriage
What is a miscarriage?
The definition of a miscarriage is the loss of a pregnancy between conception and 24 weeks into the pregnancy. Research shows that about 1 in 3 pregnancy end in miscarriage.
Types of miscarriage
Threatened miscarriage – This is when there is bleeding in early pregnancy but the cervix has remained tightly closed and the pregnancy has a chance to continue.
Inevitable miscarriage –This is when there is bleeding in early pregnancy but the cervix has opened and the pregnancy is going to be lost.
Incomplete miscarriage –This is where the miscarriage has taken place and of the has been lost but some of the pregnancy matter has remained in the womb. The cervix is usually found to be opened.
Complete miscarriage –This is when the pregnancy has been completely lost, the cervix is open and there is no evidence left inside of the womb of pregnancy.
Missed miscarriage – This is where the baby stop growing weeks before but the pregnancy was not lost. This can be indicated buy the loss of dark brownish red blood and the sudden disappearance of any pregnancy symptoms.
Blighted Ovum- This is where the sack is present but no baby is inside.
What causes a miscarriage?
Doctors aren't able to pinpoint the reason for most early miscarriages but it seems that a baby which is abnormal in some way, tends to miscarry. Probably at least half of all miscarriages in the first trimester of pregnancy are the result of chromosomal abnormalities that prevent the baby from developing normally. Later miscarriages after 20 weeks may be the result of an infection or an abnormality of the uterus or placenta, or weak cervix, sometimes called an "incompetent cervix" that is not strong enough to keep the womb tightly closed until the baby is ready to be born.
Unfortunately, two of the tests -- amniocentesis and chorionic villus sampling (CVS) -- used to detect abnormalities in babies can also cause miscarriage. Amniocentesis, generally performed between the 15th and 18th weeks of pregnancy, results in miscarriage for around one per cent of women. CVS, which is performed at around 12 weeks of pregnancy, may cause miscarriage in between one and two per cent of women.
Miscarriage symptoms
The most common symptom is vaginal bleeding, which can range from light spotting to heavier than a period. There may be blood clots, or other tissue that is not clearly identifiable. Sometimes a sac-like structure is seen.
Some bleeding is very common during pregnancy, and vaginal bleeding does not always signal a miscarriage has taken place, especially if the bleeding is light and only lasts a short time. Bleeding that is prolonged or heavy, like a period, is more likely to lead to miscarriage.
Often there is cramping, with period-type pains. Some women find that the usual symptoms of pregnancy, such as breast tenderness, feeling sick and having to pass urine more frequently than usual, may stop unexpectedly.
What to do if a miscarriage is suspected
If a woman is bleeding from the vagina and feels pain then she must consult her doctor.
When is it necessary to consult a doctor immediately?
· If the woman is bleeding at such a rate that she needs more than one sanitary towel per hour. In this case, too much blood is being lost and the flow must be stopped.
· If the woman feels weak or faint. These are both signs that she is losing too much blood.
· If the woman experiences severe stomach pain, this may be a symptom of an ectopic pregnancy.
· If the woman experiences fever, shivering or a smelly vaginal discharge, this can be a sign of an infection or inflammation.
All these conditions are potentially serious and must be treated immediately.
What does the doctor do?
An abdominal examination is usually combined with an internal (pelvic) examination. In this way, it is possible to determine if the bleeding is a sign of a pregnancy that is destined to miscarry or one that may continue. An ultrasound scan is the most useful investigation. This is performed through the abdomen or through the vagina and gives precise information about whether the pregnancy is continuing or not.
At hospital
Women with bleeding in early pregnancy may be referred to an early pregnancy assessment unit, based at a local hospital. Usually an ultrasound scan and other tests are needed to find out what is happening.
After a discussion of the symptoms, and possibly an examination, some tests and investigations may be needed:
Blood count This is to make sure the bleeding hasn't caused anaemia.
Blood group Women who have a rhesus negative blood group may need to have an injection to prevent problems for subsequent pregnancies.
Pregnancy test Sometimes, a sensitive blood test for the pregnancy hormone, beta HCG, is sometimes taken.
Ultrasound scan This will show the uterus and any developing embryo. If all is well and the pregnancy is sufficiently advanced, a fetal heartbeat can be seen. If pregnancy is not very far on (less than six to seven weeks) it is sometimes not possible to tell if everything is normal, and another scan is needed in seven to 10 days time.
What if my pregnancy is continuing?
Provided the bleeding is not too heavy and the pain is controlled by simple painkillers, then you can go home. As long as the bleeding continues, it is advisable to keep off work. Bed rest is not essential and does not influence whether the bleeding will continue and result in a miscarriage or not. If a pregnancy is destined to miscarry, there is, unfortunately, nothing effective that you or your doctor can do.
What if my pregnancy is not continuing?
If a miscarriage is complete then no further treatment is needed. The other types of miscarriage frequently require treatment, though in some cases it is appropriate to see first if nature takes its course. The decision on whether medical treatment is needed depends on the stage of pregnancy, the amount of bleeding, and each woman's personal choice. When miscarriage occurs under 10 weeks, it is more likely to complete spontaneously.
For missed miscarriage or when there is significant bleeding, treatment with medicines or surgery may be needed to remove the remaining pregnancy tissue. Medicines are effective for miscarriage under seven weeks, or where there is a small amount of tissue remaining in the uterus. Although bleeding may be more prolonged afterwards, research suggests that avoiding an operation may halve the risk of an infection.
A medication could be prescribed that makes the uterus contract so that the remainder of the pregnancy is expelled.
Surgical treatment involves going to theatre for a short operation to empty the uterus. This is known as an evacuation of retained products of conception (ERPC), but is sometimes called a dilatation and curettage (D&C). It takes about 5 minutes. A soft plastic tube is passed through the cervix into the uterus and the pregnancy material is removed by suction.
What happens after a miscarriage?
Following a miscarriage, it is advisable to take it easy and rest for a couple of days. It will help if the woman has someone she trusts with her, so that she can talk openly about her feelings. After a couple of days it is often helpful to return to a normal daily routine.
After a miscarriage a woman might experience headaches or have trouble sleeping. She may also experience lack of appetite and fatigue.
Many women feel anger and sadness after a miscarriage, while many others experience a strong sense of guilt, even though it is not their fault. These are all natural reactions.
A miscarriage can be frightening, confusing and depressing. It is natural to feel grief over the loss of a child. Women should not let people ignore or belittle what they have been through. The people they choose to talk to must be prepared to listen to what they have experienced and deal with the strong emotions involved.
Any woman who finds it too difficult to deal with her grief, or who continues to feel depressed, should consult her doctor for further help.
When can I try for another baby?
There are no hard-and-fast rules. The right time to try for children again will vary from one couple to another: some will want to start a couple of weeks or months after the bleeding has stopped, others will want to wait longer. It is, of course, advisable to recover from the worst of the emotional upset before starting another pregnancy.
Recurrent miscarriage
Having a miscarriage is one of the most devastating things that can happen to a woman and her partner. There is little support offered to the woman and her partner by the authorties and is often just brushed under the carpet, it can be most frustrating to a women and her partner because they are never given any reason and often enough are just told to go away and try again. If a woman suffers a miscarriage the chances are that her next pregnancy will not encounter any problems and will go on and have a successful pregnancy the next time, however if it happens more than once it would be wise to have this investigated.
If a woman suffers from Recurrent Pregnancy Loss (more than one consecutive miscarriage) Investigations can be done Unfortunately in the UK doctors will not carry out these tests until three or more Pregnancy losses occur, this can be frustrating for a woman and her partner.
Only 2% of women will suffer Recurrent Pregnancy Loss
RECURRENT PREGNANCY LOSS: EVALUATION
1. Histerosalpingogram or hysteroscopy to investigate the uterine cavity.
2. Investigation for hormonal deficiency of progesterone. ( This can be done by bloodwork or an en dometrial biopsy)
3. Karyotyping of each partner. (Bloodwork)
4. Immunologic Causes (Bloodwork)
If a full investigation is Carried out on couples with 2 or 3 consecutive losses 50% will come back with no underlining cause. (Unexplained Recurrent Pregnancy Loss) Only half the couples tested will be found to have a reason for their RPL. This can prove frustrating for the couple. When no underlining cause is found the prognosis for future pregnancies is good.
Information for this page from
https://www.babycentre.co.uk/pregnancy/griefandloss/understandingmiscarriage/?_requestid=779355
https://www.netdoctor.co.uk/diseases/facts/miscarriage.htm
Support sites for miscarriage
Links with info about blighted ovum.
https://health.ivillage.com/gyno/gynoreprohealth/0,,6hhs,00.html
https://www.medcyclopaedia.com/library/topics/volume_iv_2/b/blighted_ovum.
The Miscarriage Association is a registered UK charity that provides support in all aspects of pg loss and they also have a help line:-
https://www.miscarriageassociation.org.uk/
This internet page has a good explanation and information on Dilation and Curettage (D&C) :-»-
https://www.netdoctor.co.uk/health_advice/facts/curettage.htm
https://www.emedicinehealth.com/dilation_and_curettage_dandc/article_em.htm
https://www.miscarriagesupport.org.nz/grief_issues.html
https://www.womens-health.co.uk/miscarr.htm
Tests that may be available following miscarriage
https://www.conceivingconcepts.com/medical/immune1.html#NK
https://millenova.com/tests/apa.asp
What is a miscarriage?
The definition of a miscarriage is the loss of a pregnancy between conception and 24 weeks into the pregnancy. Research shows that about 1 in 3 pregnancy end in miscarriage.
Types of miscarriage
Threatened miscarriage – This is when there is bleeding in early pregnancy but the cervix has remained tightly closed and the pregnancy has a chance to continue.
Inevitable miscarriage –This is when there is bleeding in early pregnancy but the cervix has opened and the pregnancy is going to be lost.
Incomplete miscarriage –This is where the miscarriage has taken place and of the has been lost but some of the pregnancy matter has remained in the womb. The cervix is usually found to be opened.
Complete miscarriage –This is when the pregnancy has been completely lost, the cervix is open and there is no evidence left inside of the womb of pregnancy.
Missed miscarriage – This is where the baby stop growing weeks before but the pregnancy was not lost. This can be indicated buy the loss of dark brownish red blood and the sudden disappearance of any pregnancy symptoms.
Blighted Ovum- This is where the sack is present but no baby is inside.
What causes a miscarriage?
Doctors aren't able to pinpoint the reason for most early miscarriages but it seems that a baby which is abnormal in some way, tends to miscarry. Probably at least half of all miscarriages in the first trimester of pregnancy are the result of chromosomal abnormalities that prevent the baby from developing normally. Later miscarriages after 20 weeks may be the result of an infection or an abnormality of the uterus or placenta, or weak cervix, sometimes called an "incompetent cervix" that is not strong enough to keep the womb tightly closed until the baby is ready to be born.
Unfortunately, two of the tests -- amniocentesis and chorionic villus sampling (CVS) -- used to detect abnormalities in babies can also cause miscarriage. Amniocentesis, generally performed between the 15th and 18th weeks of pregnancy, results in miscarriage for around one per cent of women. CVS, which is performed at around 12 weeks of pregnancy, may cause miscarriage in between one and two per cent of women.
Miscarriage symptoms
The most common symptom is vaginal bleeding, which can range from light spotting to heavier than a period. There may be blood clots, or other tissue that is not clearly identifiable. Sometimes a sac-like structure is seen.
Some bleeding is very common during pregnancy, and vaginal bleeding does not always signal a miscarriage has taken place, especially if the bleeding is light and only lasts a short time. Bleeding that is prolonged or heavy, like a period, is more likely to lead to miscarriage.
Often there is cramping, with period-type pains. Some women find that the usual symptoms of pregnancy, such as breast tenderness, feeling sick and having to pass urine more frequently than usual, may stop unexpectedly.
What to do if a miscarriage is suspected
If a woman is bleeding from the vagina and feels pain then she must consult her doctor.
When is it necessary to consult a doctor immediately?
· If the woman is bleeding at such a rate that she needs more than one sanitary towel per hour. In this case, too much blood is being lost and the flow must be stopped.
· If the woman feels weak or faint. These are both signs that she is losing too much blood.
· If the woman experiences severe stomach pain, this may be a symptom of an ectopic pregnancy.
· If the woman experiences fever, shivering or a smelly vaginal discharge, this can be a sign of an infection or inflammation.
All these conditions are potentially serious and must be treated immediately.
What does the doctor do?
An abdominal examination is usually combined with an internal (pelvic) examination. In this way, it is possible to determine if the bleeding is a sign of a pregnancy that is destined to miscarry or one that may continue. An ultrasound scan is the most useful investigation. This is performed through the abdomen or through the vagina and gives precise information about whether the pregnancy is continuing or not.
At hospital
Women with bleeding in early pregnancy may be referred to an early pregnancy assessment unit, based at a local hospital. Usually an ultrasound scan and other tests are needed to find out what is happening.
After a discussion of the symptoms, and possibly an examination, some tests and investigations may be needed:
Blood count This is to make sure the bleeding hasn't caused anaemia.
Blood group Women who have a rhesus negative blood group may need to have an injection to prevent problems for subsequent pregnancies.
Pregnancy test Sometimes, a sensitive blood test for the pregnancy hormone, beta HCG, is sometimes taken.
Ultrasound scan This will show the uterus and any developing embryo. If all is well and the pregnancy is sufficiently advanced, a fetal heartbeat can be seen. If pregnancy is not very far on (less than six to seven weeks) it is sometimes not possible to tell if everything is normal, and another scan is needed in seven to 10 days time.
What if my pregnancy is continuing?
Provided the bleeding is not too heavy and the pain is controlled by simple painkillers, then you can go home. As long as the bleeding continues, it is advisable to keep off work. Bed rest is not essential and does not influence whether the bleeding will continue and result in a miscarriage or not. If a pregnancy is destined to miscarry, there is, unfortunately, nothing effective that you or your doctor can do.
What if my pregnancy is not continuing?
If a miscarriage is complete then no further treatment is needed. The other types of miscarriage frequently require treatment, though in some cases it is appropriate to see first if nature takes its course. The decision on whether medical treatment is needed depends on the stage of pregnancy, the amount of bleeding, and each woman's personal choice. When miscarriage occurs under 10 weeks, it is more likely to complete spontaneously.
For missed miscarriage or when there is significant bleeding, treatment with medicines or surgery may be needed to remove the remaining pregnancy tissue. Medicines are effective for miscarriage under seven weeks, or where there is a small amount of tissue remaining in the uterus. Although bleeding may be more prolonged afterwards, research suggests that avoiding an operation may halve the risk of an infection.
A medication could be prescribed that makes the uterus contract so that the remainder of the pregnancy is expelled.
Surgical treatment involves going to theatre for a short operation to empty the uterus. This is known as an evacuation of retained products of conception (ERPC), but is sometimes called a dilatation and curettage (D&C). It takes about 5 minutes. A soft plastic tube is passed through the cervix into the uterus and the pregnancy material is removed by suction.
What happens after a miscarriage?
Following a miscarriage, it is advisable to take it easy and rest for a couple of days. It will help if the woman has someone she trusts with her, so that she can talk openly about her feelings. After a couple of days it is often helpful to return to a normal daily routine.
After a miscarriage a woman might experience headaches or have trouble sleeping. She may also experience lack of appetite and fatigue.
Many women feel anger and sadness after a miscarriage, while many others experience a strong sense of guilt, even though it is not their fault. These are all natural reactions.
A miscarriage can be frightening, confusing and depressing. It is natural to feel grief over the loss of a child. Women should not let people ignore or belittle what they have been through. The people they choose to talk to must be prepared to listen to what they have experienced and deal with the strong emotions involved.
Any woman who finds it too difficult to deal with her grief, or who continues to feel depressed, should consult her doctor for further help.
When can I try for another baby?
There are no hard-and-fast rules. The right time to try for children again will vary from one couple to another: some will want to start a couple of weeks or months after the bleeding has stopped, others will want to wait longer. It is, of course, advisable to recover from the worst of the emotional upset before starting another pregnancy.
Recurrent miscarriage
Having a miscarriage is one of the most devastating things that can happen to a woman and her partner. There is little support offered to the woman and her partner by the authorties and is often just brushed under the carpet, it can be most frustrating to a women and her partner because they are never given any reason and often enough are just told to go away and try again. If a woman suffers a miscarriage the chances are that her next pregnancy will not encounter any problems and will go on and have a successful pregnancy the next time, however if it happens more than once it would be wise to have this investigated.
If a woman suffers from Recurrent Pregnancy Loss (more than one consecutive miscarriage) Investigations can be done Unfortunately in the UK doctors will not carry out these tests until three or more Pregnancy losses occur, this can be frustrating for a woman and her partner.
Only 2% of women will suffer Recurrent Pregnancy Loss
RECURRENT PREGNANCY LOSS: EVALUATION
1. Histerosalpingogram or hysteroscopy to investigate the uterine cavity.
2. Investigation for hormonal deficiency of progesterone. ( This can be done by bloodwork or an en dometrial biopsy)
3. Karyotyping of each partner. (Bloodwork)
4. Immunologic Causes (Bloodwork)
If a full investigation is Carried out on couples with 2 or 3 consecutive losses 50% will come back with no underlining cause. (Unexplained Recurrent Pregnancy Loss) Only half the couples tested will be found to have a reason for their RPL. This can prove frustrating for the couple. When no underlining cause is found the prognosis for future pregnancies is good.
Information for this page from
https://www.babycentre.co.uk/pregnancy/griefandloss/understandingmiscarriage/?_requestid=779355
https://www.netdoctor.co.uk/diseases/facts/miscarriage.htm
Support sites for miscarriage
Links with info about blighted ovum.
https://health.ivillage.com/gyno/gynoreprohealth/0,,6hhs,00.html
https://www.medcyclopaedia.com/library/topics/volume_iv_2/b/blighted_ovum.
The Miscarriage Association is a registered UK charity that provides support in all aspects of pg loss and they also have a help line:-
https://www.miscarriageassociation.org.uk/
This internet page has a good explanation and information on Dilation and Curettage (D&C) :-»-
https://www.netdoctor.co.uk/health_advice/facts/curettage.htm
https://www.emedicinehealth.com/dilation_and_curettage_dandc/article_em.htm
https://www.miscarriagesupport.org.nz/grief_issues.html
https://www.womens-health.co.uk/miscarr.htm
Tests that may be available following miscarriage
https://www.conceivingconcepts.com/medical/immune1.html#NK
https://millenova.com/tests/apa.asp
