The pregnancy physicians at Gainesville's All About Women discuss the medical and emotional aspects of miscarriage
Miscarriages aren't often talked about, but they occur more often than you might expect. Many women are surprised to learn that at least 15 to 20% of all pregnancies end in miscarriage. The number is likely much higher, but these pregnancies often times end before a woman even knows that she is pregnant.
Having a miscarriage can be a sad and confusing time, but learning more about miscarriages - their cause, course, and treatment - can at least help you prepare for what's to come and perhaps give you a measure of comfort in knowing that most women who miscarry go on to have successful pregnancies.
Risk of Miscarriage
A miscarriage is the most common cause of pregnancy loss. The medical term for miscarriage is spontaneous abortion . Miscarriages occur any time before the 20th week of pregnancy, though most occur before the end of the first trimester. Once a heartbeat is detected, usually around the 12th week of pregnancy, the chance of a miscarriage significantly decreases.
Women have a greater risk of miscarrying as they age. While 15% of women under the age of 34 miscarry, 25% of women between the age of 35 and 39 will miscarry. Women over the age of forty have a 40% chance of miscarriage, with the risk increasing further after the age of 45.
Symptoms and Treatment of Miscarriage
If you are experiencing bleeding and cramping, you may be beginning to miscarry. You can have bleeding during the first trimester without miscarrying - about fifty percent of women who bleed will lose their pregnancy to a miscarriage. Many women who miscarry also notice that they are no longer experiencing signs of early pregnancy such as nausea, tiredness, or breast tenderness.
If you are spotting or bleeding and concerned about a miscarriage, you should contact your midwife or OB/GYN. While there is usually no way to prevent a miscarriage, you will need to be in close contact with your healthcare provider in case you do miscarry.
Some women have no signs of a miscarriage and do not know that their pregnancy has ended until a heartbeat cannot be detected during a sonogram. Your doctor will tell you to expect to miscarry within the next several weeks. Sometimes it can take up to six weeks before an ended pregnancy miscarries naturally.
Cause of Miscarriage
Over half of all miscarriages are caused by chromosomal anomalies in the egg or sperm. While it sounds serious, a chromosomal anomaly simply means that the egg or sperm had a defect. Miscarriages caused by chromosomal anomalies do not indicate a future risk of miscarriage.
Other causes of miscarriage include:
- Abnormalities of the uterus or cervix
- Smoking or substance abuse
- Chronic illness (such as poorly controlled diabetes, autoimmune processes, kidney disease)
If you miscarry, particularly more than once, your doctor may want you to collect some of the passed tissue for lab testing. These tests will help determine if there are any genetic or other health factors, such as hormonal imbalances, that can be controlled or monitored to help prevent a future miscarriage.
Again, most women who miscarry proceed to have healthy, successful pregnancies.
Course of a Miscarriage
The height of a miscarriage involves heavy bleeding for several hours. It may begin with light spotting and cramping, or heavy bleeding may begin suddenly. You will pass large clots of blood and may have mild to heavy cramping. You may want to begin taking an over the counter painkiller or one that your doctor has prescribed early in the miscarriage to prevent cramping from escalating.
Most miscarriages can happen at home, though you should be stay in contact with your OB/GYN or midwife. They may want you to go to the hospital if bleeding becomes heavy. You should also go to the hospital if you experience any foul odors or fevers that could indicate an infection needing immediate treatment.
Following the period of heavy bleeding, lighter bleeding and spotting will continue over the course of a week or two, similar to a period.
If you learn of an impending miscarriage at your appointment, it may take several weeks before a miscarriage begins naturally. If your pregnancy was in the early stages, your doctor may be able to prescribe you a medication such as misoprostol to cause uterine contractions and expulsion. Or, if you do not miscarry naturally after several weeks, your doctor may schedule you for a D&C in order to complete the miscarriage.
You will have a follow up appointment several weeks after your miscarriage to make sure everything has passed. A blood test will ensure that your hormone levels have normalized. Some miscarriages are incomplete and require a surgical procedure, usually a D&C, to remove remaining tissues.
If you are Rh-negative, you may need a RH immune globulin shot within 72 hours of your miscarriage to ensure you don't have problems in your next pregnancy.
You can usually have sex starting four weeks after a miscarriage and your period will likely come back after six weeks. Though it is possible to get pregnant immediately following a miscarriage, your healthcare provider may recommend you wait a full menstrual cycle before you try to get pregnant again.
Emotionally, it may take longer before you are prepared.
The Emotional Side of Miscarriage
Grief, guilt, sadness, or relief are all feelings that are common when you experience a miscarriage. If you miscarried before 12 weeks, you may feel alone or isolated if no one knew you were pregnant. If you share that you've miscarried, you may feel like people dismiss it because you weren't far along in your pregnancy. But the truth is that regardless of how far along you were, you've probably already thought out your whole pregnancy and imagined holding your baby in your arms. It's okay to grieve. By sharing your miscarriage, you may learn of women in your life who have had miscarriages that you didn't even know about.
The pregnancy physicians and Gainesville's All About Women are here to help you through the painful course of miscarriage with both competent medical care and compassion. If you are concerned about miscarriage or have other pregnancy concerns, contact our office in Gainesville or Lake City to schedule an appointment today.‹ All About Women OB/GYN Knowledge Center