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Information on Miscarriage
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Information on Miscarriage WHAT IS A MISCARRIAGE? A miscarriage is the loss of a pregnancy before the baby can live outside the womb. Miscarriage is also used to describe the process of passing the baby, placenta and the bag of water out of the uterus. When you are miscarrying, there is usually a predictable sequence of events. WHAT THINGS INDICATE THAT I MIGHT MISCARRY? The most common symptoms of miscarriage are vaginal bleeding, with or without low abdominal cramps, early in pregnancy. Both cramps and light bleeding may occur in a normal pregnancy. If this light bleeding resolves on its own the pregnancy usually continues without further problems. However, if you have heavy bleeding and severe cramps, early in pregnancy, call the office so that we can help you find out what is going on. WHAT HAPPENS DURING A MISCARRIAGE? When you become pregnant, the fertilized egg implants in the wall of the uterus and grows into a placenta, a baby and a gestational sac (bag of waters). If a miscarriage occurs, blood leaks from the place where the baby is implanted and works its way out through the cervix and into the vagina. Early in the miscarriage process, the bleeding is usually light red or pink, but as the miscarriage progresses, the bleeding persists and becomes heavier. You may pass small clots and gradually progress to larger clots, sometimes getting to 2 to 3 inches or larger. At some point, the uterus begins to cramp (this feels like painful menstrual cramps) and the cervix opens. After the cervix is open, the placenta, the bag of water, the baby and any other tissue come out of the uterus and miscarry through the vagina. HOW COMMON IS MISCARRIAGE? Miscarriage in early pregnancy is very common. Studies show that about 10 to 20 percent of women who know they are pregnant have a miscarriage some time before 20 weeks of pregnancy. Most miscarriages happen during the first 12 weeks of the pregnancy. WHAT CAUSES MISCARRIAGE? Many different factors can lead to miscarriage, and it is difficult to say with certainty what causes a particular miscarriage to occur. When miscarried pregnancies are carefully studied, a cause can be found in the majority of cases. The most common cause is a non-reoccurring genetic problem with the egg or sperm. Other miscarriages may be caused by exposure to viral diseases, trauma, and exposure to harmful substances (see risk factors below). In some cases, medical conditions, such as uncontrolled diabetes, or structural problems with the uterus, like uterine fibroids, can lead to miscarriage. HOW IS MISCARRIAGE DIAGNOSED? In some cases, we can make a diagnosis based on your symptoms and by examining you. If your cervix is open and we can see blood and pregnancy tissue in your cervix, the diagnosis is straightforward. In most cases of vaginal bleeding in early pregnancy, ultrasound and lab tests, sometimes carried out over several days or a couple of weeks, help to establish a diagnosis. Ultrasound is helpful in determining if the pregnancy is "viable” and capable of progressing to term. In early pregnancy, ultrasound is usually done through the vagina because it allows better visualization of the uterus, tubes, ovaries and the pregnancy. EVALUATING THE FETAL HEART BEAT Very early in pregnancy, at about 6 weeks after the last menstrual period, ultrasound can demonstrate the motion of the your baby’s heartbeat. If the pregnancy has progressed to the stage where a heartbeat should be present, the failure to detect a heartbeat during an ultrasound exam usually means the baby is not alive. On the other hand, presence of a fetal heart, which is beating at a normal rate, indicates the pregnancy is still be viable and a miscarriage is less likely. A fetal heartbeat that is slower than normal may indicate that a miscarriage is likely. RISK FACTORS WHICH ARE ASSOCIATED WITH MISCARRIAGE: · Age — Advancing age of the mother is the most important risk factor for miscarriage. Miscarriage is more common as age of the mother increases. · Number of pregnancies — The risk of miscarriage increases as the number of pregnancies goes up. That is, women who have been pregnant two or more times have an increased risk of miscarriage. · Previous miscarriage — A history of previous miscarriage also increases your chance of miscarriage in your next pregnancy. If you have never delivered a baby and have a miscarriage, you have about a 20 percent chance of miscarrying your second pregnancy. If you have had two miscarriages and no children, the risk of a miscarriage is 28 percent. After three losses, the miscarriage rate rises to 43 percent. By comparison, only 5 percent of women, whose previous pregnancy was successful, miscarried in the next pregnancy. · Smoking — There is evidence that heavy smoking (more than 10 cigarettes a day) is associated with an increased risk of miscarriage. · Alcohol — Consumption of more than 30 ounces of alcohol per month doubles your risk of miscarriage. If you have more than 3 drinks per week during the first 12 weeks of pregnancy, you will be at increased risk of miscarriage. · Fever — Pregnant women who develop fevers of 100 degrees or more appear to have an increased risk of miscarriage. · Trauma — Putting instruments into the uterus, as occurs during an amniocentesis or chorionic villus sampling, (types of prenatal testing) increases the risk of miscarriage. · Caffeine — In one study, some women who took in 500 mg of caffeine per day had an increased risk of miscarriage (8 ounces of coffee contains 100 to 135 mg of caffeine). STAGES AND TYPES OF MISCARRIAGE: · Threatened miscarriage — If you have vaginal bleeding early in pregnancy, but no other signs of problems, this is a threatened miscarriage. If you are more than six weeks along ultrasound will usually demonstrate a fetal heartbeat in a healthy pregnancy. About half of women who have a threatened miscarriage continue to term with a healthy pregnancy. In the other half, the bleeding becomes heavier and miscarriage occurs. · Inevitable miscarriage — Once the cervix opens and bleeding is heavy, or if the bag of water breaks, miscarriage will inevitably occur. · Incomplete miscarriage — If you have passed most of the pregnancy tissue, but some remains in the uterus, this is an incomplete miscarriage. Typically, the baby passes early in the miscarriage, and only pieces of the placenta and membranes remain. Your cervix remains open, and you may bleed heavily with an incomplete miscarriage. · Complete miscarriage — If you pass all of the baby, membranes and placenta, you have had a complete miscarriage. Complete miscarriages usually occur spontaneously in pregnancies that are less than eight weeks from the last period. Even after a complete miscarriage you will have bleeding which tapers off for several days, like at the end of a period. If you are unsure if you have completely miscarried, an ultrasound examination confirms the diagnosis. · Septic miscarriage — Rarely, women who have a miscarriage may develop an infection in the uterus, also known as a septic miscarriage. Symptoms include fever, chills, extreme fatigue, abdominal pain, vaginal bleeding, and a thick vaginal discharge with an unpleasant odor. This kind of miscarriage requires urgent intervention to prevent damage to the uterus, tubes and ovaries. WHAT IS THE TREATMENT FOR MISCARRIAGE? Unfortunately, there is no known treatment which can stop a miscarriage. Once we are sure that a miscarriage is inevitable or has already started to occur, several options are available depending on the stage of the miscarriage, what you are experiencing, and other factors. The three main options are: natural miscarriage at home, medical treatment, or surgical treatment. · Natural miscarriage at home — In some situations, you may require very little treatment. If you are at less than eight weeks from your last menstrual period, have normal blood pressure, pulse and temperature, and no signs of infection, you may decide to allow your pregnancy to miscarry at home. The contents of the uterus will usually pass within two weeks of the start of bleeding, but may occasionally be delayed as long as three to four weeks. Once you have passed the placenta, membranes and the baby, we will have you return to the office for an ultrasound to make sure that the miscarriage is complete. If you have had a complete miscarriage, after ultrasound demonstrates that all the tissue is out of the uterus, further treatment is usually unnecessary. · Medical treatment — If you have elected to let the miscarriage occur on its own you may also choose to use Misoprostol®, a medications which stimulates the uterus contract and helps you pass the pregnancy tissue more quickly. Misoprostol is usually placed in the vagina, and works within 12 to 24 hours. · Surgical treatment — The conventional treatment for an early miscarriage is a surgical procedure called dilation and curettage, or “D&C”. This surgery is usually done in an outpatient surgery center, or sometimes in the emergency room. After giving anesthesia, we will dilate your cervix and remove the pregnancy tissues by gently scraping the inside of the uterus or using suction. As with any surgical procedure, there is a small risk of complications. Possible complications include perforation of the uterus, formation of scar tissue in the uterus, trauma to the cervix, and infection, which could lead to future fertility problems. A D&C is usually the best choice for women who cannot or do not want to wait for a natural miscarriage at home, for women who are over eight weeks along or if you have heavy bleeding or signs of an infection. WHAT HAPPENS AFTER A MISCARRIAGE? Following miscarriage, we advise you to maintain "pelvic rest" for two weeks. This means not having sex or putting anything, such as a tampon, into the vagina. Usually it is best to wait 2 to 3 months before attempting to become pregnant again. If you need it, we can help you with contraception or birth control until you are ready to try again. If you have a D&C we may give you medications to help decrease bleeding and reduce the risk of infection. If you have Rh-negative blood you will also need to receive a drug called Rhogam®. This medicine helps protect future pregnancies against problems that can occur due to sensitization. You will experience a wide range of emotions following your miscarriage. There is no right or wrong way to feel. You will probably experience a grief reaction because losing a wanted pregnancy is a significant loss! If your sense of grief is overwhelmingly strong and long lasting please call us so we can help you with a referral for grief counseling or other treatment. If you become profoundly sad, feel like you are losing hope or become despondent or are worried that you might hurt yourself or others, please call the office so we can help you. WHERE TO GET MORE INFORMATION A number of other sites on the Internet have information about miscarriage. Information provided by the National Institutes of Health (http://nih/gov/), American College of Obstetricians and Gynecologists (http://www.acog.com), and WebMD (http://www.webmd.com/), are reliable sources of information, although the frequency with which they are updated is variable. Another good source of information is the National Library of medicine (http://www.nlm.nih.gov/medlineplus). Sources on the web can be helpful but are always generalized. The best resource for finding out important information, which relates to you personally, is your healthcare provider. Because every patient is different, it is important to consider how individual factors modify the general information and apply to your personal situation. Please call us if we can be of help.
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