It is estimated that as many as one in five pregnancies end in miscarriage although many remain undetected.
Miscarriage is the spontaneous ending of a pregnancy before the foetus is mature enough to survive outside the womb, usually occurring before the gestational age of 24 weeks.
It is estimated that as many as one in every five pregnancies ends in miscarriage. Many of these may occur undetected in the early stages of pregnancy before a woman is aware that she has conceived.
Not all miscarriages happen the same way.
Threatened Miscarriage
If there is bleeding without pain in the first trimester and the foetus remains in tact through to full term, this is known as a threatened miscarriage. Often bleeding in the early stages occurs at the time that a normal period is due. Once you are pregnant, hormones halt menstruation but sometimes these levels are not high enough to prevent scanty bleeding.
Some doctors may advise injections of progesterone to stop the bleeding. The blood comes from the placenta where it is not properly attaching to the uterine wall or from around the cervix. It is very rare for blood to come from the baby.
Missed Miscarriage
A missed miscarriage occurs when the foetus dies but remains in the womb and is either naturally expelled later or removed by an operation.
Inevitable Miscarriage
When the foetus dies and is expelled from the womb, this is known as an inevitable miscarriage.
Incomplete Miscarriage
Sometimes small fragments of the placenta or blood clots in your womb, this is termed an incomplete miscarriage.
Late Miscarriage
Late miscarriage is often the result of an incompetent cervix that starts to dilate long before it should. The first sign may be the breaking of the waters due to the dilating cervix rupturing the amniotic sac. It is thought that a previous abortion performed beyond 12 weeks, repeated mid-term pregnancy miscarriage or a previous difficult labour could all be factors linked to incompetent miscarriage.
If a miscarriage occurs after 24 weeks, it is termed premature birth and the birth and the death has to be registered. Medical professionals consider a developing baby beyond 24 weeks as “viable” meaning that the baby has a strong chance of surviving with the help of advanced technological and special care.
The cause of miscarriage is not always known. While miscarriage is always distressing it may help to know that the majority of miscarried foetuses are found to have severe chromosomal disorders. These babies would not have been able to survive outside the womb. Medical professionals are unable to explain exactly how this occurs though it seems nature has an ability to detect an abnormal foetus and triggers spontaneous abortion. Sometimes the foetus has failed to develop and what is called a blighted egg or ovum, is expelled. It is estimated that one in six miscarriages may be the result of a faulty ovum failing to grow. The presence of fibroids in the uterus has also been linked to miscarriage. Hormonal imbalance may be another factor as some women who have suffered repeated miscarriages have also experienced trouble conceiving.
A miscarriage after the 20th week may be due to placental insufficiency. The placenta may fail to function inhibiting the supply of oxygen and nutrients to the foetus. In such cases, improved preconception care* including dietary advice may be recommended before trying to conceive again.
Recent findings in Australia have shown that half of all miscarriages can be attributed to the mother and half to the male partner. Statistics also reveal that the potential for miscarriage increases where the male and female are exposed to oil based paints, glues, x-rays or oven cleaners.
Possible Warning Signs
These symptoms are not always indicative of miscarriage but must always be treated seriously. If you do experience any of the following contact your doctor or health professional.
- severe abdominal pain or cramping followed by bleeding
- spotting or discharge with dark blood
- dizziness
- high fever
A pain in the shoulder could be a sign of ectopic pregnancy, where conception occurs outside the womb. An ectopic pregnancy must be medically terminated.
In the event of miscarriage
Following miscarriage, your doctor or medical professional may suggest an ultrasound scan to determine if your womb is clear. If you have had an “incomplete miscarriage” some doctors advise surgical removal of any remaining contents in a procedure known as dilation and curettage. There are differing views on whether or not this is necessary. Some doctors feel it prevents infection that if left undetected may affect your chances of future pregnancy. The other school of thought is that this is a traumatic experience that is rarely necessary.
The grief caused by an early miscarriage is often underestimated and the emotional and hormonal repercussions can take some time to heal. Miscarriage, at whatever stage of pregnancy, is for most women equivalent to losing a baby. Although there may be a little comfort in knowing that the pregnancy just wasn’t meant to be, the actuality of dealing with loss can be extremely painful for the entire family. It is important that you talk about your feelings together and help each other through this time of mourning.
In some cases expecting parents are faced with the decision to terminate a pregnancy due to suspected foetal abnormality. It is often said that this is one of the drawbacks of modern medical technology and antenatal testing.
Grieving
Most hospitals have a trained professional to guide you through this time. But sometimes you may find yourself left alone, in shock, to cope with the dreaded thoughts in your head. It is hard to deal with such anguish alone and steps must be taken to console your loss. Some counsellors believe touching your baby can be a positive place to begin your grieving. You may wish to ask your medical professional if you can hold your baby.
Some people choose to name their baby, either informally or in a religious ceremony, and arrange a funeral to help the healing. If the miscarriage occurs late in pregnancy, you may wish to keep a memento like a handprint or lock of hair. There are many support groups often run by people who have experienced a miscarriage or death of a child themselves.
It is a good idea to see your doctor or obstetrician about six weeks afterwards to talk about what happened and why. You may be advised to wait a while before trying to conceive so that you can recover physically, emotionally, hormonally and psychologically. The time will come when you feel ready to try again. Most women who miscarry go on to have happy, healthy children.