miscarriage

Miscarriage

About one in ten confirmed pregnancies ends in a miscarriage. A miscarriage is no less distressing just because it’s common, it can be a difficult experience for you and your partner. Most miscarriages happen in the first trimester (the first 13 weeks).

Symptoms of a miscarriage

By far the most common symptom is bleeding. This can vary from light spotting to a heavy flow. Aside from the bleeding, you might also experience pain, which can vary in intensity. You might also feel other pregnancy signs fading away, less nausea, less tired and you breast getting less tender and large.

Sometimes you will not notice that you are having a miscarriage until we do the first scan at the practice. We will see that the embryo has stopped growing or that the heart is not beating.

Causes of miscarriage

A miscarriage is usually due to a fetal abnormality. It is seldom a hereditary disorder or due to illness by the mother.

What can you do

A miscarriage cannot be stopped and you cannot use medication to prevent it. If you are having a miscarriage there is unfortunately nothing to stop it.

Usually the miscarriage will happen within two weeks after the bleeding has begon or after the scan took place. Often you will see the bleeding increase during a couple of hours. It will often be more than a normal period. At the same time you will experience pain in the uterus, like contractions. This will increase until you lose the embryo.

When you lose the embryo you might also lose blood clots, they might be as big as a grapefruit. One of these clots might contain the embryo, membranes and placenta. If you do not lose the embryo, or only experience a heavy flow, you should always call us (24 hours a day).

When you have lost the embryo, the bleeding and pain should get much less. Bleeding can also go on for ten days, but it should get less every day.

It is not necessary to keep the embryo or any of the clots. But if you prefer us to examine whether the miscarriage is complete, you can always call us.

Waiting

Most women prefer to wait until the miscarriage ends naturally. Usually you will lose the embryo within a couple of days after the bleeding has started, but sometimes it will take two weeks. If you prefer to wait, please talk to the midwife how long you want to wait and if there is any reason to undergo urettage (D and C procedure).

If you have a rhesus negative blood type it might be necessary to have anti-D immunoglobuline to avoid a build-up of antibodies against rhesus positive blood, which can cause problems in a following pregnancy.

 

Call the midwife

If you think you are having a miscarriage, you can always call us. We will ask you questions about your symptoms and together we will decide whether it is necessary to make an ultrasound to confirm the miscarriage. Bleeding in the first trimester of pregnancy is not always a sign of the beginning of a miscarriage. In 50% of the cases it will result in a miscarriage. Pain or decreasing signs of pregnancy such as nausea can be normal and will not necessarily lead into miscarriage.

If you have the following signs and/or symptoms, it is important to call us:

• A heavy pain in your uterus
• A fever above 38 degrees Celsius
• Heavy bleeding, more than a period

Curretage

Some women find it difficult to wait if they experience a miscarriage. If you find it difficult to wait or if you are bleeding heavily then you can ask your midwife for a consultation at the gynaecologist. A curettage is a small operation which makes sure the uterus is free of all the tissue that should come out. It will be performed under general anaesthetics in hospital.

The last couple of years misoprostol has been used as a medicine to avoid surgery, it is a tablet that is inserted in the vagina and makes the cervix soften and dilate. This might be recommended and prescribed by a gynaecologist in certain situations.

After a miscarriage

After a miscarriage you can get pregnant as soon as you wish. It can take some time for your menstrual cycle to get back to normal. Usually a next pregnancy does not give complications. If you have had more than two miscarriages it is possible to test your blood for hormonal imbalances or to test for other problems causing miscarriage.

Recovery after a miscarriage

Usually your body recovers fast after a miscarriage. The bleeding might take a little longer than a normal period, but afterwards you should be back to normal. Emotionally it can be very distressing to experience a miscarriage. It is important to allow yourself and your partner time to mourn the loss of your baby and pregnancy. Your partner might grieve differently than you do.

Friends and family could be a support but could also make well-meaning insensitive remarks. If you need to talk to one of the midwives about your miscarriage or if you have questions, please call us and we can make an appointment.