Miscarriage

Every year in the UK, hundreds of thousands of women are affected by miscarriage. A miscarriage is when a pregnancy ends before 24 weeks. In most cases, there is no way of preventing a miscarriage.

Just because you experience miscarriage it doesn't mean that you won't be able to conceive again, and often most women go on to have a successful pregnancy.

What is it?
The medical definition of miscarriage is the 'spontaneous loss of a pregnancy before 24 weeks'. Miscarriage is very common, yet so often not talked about. It occurs in 10 to 20 percent of confirmed pregnancies and in the first 12 weeks of pregnancy.

Miscarriage symptoms
The most common symptom is vaginal bleeding, which can range from light spotting to heavy bleeding unlike a period. You may see blood clots, brown discharge or other tissue that is not clearly identifiable.

Very often miscarriage symptoms involve cramping, with pelvic or back-pain. You may find that the usual symptoms of pregnancy, such as breast tenderness, feeling sick and having to go to pass urine more frequently than usual, stop suddenly.

Sometimes there are no signs or symptoms of miscarriage and pregnancy symptoms continue, and the miscarriage is only discovered in a routine scan.

Why does it happen?
About half of all early miscarriages occur because of a problem in the way genetic material from the egg and sperm has combined during fertilisation. It is often very difficult to find out why this has happened but it is more likely to be due to chance rather than to any underlying problem with either parent.

Imbalances in pregnancy hormones, problems in the immune system, and some serious infections (not minor coughs or colds) are believed to make miscarriages more likely. Also statistically, the risk of miscarriage increases with age, because of the declining quality of the eggs. If a woman drinks too much alcohol or smokes heavily, the risk of a miscarriage is higher. It is also increased with multiple pregnancies, such as twins.

Often the cause of a miscarriage remains unknown. If a miscarriage has started there is very little that can be done to stop it.

What should I do if I notice bleeding in pregnancy?
If you experience vaginal bleeding at any time during pregnancy it is worth contacting your doctor or midwife for advice.

You would probably be referred to an early pregnancy assessment unit and may be given an ultrasound scan.

An ultrasound scan will show the uterus and any developing embryo. If all is well and the pregnancy is advancing, a fetal heartbeat can be seen. If the pregnancy is not very advanced (less than six to seven weeks) it is sometimes not possible to tell if the pregnancy is continuing, and you may be recommended to have another scan in 7 to 10 days time.

Sometimes a blood test for beta hCG is taken. This is a sensitive blood test which identifies levels of the pregnancy hormone. You may be asked to return after 48 hours to re-take the test. In pregnancy, levels of the hormone will rise over time. If they are declining, it indicates that the pregnancy has been lost.

You may be given a blood test to find out if you have a rhesus-negative blood group. If you do, you may need an injection to prevent problems in subsequent pregnancies.

Types of miscarriage
Different names are used to describe miscarriage, and depends on what the scan or internal examination shows.

Threatened miscarriage is used to describe bleeding in early pregnancy, where the cervix is found to be tightly closed. In this case, the pregnancy is often likely to continue. Your doctor will advise the best course of action in this case.

Inevitable miscarriage describes bleeding in early pregnancy where the cervix is found to be open, suggesting that the pregnancy will be lost.

Incomplete miscarriage describes a miscarriage that has definitely started, but there is still some pregnancy tissue left in the uterus. The cervix is usually found to be open.

Complete miscarriage means that the pregnancy has been lost, the uterus is now empty and the cervix has closed.

Missed miscarriage describes a pregnancy that stopped growing some weeks ago, but there was no bleeding at that time. This type of miscarriage usually causes a small amount of dark-brown blood loss and the sudden end of normal pregnancy symptoms but there may be no symptoms at all, coming to light only at a routine scan. It is sometimes called a blighted ovum.

Miscarriage treatment options
If a miscarriage is complete then you don't need any further treatment. For a missed miscarriage or when there is significant bleeding, treatment with medicines or surgery may be recommended to remove the remaining pregnancy tissue. Some women may prefer to let nature take its course, which is called expectant management.

Surgical treatment involves an 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). Carried out under general anaesthesia, a soft plastic tube is passed through the cervix into the uterus and the pregnancy material is removed by suction.

General anaesthesia can temporarily affect your co-ordination and reasoning skills, so you should not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you are in any doubt about driving, please contact your motor insurer so that you are aware of their recommendation, and always follow your doctor's advice.

Research shows that expectant management is linked with an increased risk of bleeding, while surgical treatment carries a slightly increased risk of infection. The decision on what type of treatment is needed may depend on the stage of pregnancy, the amount of bleeding, and your personal choice. Your doctor should explain and discuss the options available to you. In most cases, you should be able to have time to think about what you would prefer.

Recurring miscarriage
As miscarriage is a very common event and many women experience two or more miscarriages, having more than one miscarriage can lead to anxieties that a normal pregnancy will never happen. After three consecutive miscarriages it would be best to have some tests to rule out a specific cause. Possibilities include possible genetic problems, hormonal disturbance, problems in the uterus, or a condition of the immune system called "antiphospholipid syndrome". This is a disease where the body's own defence mechanism causes blood clots in the placenta.

Miscarriage later in pregnancy
Four-fifths of miscarriages occur in the first 12 weeks (first trimester) of pregnancy. Pregnancy loss later than this is much less common, and the causes may be different to those described above.

After a miscarriage
The physical side effects of a miscarriage tend to mend fairly quickly. Any bleeding usually settles down within 7 to 10 days, and your next period is likely to follow between four and six weeks later. Sometimes infection can make the bleeding last longer or cause an offensive discharge. If this happens, a course of antibiotics can be prescribed and this will usually clear it up quickly.

However, the emotional effect of miscarriage can be enormous. Grief is a natural reaction to miscarriage and it is OK for it to be as painful as that after any other bereavement. Many women describe a feeling of numbness and emptiness following a miscarriage. Some women try to blank out their experience and not want to talk about it whilst others, find they need support and help.

There is no 'right' way of handling a miscarriage, and you have to go with your own feelings. It is recommended to wait at least one normal period before trying again, though it is safe to have sex when the bleeding has settled and you both feel ready.

For more information:
The Miscarriage Association
01924 200 799
www.miscarriageassociation.org.uk