What you should know about miscarriage

What is a miscarriage?

Miscarriage is a word all pregnant women fear. Having a miscarriage means losing a pregnancy before 20 weeks. Sometimes called a spontaneous abortion, an embryo or foetus is delivered before it has any chance of surviving outside the uterus.

Miscarriage is fairly common, especially in the first trimester. It is thought that 50% of pregnancies miscarry after the conceptus (product of conception) has implanted in the wall of the uterus but before the woman has realised she is pregnant. These episodes are usually believed to be a heavy, late period.

Another 15% to 20% of recognised pregnancies that make it past 6 weeks after the last period may miscarry. The highest risk time for miscarriage is between the 12th and 14th week of pregnancy.

Why does a miscarriage happen?

A miscarriage can happen for many different reasons.

There is a genetic or chromosomal abnormality

The most common finding of early miscarriage is an abnormality in the development of the embryo. Research has shown that over 50% of these miscarriages have genetic or chromosomal abnormalities. These abnormalities are not thought to have any bearing on the health of future pregnancies.

External factors

External factors known as teratogens (radiation and some chemicals, drugs or medications) can also cause miscarriage. 90% of women go on to have a normal, healthy pregnancy after a single episode of miscarriage. Recurrent miscarriages, however, need investigation and evaluation.

Other possible causes of miscarriage include:

• Unusual infections such as toxoplasmosis, listeria and syphilis
• Genital or uterine infections
• Uterine abnormality 
• Deficiency in progesterone in early pregnancy
• Maternal antibodies that disrupt the growth of the embryo and developing placenta
• Maternal smoking
• Alcohol consumption
• Use of recreational drugs.

Warning signs of a miscarriage

• Vaginal bleeding (light bleeding is fairly common in early pregnancy, but heavy painful blood loss is not)
• Abdominal pain/cramps
• Backache
• Chills/fever

What to do if you think you are having a miscarriage

If you think that you are having a miscarriage, talk to your doctor immediately. In most cases there is nothing that you can do to stop it from happening. Ultrasound scans and blood tests may be done to assist your doctor in determining the next course of action.

What happens after a miscarriage has occurred

If you expel all of the products of conception and bleeding and cramping stops it may be all over. If everything is not expelled, it is necessary to undergo a D&C (dilatation and curettage). This involves minor surgery to clear the uterus of any leftover products that could cause pain, bloating, infection and bleeding.

If you are Rhesus negative

If you are Rhesus negative, you will need to receive anti-D immunoglobulin after miscarriage. If possible the miscarried embryo/foetus will be evaluated for chromosomal abnormalities or any other signs that could give insight as to why the miscarriage happened.

There is nothing you can do to prevent miscarriage

There is nothing you can do to prevent miscarriage, but there are factors that can lower your chances. Pre-conceptual planning goes a long way. Get fit and healthy before you fall pregnant. Visit the dentist, lose weight, stop smoking and drinking and start exercising. Take folic acid.

Once you are pregnant continue with your healthy lifestyle, stop taking prescribed medications or over-the-counter medication and discuss alternatives with your doctor. Rest and relax when you feel like it and have a positive state of mind.

It is natural for a woman having experienced a miscarriage to question herself and even blame herself for her loss. It’s a normal reaction to look for a reason and to think you may have done something wrong.

Many women blame stress, emotional upsets or physical activity for causing miscarriage and although it may be an influencing factor, these things usually do not cause miscarriage.

You may need counselling and guidance through this trying time. Speaking to other women who have been through the same thing often helps heal your emotional pain.