Miscarriage frequently goes undiscussed in the broader culture, but it is not uncommon. It is estimated that between 10% and 20% of all pregnancies end in miscarriage, but that number is likely higher in reality because miscarriage can take place in the earliest stages of gestation before the pregnancy is detected.
Miscarriages occur for a number of reasons. Understanding what happens medically when a pregnancy is lost may provide a measure of comfort and understanding to women and their families affected by miscarriage.
What is a Miscarriage?
A miscarriage is defined as the spontaneous loss of a pregnancy before the 20th week of gestation. The risk for miscarriage is greatest during the first trimester of pregnancy when the embryo is rapidly developing. After the 12th week of pregnancy, the chances of miscarriage decrease significantly.
Unfortunately, once a miscarriage has begun it cannot be stopped with medical intervention. However, if a woman thinks she may be having a miscarriage, it is crucial that she seek medical care to ensure her own health and safety.
Causes of Miscarriage
Most miscarriages occur because of chromosomal anomalies in a developing embryo. Chromosomal anomalies are biological defects with the egg and/or sperm cells. In the case of a chromosomal anomaly, the embryo or fetus may stop developing and the body miscarries. This is a natural process, and while it does not make a miscarriage any less painful to endure, it is helpful to understand that in these instances, the pregnancy was never viable. Likewise, women who suffer miscarriages due to a chromosomal anomalies are not necessarily at a higher risk for future miscarriages.
Other reasons for miscarriage vary. Acute or chronic illnesses and infections can cause the loss of a pregnancy, as can anatomical abnormalities in the uterus or cervix or hormonal imbalances. If an anatomical issue is determined to have caused a miscarriage, surgery and bed rest can help future pregnancies reach full term. If a hormonal condition is diagnosed as the problem, women can often receive treatment and go on to have healthy pregnancies.
Risk Factors for Miscarriages
Some medical conditions, environmental factors and lifestyle choices can increase the risk of miscarriage.
- A history of miscarriage
- Advanced maternal and paternal age (35 years or older)
- Health disorders such as diabetes, polycystic ovarian syndrome, hypothyroidism and hormone imbalances
- Substance abuse, cigarette smoking and alcohol use
- Exposure to toxic chemicals
- Certain prescription medications
If a woman thinks that she may be at an increased risk for a miscarriage she should discuss her concerns with her obstetrician. In some cases, preventive measures and specialized services can help decrease the possibility of a miscarriage.
Signs and Symptoms of Miscarriage
The most common symptoms of miscarriage are cramping, spotting blood or heavy vaginal bleeding. Spotting does not necessarily indicate a miscarriage, as many pregnancy aches and pains are normal, but the likelihood of losing the pregnancy is higher if there is bleeding. Women who are experiencing any of these symptoms should contact their doctor immediately.
Another more subtle sign of miscarriage, especially in early pregnancy, is the cessation of pregnancy symptoms. Feelings of fatigue, nausea and breast tenderness may subside. Many of these symptoms can fluctuate throughout the early days of pregnancy and they often decrease naturally on their own as the pregnancy progresses, so it can be difficult to understand the decrease of these feelings as symptoms of miscarriage. Women who are worried that they may be experiencing a possible miscarriage should contact their obstetricians for immediate care.
Coping With Loss After a Miscarriage
A miscarriage can be a physically and emotionally painful process. Miscarriage in the earliest stages of pregnancy is similar to a menstruation. Mild to heavy cramping may accompany heavy bleeding, possibly including the passing of blood clots. These symptoms can last several days or extend into weeks, although they should gradually lessen.
It can at times be safe to miscarry at home with the support of loved ones - always follow the advice of your obstetrician - but women suffering the loss of a pregnancy should be in frequent contact with their healthcare provider. Medications can be prescribed to make the process less painful and speed it along, if necessary. If heavy bleeding is prolonged or symptoms such as fever, chills or a foul vaginal discharge develop, it may be necessary to go to the hospital.
Sometimes, a miscarriage does not resolve itself naturally. Medication can be given to cause uterine contractions and commence the miscarriage. If the pregnancy is lost after the first trimester, a surgical procedure called a D&C (dilatation and curettage) will be necessary to complete the miscarriage.
Recovering from a Miscarriage
Recovery time after a miscarriage is usually relatively short if there are no other health concerns. Women should attend a follow-up appointment with a health care provider to ensure a full recovery and to verify that there are no health complications related to the miscarriage such as a uterine infection.
It is possible to get pregnant almost immediately after a miscarriage, although some care providers prefer at least one full menstrual cycle be completed before women attempt getting pregnant again. It is also important for women and their partners to make sure they are emotionally ready before trying to conceive after a miscarriage.
Physical healing after the loss of a pregnancy can take a few days or several weeks, but emotional healing can take much longer. The feelings surrounding a miscarriage are often very complex. It is common to experience sorrow, grief and depression, but every person’s experience is their own and there is no correct way to work through a miscarriage. Adding to the complexity, partners in a relationship may cope with the effects of a miscarriage differently. Couples should respect each other’s individual healing processes as they try to heal emotionally.
Some people may benefit from therapy or a community support group. There are many local resources to help people cope with the unique emotional consequences of a miscarriage. The care providers at Kansas City ObGyn are available to help direct patients to the appropriate support systems to help facilitate healing.
Most women who have experienced a miscarriage can go on to have healthy, full-term pregnancies. Enduring a miscarriage can be a very painful experience, but it is helpful to understand that it is most often a natural response to an unviable pregnancy. The important thing is for women to understand the signs and symptoms of a miscarriage, so if necessary, they can receive care to ensure their health and a full recovery.
Dr. Crystal M. Newby, MD is a physician at Kansas City ObGyn. She received her medical degree from the University of Missouri - Kansas City School of Medicine. Dr. Newby married her fellow Kansas native high school sweetheart and they have 3 daughters.