Miscarriage is when a pregnancy spontaneously aborts because the developing baby has died. It occurs in around one in four pregnancies and usually doesn’t affect the woman’s ability to become pregnant again. A woman is classed as having recurrent miscarriage if she has three or more miscarriages in a row. She may then require help from a fertility specialist.
Some women have slight bleeding during pregnancy, called spotting, that gradually stops and does not harm the baby. However, if the bleeding is accompanied by pain or it becomes heavier, you may be having a miscarriage. You should visit your doctor in any case to check whether you are having a miscarriage.
Bleeding that does resolve may have been a "threatened miscarriage" and can be caused by bleeding from the placenta, fibroids in the uterus, sexual intercourse, or may be implantation bleeding (caused when the embryo implants into the wall of the uterus). Around half of all women who experience spotting during pregnancy will go on to have a miscarriage.
Symptoms of Miscarriage
• Bleeding (it can be spotting or heavier than a period)
• Uterine cramping that feels like severe period pain
• Sharp pain (if this is down one side only, seek medical help immediately as it is a sign of ectopic pregnancy and is potentially life-threatening)
Bleeding can last for several weeks.
Some women don’t have any symptoms of miscarriage and only discover they have lost their baby when they attend for a routine ultrasound scan. This is called a missed miscarriage.
If you suffer with bleeding and pain in pregnancy, your doctor can refer you for an emergency scan to see if the pregnancy is still viable.
If the baby has died, there are several options for your care:
Natural Miscarriage
This is when you let nature take its course and let the womb empty on its own. This can take days to several weeks. The doctors may invite you back to the hospital to have further scans to check that all products of conception have been expelled.
You will experience abdominal cramping during this time and may have blood clots or even see a tiny, intact fetus, particularly if the miscarriage is later than 10 weeks into pregnancy.
Most natural miscarriages occur without complications but if you develop a raised temperature, foul smelling vaginal discharge or flu-like symptoms, you may be developing an infection and will either be advised to have a surgically managed miscarriage or will be given antibiotics.
The risk of infection during this type of miscarriage is around 1 in 100. Around 1 in 50 women have very heavy bleeding during miscarriage that may require transfusion. Seek medical advice if you feel dizzy or faint.
Medically Managed Miscarriage
This is when you are offered tablets or vaginal pessaries to speed up the process of miscarriage or to start it, if you have had a missed miscarriage. The medication causes the womb lining to break down and the contractions to begin to expel it.
It can feel like severe period pain and it can take up to three weeks for the bleeding to stop. Some medical conditions prevent the use of this method.
The risk of infection is the same as with a natural miscarriage.
Surgically Managed Miscarriage
This is when surgeons suction out the contents of the womb. This is usually done under general anaesthetic. It is called an evacuation of retained products of conception (ERPC). The risk of infection is slightly higher than the other methods of management, at 2 - 3 per 100 women, so you will be given antibiotics as well.
Risk of uterine perforation during surgery is less than 1 in 200.
You shouldn’t use tampons or have sexual intercourse until your miscarriage is complete. Some women try for another baby as soon as they have had their first period after the miscarriage. Others like to wait a few months to allow themselves to grieve for the loss of their child.
Sources:
1. Your Miscarriage Leaflet, The Miscarriage Association. Web. 12 September 2011.
http://www.miscarriageassociation.org.uk/wp/wp-content/uploads/2011/04/Your-Miscarriage-Feb-20111.pdf
2. Management of Miscarriage Leaflet, The Miscarriage Association. Web. 12 September 2011.
http://www.miscarriageassociation.org.uk/wp/wp-content/uploads/2011/05/Management-of-miscarriage-T-Oct-10.pdf
3. Threatened Miscarriage, Pregnancy Info. Web. 12 September 2011. http://www.pregnancy-info.net/threatened_miscarriage.html
Joanna is a freelance health writer for The Mother magazine and Suite 101 with a column on infertility, http://infertility.suite101.com/. She is author of the book, 'Breast Milk: A Natural Immunisation,' and co-author of an educational resource on disabled parenting.
She is a mother of five who practised drug-free home birth, delayed cord clamping, full term breast feeding, co-sleeping, home schooling and flexi schooling and is an advocate of raising children on organic food.
Reviewed September 13, 2011
by Michele Blacksberg R.N.
Edited by Jody Smith