Miscarriages: Symptoms, Causes, Diagnosis and Treatment
Miscarriage. We know, it’s like a swear word isn’t it? We’ve taken a deep breath and thrown it out there because it is definitely something that should be discussed.
Many, many couples will face miscarriage when they are trying to conceive. Some will even miscarry before they know they are pregnant. Facing miscarriage, especially when it is repeated, is heartbreaking, and can lower your self-confidence incredibly.
And then you probably hear that stress isn’t good for fertility, so that fact really helps to make you feel better too (NOT!)
It is natural to question what you are doing or blame yourself when you lose a baby, however early in your term you might be.
But can you reduce your chances of miscarriage? And how can you keep up your spirits when you are dealing with it?
Some facts and figures about first term miscarriage
Loss of pregnancy in less than 12 weeks of gestation is called either miscarriage or spontaneous abortion. Both terms mean the same.
The first trimester of pregnancy has a far higher percentage of miscarriages when you compare to the second trimester and the third trimester of pregnancy.
Around 1 in 5 pregnancies will end in miscarriage, but around 80% of miscarriages will happen in the first trimester. Once you make it past the first 12 weeks your chances of miscarrying can be as low as 3% or 4%.
Why do so many miscarriages happen in the first trimester?
Studies show that the most common cause of early loss of a pregnancy is chromosomal abnormalities which make survival hard for the embryo. This is the basic reason why most miscarriages happen – the embryo hasn’t developed in the way it needed to to survive.
When you think about it, crafting a tiny human is a complicated process, with about a billion things that could go wrong. Most miscarriages in the early days happen because the baby would not have survived, not because of anything the mother did wrong.
Types of Miscarriage
Let’s categorise first-term miscarriage in scientific terms. These are the different kinds of miscarriage, the likely symptoms and the management steps that doctors will usually take.
1. Missed Abortion
When a missed abortion occurs, the expectant mother doesn’t have any symptom such as uterine or pelvic pain, no vaginal bleeding, no cervical dilatation, and only a mild brownish red vaginal discharge may be noticed by few.
An ultrasound would show nothing to indicate an embryo and the pregnancy is considered to be nonviable.
Management
The usual management of a missed abortion by doctors would be complete removal. As it is a nonviable pregnancy it can no longer be continued, and removal is the only effective treatment.
Management steps might include:
· Wait for the spontaneous complete abortion.
· Mifepristone is used which increases the uterine contraction and expels the embryo. This is only applied when the nonviable pregnancy has been inside the uterus for a period and has more chances of causing infection to the mother.
· Dilatation and curettage (D&C).
2. Threatened Abortion
There can be more warning signs in this case. The mother experiences vaginal bleeding, uterine cramping but as the cervical opening is tightly closed and soft it doesn’t allow expulsion of the embryo.
An ultrasound would show a viable pregnancy, with what is called ‘products of conceptus’to be seen intact.
Management
This pregnancy can be saved with lots of care. The expectant mother should restrict her activities and any type of exertion for almost a considerable period of pregnancy. Rest and care is the basic management.
<4% require a complete abortion.
3. Inevitable Abortion
This presents with significant vaginal bleeding, uterine cramping, and rupture of membranes, slow removal of conceptus as the cervix is not completely open and once it is open it expels the left-over products of the embryo.
An embryo may or may not be visible in an ultrasound; usually a nonviable pregnancy.
Management
· Manual Uterine Aspiration (MUA).
· Dilation and Curettage (D&C).
· Misoprostol.
· Supportive therapy
4. Incomplete Abortion
Incomplete abortion presents with heavy bleeding, severe uterine cramps, and the cervix is open.
Products of conceptus are observed in the ultrasound results.
Management
· Any of the following two, depending upon mother’s condition:
· Manual uterine aspiration (MUA).
· Dilatation and Curettage (D&C).
5. Complete Abortion
Presents with vaginal bleeding, uterine cramps leading to complete expulsion of embryo and placenta.
An ultrasound would show no products of the embryo or placenta visible
Management
Supportive treatment is required, no D&C.
6. Septic Abortion
A septic abortion constitutes an emergency. In this case, the contents of the uterus get infected, resulting in fever, uterine tenderness, severe pain,and hypotension.
Management
· Manual uterine aspiration (MUA)
· Dilatation and Curettage (D&C)
· IV antibiotics
Can you do anything to reduce your chances of first term miscarriage?
As we mentioned above, some miscarriages will very sadly happen anyway, regardless of what the mother does or doesn’t do. If it is helpful you should know that in most cases it isn’t your fault.
However, for many mothers-to-be, it can more helpful to have strategies and steps you can take to reduce your chances of miscarrying early in your pregnancy.
All of these minor lifestyle changes could help:
· Eat a well-balanced diet, the same as would be recommended if you were already pregnant. Eat lots of fruit and vegetables, dairy,and sources of protein and iron.
· Avoid any food not recommended for pregnant women including precooked and deli meats and seafood, premade salads, soft cheese, soft serve ice cream, uncooked egg etc.
· Stay away from alcohol, cigarettes,and any illicit drugs
· Talk to your doctor about any regular medications you are taking and if these are safe for pregnancy. There may be alternative options for you
· Don’t take anything from a pharmacy that is stronger than paracetamol, unless prescribed by the doctor
· Exercise in moderation
· Reduce stress as much as you can
· Bring yourself to within a healthy range and maintain your blood sugar levels
Taking a low-dose aspirin daily has been proven to help reduce the chances of miscarriage in women who have suffered multiple miscarriages already. Talk to your doctor about the option of this helping your chances.
It can also be very helpful to make an appointment with a gynaecologist to get a full check up and discuss your current lifestyle and possible changes you could make, and any risks you might be facing before you get started.
Some tips that may help you through this time
Whether this was your first miscarriage or the most recent of several, it can a heartbreaking situation. There is no right way to feel at this time.
Some mothers feel immense grief and loss, while others may not feel such a bond with the embryo before it was lost. Some mothers feel guilt or embarrassment, or perhaps shame that they don’t feel more upset (or less upset). Some feel incomplete, some feel as though they are failing as women.
All of these feelings are totally normal, and you might feel none of them, which is also normal. The best thing you can do is allow yourself to feel however you are feeling; your emotions and your reaction are completely your own and completely justified. Don’t beat yourself up for how you are responding.
Often mothers haven’t told anyone in the first trimester that they were pregnant, so they don’t need to tell anyone in the case of suffering a miscarriage. But then if you miscarry at this time you might really need to talk to someone about what you are going through. Even talking to a professional counsellor might help right now.
Some other things that might help include:
· Talk to your partner, family or a close friend about what you are feeling. Ask them to keep an eye on you and perhaps help to cheer you up or take your mind off things
· Try relaxation techniques like mindfulness or yoga, this can help to quieten your mind and lower your stress
· Find other activities that take your mind off your loss, such as a movie or tv show you love, reading an easy book, go shopping or hang out with girlfriends
· Do some mild, easy exercise like a gentle walk in the sun or go swimming
· Take some sick leave time off from work if you feel that you need it (or if you would rather the distraction of work then obviously keep going).
Signs to watch out for in your first trimester
If you are in the early days of your pregnancy, then you should watch out for any of the following signs:
· Abdominal cramping
· Uterine cramping
· Bleeding or dark vaginal discharge
· Fever or severe nausea
If you have any of these warning signs or you are worried in any way about your embryo, or yourself, then don’t hesitate to see a doctor to talk about your concerns.
This article is for information purpose only, any of the above treatments are not advised and must be done under doctor’s guidance.
