Types, causes, diagnosis and management of miscarriages. Learn all about Missed Abortion, Threatened Abortion, Inevitable, Complete and Incomplete Abortions.
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?
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.
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
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.
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
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.
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.
ultrasound would show nothing to indicate an embryo and the pregnancy is
considered to be nonviable.
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
Management steps might
Wait for the spontaneous
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
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.
ultrasound would show a viable
pregnancy, with what is called ‘products of conceptus’to be seen intact.
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
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.
Manual Uterine Aspiration
Dilation and Curettage
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.
Any of the following two,
depending upon mother's condition:
Manual uterine aspiration
Dilatation and Curettage
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
Supportive treatment is required,
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.
Manual uterine aspiration
Dilatation and Curettage
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
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.
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).
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
dark vaginal discharge
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.
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