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March 24, 2023

Miscarriage is a devastating and emotionally challenging experience that affects millions of women around the world every year. It is a term used to describe the loss of a pregnancy before the 20th week, and it can happen for a variety of reasons, including genetic abnormalities, hormonal imbalances, and health problems in the mother. Despite its prevalence, miscarriage remains a topic that is often shrouded in secrecy and stigma, making it difficult for women and their partners to navigate the complex emotions and medical realities that come with the experience. In this article, we will explore what miscarriage is, the common causes and risk factors, the symptoms, and the emotional impact of this loss.

 

By increasing our understanding of miscarriage, we can help to break down the barriers that prevent women from seeking support and compassion during this difficult time.

 

Defining Miscarriage

 

Miscarriage, also known as spontaneous abortion, refers to the sudden termination of a pregnancy during the first 20 weeks of gestation. It is important to understand that the term "miscarriage" does not imply any fault or wrongdoing on the part of the pregnant individual. In most cases, miscarriages occur due to factors outside of their control, such as fetal growth cessation.

 

But miscarriages are not limited to just one type. To help further understand this, it's important to know the different types as well and they are as follows:

 

• Missed miscarriage. This type of miscarriage occurs when the pregnancy ends without any symptoms, and the individual remains unaware of it until an ultrasound confirms that the fetus has no heartbeat.
• Complete miscarriage. In a complete miscarriage, the individual experiences bleeding and passes fetal tissue. An ultrasound confirms that the uterus is empty, indicating that the pregnancy has ended.
  Recurrent miscarriage. This type of miscarriage refers to the loss of three consecutive pregnancies and occurs in about 1% of couples.
• Threatened miscarriage. With a threatened miscarriage, the cervix remains closed, but the individual experiences bleeding and pelvic cramping. In most cases, the pregnancy continues with no further issues, but the healthcare provider may monitor the individual more closely for the rest of the pregnancy.
• Inevitable miscarriage. In this type of miscarriage, the individual experiences bleeding, cramping, and the cervix begins to open (dilate). There may also be leakage of amniotic fluid, and a complete miscarriage is likely to occur.

 

Further Understanding: Possible Causes and How to Know if You're Having a Miscarriage 

 

Around 50% of all first trimester (up to 13 weeks) miscarriages are caused by chromosomal abnormalities. Chromosomes are minuscule structures inside the cells that carry an individual's genes, which determine their physical attributes such as hair and eye color, blood type, and assigned sex.

 

When an egg and sperm unite during fertilization, two sets of chromosomes combine. If either the egg or sperm has more or fewer chromosomes than usual, the fetus will have an abnormal number, which can result in a miscarriage. As the fertilized egg develops into a fetus, its cells divide and multiply multiple times. Abnormalities during this process can also lead to miscarriage.

 

Most chromosomal problems occur randomly, and the reason behind it remains largely unknown.

 

Understand that there might be several causes that can lead to miscarriage, including:

 

• Severe kidney disease.
• Congenital heart disease.
• Diabetes that isn't managed.
• Thyroid disease.
• Radiation.
• Certain medicines, such as the acne drug isotretinoin (Accutane®).
• Severe malnutrition.
• Age.
• Uterine abnormalities.
• Incompetent cervix (your cervix begins to open too early in pregnancy).
• Lifestyle factors such as smoking, drinking alcohol or using recreational drugs.
• Disorders of the immune system like lupus.
• Infection.
• Exposure to TORCH diseases.
• Hormonal imbalances.
• Improper implantation of fertilized egg in your uterine lining.

 

There is no scientific evidence to suggest that stress, exercise, sexual activity, or prolonged use of birth control pills can cause miscarriage. Therefore, it is crucial not to blame oneself for experiencing a miscarriage, regardless of the circumstances. In most cases, miscarriage occurs due to factors outside of an individual's control and is not a result of something they did or did not do.

 

Miscarriage Risk Factors

 

A risk factor refers to a characteristic or action that heightens the likelihood of an individual developing a particular illness or ailment. The following are some risk factors associated with miscarriage:

 

• Age. Research indicates that individuals in their 20s have a 12% to 15% chance of experiencing a miscarriage, while those over 40 have a risk of about 25%. Most age-related miscarriages occur due to chromosomal abnormalities in the fetus, such as missing or extra chromosomes.
• Previous miscarriage. If an individual has had one miscarriage, their chances of experiencing another are approximately 25%, which is only slightly higher than someone who hasn't had a miscarriage.
• Health conditions. Certain health conditions, such as unmanaged diabetes, infections, or issues with the uterus or cervix, can increase the likelihood of a miscarriage.

 

It is advisable to speak with your pregnancy care provider about the risk factors associated with miscarriage. After reviewing your medical history, they can assess your individual risk and provide further guidance.

 

 

Miscarriage: How Is It Diagnosed? 

 

Your pregnancy care provider may employ various methods to confirm a miscarriage, including:

 

• Ultrasound test. This test can check for the presence of a fetal heartbeat or a yolk sac, which is one of the first fetal structures visible on ultrasound.
• Blood test. A blood test may be conducted to measure the level of human chorionic gonadotropin (hCG), a hormone produced by the placenta. A low hCG level may indicate a miscarriage.
• Pelvic exam. Your provider may perform a pelvic exam to determine if your cervix has opened.

 

Possible Treatments for a Miscarriage 

 

In the event of a pregnancy loss, it is crucial to remove the fetus from the uterus to avoid potential complications such as infection or bleeding.

 

If the miscarriage is complete and all fetal tissue is expelled from the uterus, further treatment is typically unnecessary. Your pregnancy care provider may perform an ultrasound to confirm that no tissue remains in the uterus.

 

However, if your body is unable to expel all of the tissue naturally or if there is no bleeding, your provider may suggest using medication or surgery to remove the remaining tissue.

 

Surgical Treatment

 

If your body has not expelled all the pregnancy-related tissue or you are experiencing heavy bleeding, your pregnancy care provider may suggest a dilation and curettage (D&C) or dilation and evacuation (D&E). Surgery may be the only option if the pregnancy is beyond 10 weeks' gestation. During these procedures, your cervix will be dilated, and any remaining tissue will be gently removed from your uterus through scraping or suction. Your provider will perform these surgeries in a hospital under anesthesia.

 

Nonsurgical Treatment

 

Your pregnancy care provider might suggest waiting to see if you naturally pass the pregnancy, especially if you have a missed miscarriage. However, this process may take several days, and it may not be safe to wait or you may prefer to remove the tissue quickly. In such cases, your provider may prescribe medication to help your uterus expel the pregnancy. Note that these options are usually available for pregnancies before the 10-week mark.

 

If a miscarriage is suspected, but not confirmed, your provider may prescribe bed rest for a few days. They might also keep you under observation in the hospital overnight. Once the bleeding stops, you can return to your routine activities. In the case of cervical dilation, you may be diagnosed with an incompetent cervix, and your provider may perform a cervical cerclage to close the cervix.

 

Symptoms After Miscarriage 

 

After a miscarriage, it is common to experience spotting and mild discomfort. However, it is important to contact your healthcare provider immediately if you experience heavy bleeding or worsening bleeding, fever, chills, or intense pain, as these could be signs of an infection. It is advised to avoid inserting anything into your vagina for at least two weeks after a miscarriage, including tampons, sexual intercourse, and fingers or sex toys. Your provider will schedule a follow-up appointment to discuss your recovery and any potential complications.

 

What To Do After Repeat Miscarriages

 

If you have experienced three or more miscarriages in a row, known as repeated miscarriage, your healthcare provider may recommend additional tests to determine the underlying cause. These tests may include genetic tests such as karyotyping, which checks for chromosome abnormalities in you and your partner, or testing tissue from the miscarriage for chromosome irregularities.

 

Additionally, blood tests may be conducted to check for autoimmune or hormone conditions that may be contributing to the miscarriages. Your provider may also perform a hysterosalpingogram, which is an X-ray dye test of your uterus and fallopian tubes, a hysteroscopy where they view the inside of your uterus using a thin, telescope-like device, or a laparoscopy, where they view the pelvic organs with a lighted device, to examine your uterus.

 

If you experience heavy bleeding, fever, chills or intense pain, contact your healthcare provider immediately as these could be signs of an infection. It is important to follow any recommendations given by your provider to ensure proper care and treatment.

 

 

How to Cope with Miscarriage? 

 

Losing a pregnancy can be an incredibly difficult experience, and it's important to take the time you need to grieve and heal. Coping with a miscarriage can involve a range of strategies, including talking to your partner, friends, and family about your feelings, seeking support from a pregnancy loss support group, and considering professional counseling. It's also important to take care of yourself physically by eating well, getting enough rest, and engaging in gentle exercise, if you feel up to it. Some people find comfort in creating a memorial for their lost pregnancy, such as planting a tree or making a scrapbook.

 

It's important to remember that healing is a process, and there is no "right" way to cope with a miscarriage. Be kind to yourself, and know that it's okay to feel a range of emotions as you navigate this difficult time.

 

Understanding miscarriage and its potential causes is important for those who are trying to conceive or have experienced pregnancy loss. While miscarriage can be a devastating experience, it’s essential to seek medical attention and emotional support to help you cope with the loss. Remember that miscarriage is a common experience, and you are not alone in your grief.

 

Reach out to your healthcare provider, loved ones, or support groups to get the help you need. With the right care and support, you can move forward and eventually try to conceive again with hope and confidence.