Miscarriage 101
Miscarriage is physically hard, heartbreaking, and unfortunately extremely common; 1 in 4 known pregnancies will end in one. There are numerous different reasons that a miscarriage may occur and the majority of the time it is completely out of your control. If you have experienced a miscarriage, the team at Women in Motion holds space for you. During this extremely hard time, lean on your village and please don’t forget that you are strong and you will get through this.
Symptoms of a Miscarriage
Most miscarriages occur during the first trimester of pregnancy (weeks 1-13). The most common symptoms are:
Bright red, period like bleeding from the vagina
Pain or cramping in the abdomen or lower back
Fluid or tissue passing from the vagina
If you are pregnant and experiencing any of these symptoms call your birth provider immediately.
Causes of a Miscarriage
The most common cause of miscarriage is when a baby doesn’t develop correctly. According to the Mayo Clinic, about half to two-thirds of miscarriages in the first trimester are linked with extra or missing chromosomes. Other causes of miscarriages that are far less common are uncontrolled diabetes, infection, hormonal problems, problems with the uterus or cervix, thyroid disease, and obesity.
What DOESN’T Cause a Miscarriage
Exercise, sex, stress, and the use of hormonal birth control prior to becoming pregnant are all myths that people believe cause a miscarriage. This definitely isn’t the case! Please do not blame yourself, the majority of time a miscarriage is completely out of your control.
Risk Factors
Age
If you are older than 35 years old you have a higher risk of miscarriage than someone younger. The miscarriage risk increases with age.
Previous miscarriage(s)
If you have experienced a miscarriage in the past, you are at a higher risk of experiencing another one.
Uterine or cervical problems
Smoking, alcohol, or illegal drug use
Weight
Being underweight or overweight increases the risk for miscarriage
Genetic Conditions
If one person is a carrier for a genetic condition there is a higher risk of miscarriage as they may pass on that condition.
Types of Miscarriages
Spontaneous Miscarriage
This type of miscarriage occurs when you pass the pregnancy spontaneously. The most common symptoms of this type of miscarriage are bright red, period like bleeding and intense cramping.
Missed Miscarriage
This type of miscarriage occurs when you don’t have typical miscarriage symptoms but you find by ultrasound that the fetus has stopped developing and doesn’t have a heartbeat.
Chemical Pregnancy
This type of miscarriage occurs before the fifth week of pregnancy. Since it occurs so early, some women may think the bleeding is from their regular period.
How is a Miscarriage Diagnosed?
Blood Tests
If you present with symptoms of a miscarriage, your provider may order blood work to look at your beta HCG levels. Normally with a healthy pregnancy, this number will be doubling every 48 hours at the beginning of pregnancy. If the level is dropping or not rising appropriately, your provider may recommend an ultrasound to determine the viability of the pregnancy.
Ultrasound
This is the most common way to diagnose or confirm a miscarriage. An ultrasound will be able to show if the fetus is in the uterus, developing appropriately, and has a heartbeat. If bleeding has already started, the ultrasound will show if there are remains of the pregnancy left in the uterus.
Management of Miscarriages
If a miscarriage has been confirmed, your provider will recommend the following treatment options.
Expectant Management
You may choose to let the miscarriage progress naturally. This is recommended when you are showing no signs of infection and your body is already starting the process of miscarrying, i.e. bleeding and cramping. It can take a few weeks for the body to pass the pregnancy tissue naturally and according to the National Institute of Health (NIH) this type of management has a 66-91% success rate depending on the type of miscarriage. If expectant management isn’t successful, you will need medication or surgery to help the process.
Medical Management
Your provider will prescribe you two medications, mifepristone and misoprostol to take at home to initiate the miscarriage process. Mifepristone specially blocks the hormone progesterone, which is needed for a pregnancy to progress and Misoprostol stimulates your uterus to contract. Mifepristone is taken by mouth and misoprostol is administered vaginally or placed in the side of your cheek so it can be absorbed. These two medications in combination have a success rate of 81-95% according to the NIH. Your provider will give you specific instructions on how to take the medications and the time frame for them.
Surgical Management
If your body does not miscarry naturally, you are having heavy bleeding, showing signs of infection, or you want to expedite the process for your emotional well being your provider will recommend a dilation and curettage (D&C). This procedure is needed in 5-20% of cases and has a success rate of 97-98% per the NIH. A D&C is done under conscious sedation where the provider opens your cervix and removes the pregnancy tissue from the uterus. Complications from a D&C are rare.
When to call your provider
You should call your provider immediately if you have any of these symptoms following management of a miscarriage
Heavy bleeding - soaking through a large maxi pad in an hour
Fever
Severe abdominal pain
When can we start trying again?
Most women will get a period one to two weeks after bleeding from the miscarriage has resolved. Starting to try and conceive again is a very personal decision between you and your partner but most providers will recommend at least waiting one cycle so your body can fully recover before trying again. There are numerous other factors that come into play when determining if you are ready to try and conceive again after a miscarriage though. Please make sure you are taking care of yourself emotionally and physically!