What is Miscarriage?

A miscarriage is the loss of a fetus before 20 weeks of gestation. Miscarriages are also called spontaneous abortion or early fetal loss. Unfortunately, about 50% of all pregnancies end in miscarriage. Most miscarriages happen so early in pregnancy before a woman realize she is pregnant or misses a menstrual period. As many as 15% to 20% of women who realize that they are pregnant end up having miscarriages. Early pregnancy loss tends to occur in the first trimester (within 3 months of pregnancy.)  The chances of having a miscarriage decrease as your pregnancy grows. After 20 weeks, you are unlikely to experience miscarriage and if it happens, it is called a stillbirth.

What are the Symptoms of Miscarriage?

The following are symptoms of miscarriage:

• Vaginal bleeding. The bleeding begins as a brownish discharge and goes from light to heavy.
• Severe cramps and pain in your belly, lower back, and pelvic area.
• Diminishing early pregnancy signs such as nausea, vomiting, and breast tenderness.
• Fatigue
• Weight loss

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It is important to note that you vaginal bleeding, or having severe pain in your lower back, abdomen, or pelvic area while pregnant does not always suggest you are having a miscarriage. These symptoms can be caused by other conditions such as ectopic (tubal) pregnancy.

To learn more information on what is an ectopic pregnancy, ectopic pregnancy complications, or signs you’re having an ectopic pregnancy, go to Pregnancy Pukeology Episode 23: Ectopic Pregnancy Complications blog.

In addition, early pregnancy signs tend to diminish as your pregnancy progress. So, their disappearance only rarely suggests the possibility of a miscarriage.

What happens when you have a miscarriage?

Many miscarriages happen at home with heavy bleeding especially if you are in your first trimester.  If you continue to have heavy bleeding even after delivering what looks like a large blood clot, please see your OBGYN because there could be fetal reminisce, or remains of the baby still stuck inside.  If the dead fetus is not removed medically in a procedure called a suction D&C (dilation and curettage) and stays within the uterus for 4 weeks, this can cause a change in the mother’s blood clotting system posing a threat of serious bleeding. Ultrasound at your physician’s office will help you to make the decision as to if surgical intervention is needed.

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How do you know when you had a miscarriage?

Or if you are in your late second trimester early third trimester and no heartbeat is detected a still birth delivery may be performed. You will have an epidural and be induced to pass the baby vaginally. Every hospital has amazing bereavement programs for these parents and you can choose to be part of a ceremony to honor your lost child.

What Causes Miscarriages?

Most miscarriages happen due to an imbalance in pregnancy hormones which results in abnormal development of the fetus. If you've heard the word "chemical pregnancy" thrown around and are curious what's the difference between a miscarriage and a chemical pregnancy be sure to check out this blog: What is a chemical pregnancy?

The following are factors that cause miscarriage:

Chromosomal and gene anomaly

A developing fetus consists of a set of chromosomes contributed by both the mother and father. An extra or missing chromosome lead to abnormal development of the fetus and are responsible for about 50% of the miscarriages. Chromosomal abnormalities can lead to:

• Intrauterine fetal demise – an event where the embryo forms but fails to develop and die. This happens very early in pregnancy before pregnancy loss symptoms occur.
• Blighted ovum – no embryo forms.
• Molar pregnancy. In a complete molar pregnancy, the father contributes to both sets of chromosomes. Usually, fetal development doesn’t occur. There is also abnormal growth of the placenta.

In a partial molar pregnancy, the father contributes two sets of chromosome and the maternal chromosome usually remain. This results in abnormal development of the fetus and the placenta. Both molar and partial molar pregnancies lead to unviable pregnancies.

Maternal Causes of Miscarriages

A woman with underlying medical conditions and poor lifestyle habits can also miscarry. But sexual intercourse, exercise, and working do not cause miscarriages. The following factors can interfere with the development of the fetus leading to a miscarriage.

• Uncontrolled diabetes
• Thyroid disease
• Uterus or cervix problems
• Infections
• Hormonal problems
• Uncontrolled high blood pressure
• Drug and excess alcohol consumption
• Trauma
• Obesity

Depression & anxiety following early pregnancy miscarriage

A miscarriage is an intense period of emotional and psychological loss that tends to improve following several months. It is important to get the help you need and be screened for depression and anxiety following a tragedy like this. About 15% experienced clinically significant depression after miscarriages for up to three years. LADIES IT IS NOT YOUR FAULT! Don’t blame yourself, don’t hold back your tears, and give yourself time to grieve.  It’s okay, and as a medical professional please seek help if you need it.  It makes you stronger.

When to Get Pregnant After a Miscarriage

Again this depends on how soon after pregnancy you miscarried. If a miscarriage happens so early in pregnancy you might want to give your body two months to “reset” before starting baby-making sex. You might wait longer if you miscarried after 12 weeks or had an incomplete miscarriage that needed a dilation and curettage.

The goal is to allow your body to get back to its normal cycle. A full menstrual cycle returns two months after miscarriage. Waiting for a complete and normal menstrual cycle ensures that the pregnancy hormones to reduce to levels that they cannot be detected. This also ensures the uterus heal and return normal so that it gets ready for another pregnancy.

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When to start progesterone to prevent miscarriage

It is important to have a blood test done six weeks after a miscarriage to determine whether the pregnancy hormones are low. New evidence states that giving progesterone could prevent 8450 miscarriages per year, so talk to your OBGYN or IVF specialist, if you have had a history of miscarriages in the past about progesterone treatment. 

Why is it so easy to get pregnant after a miscarriage?

There are controversial reports on whether miscarriage increases fertility. The truth is, it is not clear whether it is easy to conceive after a miscarriage. If you experience miscarriage very early in your pregnancy, it will be so easy to get pregnant again because your body will take a very short period to “reset” your menstrual cycle. Data analyzed from a 2016 study from the National Institute of Health, published in the journal Obstetrics & Gynecology, found 7 in 10 women to conceive within 3 months of miscarriage.