Loss and Longing - A health feature on miscarriages

Issue 74 November 2010

A miscarriage is one of the most difficult experiences a woman can endure; both emotionally painful and physically draining. In miscarriage awareness week, Dr. Noreen A Kassem provides insight. 

In medical terms, a miscarriage is a spontaneous ending of a pregnancy before the 20th week or before the foetus (unborn baby) is developed enough to survive. Miscarriages occur in approximately 10-15 percent of all confirmed pregnancies, and almost 90 percent occur within the first eight weeks of pregnancy.

A miscarriage at any point in a pregnancy can be a devastating experience for a mother as well as a father. Understanding the causes and risks of a miscarriage can help a couple move forward in hopes of a family or more children.

Signs of a Miscarriage

In some cases, a miscarriage will not have any initial symptoms. Signs of a miscarriage vary depending on the duration of the pregnancy.

In the first six weeks of pregnancy, the most common sign of a very early miscarriage is bleeding. A miscarriage that occurs between weeks six and 12 may have bleeding as well as moderate pain and cramping. A miscarriage after the first trimester can have severe symptoms including bleeding and pain that can be as severe as labour pains. An expectant mother should contact her doctor if she has any signs of bleeding or cramping. An ultrasound can be done as early as week five of the pregnancy to determine if the baby is developing normally. Sometimes, there are no signs and it is an ultrasound scan which will reveal that the baby has died and the pregnancy has not developed.

Causes and Treatment

Most patients do not need treatment after a miscarriage. A mother who has had three or more consecutive miscarriages (two or more in the over 35s) are deemed as ‘recurrent’ and further tests should be done to determine if there is an underlying cause. Most women have an 85 percent chance that a subsequent pregnancy will be carried to term successfully.

Almost 60 percent of miscarriages are caused by random genetic defects that are unavoidable and do not mean the mother will not have another successful pregnancy. An inherited defect that causes a miscarriage can come from either the father or the mother. Other causes of miscarriages include hormonal imbalances, viruses and other recurrent infections, immune disorders, metabolic disorders such as diabetes, systemic diseases such as lupus, structural problems in the womb and severe or prolonged stress. Approximately 50 percent of all recurrent miscarriages do not have a known cause.

Tests can be carried out to determine if there is an underlying condition that could cause recurrent miscarriages. These involve analysing blood samples for certain blood clotting disorders and the presence of certain antibodies. Some of the tests include post miscarriage scans, antibiotics and ERPC. A doctor may also check for structural abnormalities in the womb and determine the health of the womb, fallopian tubes and the lining of the womb (endometrium). Other tests can check for infections and chronic autoimmune conditions that may be causing the miscarriage.

Though most women who have had a miscarriage do not need treatment to have a healthy pregnancy, in some cases treatment may be prescribed to treat underlying causes. Current miscarriage treatments include hormonal supplements to help support the health of the womb, aspirin and other medications to prevent excess blood clotting, treatment for infections and surgery to correct any structural abnormalities. Testing and treatment can provide the best chance of avoiding future miscarriages.

The Healing Process

Mourning is a natural process after the loss of a child, even one that the parents have not seen or held. It is important to allow this grief and pain to run its course, which is a duration that varies widely between individuals. Emotions after a miscarriage may include a deep sense of loss, guilt, a sense of failure and sadness.

Some mothers may feel that their reaction to a miscarriage is too strong for a child that was never a complete reality. However, a miscarriage at any time in a pregnancy can be very painful and healing may take months or longer. Well-meaning family and friends may assure the mother that she will have more children, but a miscarriage is a devastating source of anxiety and fear that she will not be able to have a normal pregnancy.

It is important for the couple, particularly the mother to know that grief after a miscarriage is a natural and slow process.  Crying is a normal part of grieving and may come in waves even many months after the miscarriage. The support of family and friends and praying can be a very calming influence.

Seeking help and answers to questions after a miscarriage can be healthy for the parents and the mother and father should be encouraged to consult a doctor or professional counsellor. Attending a support group for mothers can also be very beneficial for sorting personal experiences and feelings.

The physical effects of a miscarriage can also be demanding; both physically and emotionally. Medical treatment may be needed during a miscarriage that can lead to long-term effects; including fatigue, anemia, pain and hormonal imbalances.

www.miscarriageassociation.org.uk

Types of Miscarriages

It is important for an expectant mother to be aware of the various kinds of miscarriages that can occur. It is possible that symptoms which may appear to be a miscarriage, may not result in the termination of a pregnancy.

Threatened Miscarriage
A threatened miscarriage is any bleeding from the womb during pregnancy. Almost one in four women experience some bleeding during the first trimester of pregnancy along with other symptoms such as cramps and lower back pain. However, only about 50 percent actually have a miscarriage.

Complete Miscarriage
This type of miscarriage most often occurs within the first 10 weeks of pregnancy and can happen very quickly, without serious symptoms and most mothers do not require medical care.

Inevitable Miscarriage
This occurs when a miscarriage is in the process of occurring but has not yet reached completion. The mother may require rest and medical care while she waits.

Missed Miscarriage
A missed miscarriage occurs when the developing foetus does not have a heart beat and has stopped growing, yet the body has not yet realised that a miscarriage has occurred. There are typically no symptoms of a missed miscarriage and the mother will require medical care, after a scan confirms the miscarriage.

Recurrent Miscarriage
Recurrent miscarriages are classified as three or more consecutive, spontaneous miscarriages (two in the over 35s). This condition affects about one percent of couples.