Miscarriage,  probably the worst word any pregnant woman knows. Miscarriage: The Facts sets out all the things you need to know about miscarriage and tries to lay some fears to rest.

Miscarriage

Miscarriage is the spontaneous loss of a pregnancy before 24 weeks. Approximately 10% of known pregnancies end in miscarriage.   In reality most miscarriages happen in the first 12 weeks, this being the time that the fertilised embryo is embedding into the endometrium and 80% of miscarriages are lost in these first few weeks.  You may see miscarriage called ‘spontaneous abortion’ which might make you think of the negative aspects that ‘abortion’ brings. But this is the medical term for miscarriage.   The figure for miscarriage could be higher if we could measure those lost before the first period is missed, so end in either a slightly later period or the period may be on time.

Causes

  • Random miscarriages account for 50-70%  and usually there is no known cause.
  • Chromosomal abnormalities accounts for 2-5%.
  • Increasing maternal age  – aneuploidy associated with older oocytes (error in cell division such as Down Syndrome).
  • Structural abnormalities of the uterus. This is seen in 10-20% of miscarriages.
  • Multiple fibroids, both intramural and submucosal is associated with increased risk.
  • Poorly controlled Diabetes or other chronic conditions.
  • A genetic abnormality in the family history or a previous pregnancy with abnormalities.
  • Cervical incompetence where the cervix opens up and this can lead to mid-trimester miscarriage.
  • Antiphospholipid Syndrome(APS) causes recurrent miscarriage but this is a treatable cause of miscarriage.

Signs and Symptoms

  • Light to heavy vaginal blood loss  – This may be similar to a period, or may be light spotting  – Bear in mind however that many women experience spotting and light bleeding in early pregnancy and go on to have a successful delivery.
  • Abdominal Pain – This will usually start after the bleeding has started. It may be cramp like in nature, or sharp, be persistent or intermittent.  Sadly if you have both bleeding and pain, the chances of the pregnancy continuing are slim.

Be aware that pain in early pregnancy can be a sign of an ectopic pregnancy so should not be dismissed. Pain and bleeding in early pregnancy needs immediate support by seeing your gynaecologist or attending A&E.

Mr Penman always has emergency appointments for bleeding and pain in pregnancy and you should ring the Spire Alexandra Hospital and request an emergency appointment to see Mr Penman that day. 

  • Sometimes there are no signs or symptoms but is detected when you go for your first scan and the fetus is not the size it should be or there is no heartbeat.  In this instance, you can wait for nature to take its course, or have a surgical procedure to remove the products of conception.

Scanning

Any woman arriving at Mr Penman’s office, with signs of a miscarriage will be immediately scanned.  Mr Penman can then see what is happening, check the fallopian tubes to rule out an ectopic pregnancy and cause of bleeding and pain.  Mr Penman will then check the the fetal sac for a heartbeat and any  reasons why you may be experiencing pain and bleeding.  If a heartbeat is found, the risk of miscarriage drops to very low even in the presence of bleeding.

If however there is no heartbeat and the gestational sac is of the correct size, it may be unfortunately that you have lost the pregnancy.  If the gestational sac is smaller than expected, it may be that your dates are not correct and so a scan will be booked for a week or so later and blood tests will be arrange to test for the pregnancy hormone as this will be a good indicator of how established the pregnancy is.

These observations allows Mr Penman to assess your pregnancy and give you a plan of action. Unfortunately there is nothing that can be done for miscarriage to stop it happening if it has already started.

Recurrent Miscarriage 

Miscarriage is  classed as recurrent when the mother has had 3 consecutive miscarriages. If you have had one miscarriage, you are no more likely to have a second one than anyone else, but after you have had three consecutive miscarriages, the risk of a further jumps to 40%.

The situation of miscarriage is devastating if you were trying for a baby.  The feeling of loss of that life, the child you had already been imagining who they would be. It can be made even worse by the fact that you are most likely never going to find out why you miscarried.  Frequently there is no reason, and only after having the second would there be a recommendation to send any products of conception off for analysis to test for any abnormalities that potentially could be treated.

Recurrent Miscarriage Tests

There are certain tests that can be done to see if you are carrying any antibodies, particularly for APS (sticky blood). This is one of the conditions that can cause miscarriage by causing blood to clot and so kill the developing fetus. This can be treated with blood thinners such as small doses of aspirin.  There are other chromosomal tests that can be performed on you and your husband to look for anything that may cause problems when trying to become pregnant, but frequently there is nothing found that could cause miscarriage which is frustrating and can be depressing.

Mr Penman can carry out any necessary tests for recurrent miscarriage.  He can also discuss your miscarriages with you and work out a plan to try and achieve a successful pregnancy with you, although as said before, recurrent miscarriage frequently has no known cause, so treating it is incredibly tough.