Pregnancy Forum - How Does One Have a Miscarrige?

What is a miscarriage?
Miscarriage is the loss of a pregnancy in the first 20 weeks. On average, about 15 percent of known pregnancies end in miscarriage, and more than 80 percent of the time, it happens in the first trimester. (this doesn't include situations where you lose a fertilized egg before you get a positive pregnancy test. Studies have found that 30 to 50 percent of all fertilized eggs are lost before a woman finds out she's pregnant because they happen so early that she goes on to get her period about on time.) if you lose a baby after 20 weeks of pregnancy, it's called a stillbirth.

What causes a miscarriage?
Between 50 and 70 percent of first trimester miscarriages are thought to be random events caused by chromosomal abnormalities in the fertilized egg. Most often, this means that the egg or sperm had the wrong number of chromosomes, and as a result, the fertilized egg is unable to develop normally. In other cases, a miscarriage can be caused by problems that occur during the delicate process of early human development — for example, when an egg doesn't implant properly in the uterus or when an embryo has structural defects that don't allow it to continue developing. Since most practitioners won't do a full-scale work-up after a single miscarriage, it's usually impossible to tell why the pregnancy was lost. (and even when a detailed evaluation is performed — say after you've had two or three consecutive miscarriages — the cause still remains unknown in about half of cases.)

when there are chromosomal problems in the fertilized egg, you may end up with a blighted ovum, where a placenta and gestational sac begin to develop but there's no baby inside, either because the embryo failed to develop or stopped developing very early. In other cases, the embryo does develop for a little while but has abnormalities that make it impossible for it to continue to survive and it stops developing before it has a heartbeat. Once your baby has a heartbeat — it's usually visible on ultrasound at around 6 weeks — the chance of having a miscarriage decreases significantly.

What kinds of things might put me at a higher risk for miscarriage?
Though any woman can miscarry, some are more at risk than others. Here are the most common risk factors:
• age the older you are, the more likely you are to miscarry, partly because older women are more likely to have babies with chromosomal abnormalities. In fact, you're about twice as likely to miscarry at age 40 as you are at age 20.

• a history of miscarriages if you've had more two or more consecutive miscarriages, you're more likely than other women to miscarry again.

• having certain diseases or disorders having poorly controlled diabetes, certain inherited blood clotting disorders, certain autoimmune disorders (such as antiphosphilipid syndrome or lupus), and certain hormonal disorders such as a luteal phase defect (where you have low levels of progesterone) or polycystic ovary syndrome can increase your risk. Researchers are also studying the potential risk of having an immune system disorder where a mother produces antibodies against the pregnancy.

• problems with your uterus or cervix having certain uterine abnormalities or a weakened or abnormally short cervix (sometimes called an "incompetent cervix" or "cervical insufficiency") can increase your risk.

• a history of birth defects or genetic problems if you've had a child with a birth defect or you or your partner have a family history of genetic problems, you're more at risk.

• certain infections research has shown a somewhat higher risk for miscarriage if you have certain infections such as listeria, toxoplasmosis, mumps, rubella, measles, cytomegalovirus, parvovirus, and hiv. Certain infections inside the uterus have also been linked to an increased risk of miscarriage. Some studies have linked having a high fever early in pregnancy to an increased risk, but other studies have not.

• smoking, drinking, and using drugs smoking a lot, drinking too much alcohol, and using drugs like cocaine and ecstasy during pregnancy can all increase your risk for miscarriage. Even drinking more than four cups of coffee a day has been associated in studies with a higher risk for pregnancy loss.

• taking certain medications certain medications have been linked to increased risk of miscarriage, so it's important to ask your caregiver about the safety of any medications you're taking even while you're trying to conceive. This goes for both prescription and over the counter drugs, including non-steroidal anti-inflammatory drugs (nsaids) like ibuprofen or aspirin.

• exposure to environmental toxins environmental factors that might increase your risk include lead, arsenic, and some chemicals like formaldehyde, benzene, ethylene oxide, and large doses of radiation or anesthetic gases.

• paternal factors not a lot is known about how the father's condition may contribute to a couple's risk for miscarriage, though the risk increases with the father's age. Researchers are studying the extent to which sperm could be damaged by environmental toxins but still manage to fertilize an egg. Some studies have found an increased risk of miscarriage when the father has been exposed to mercury, lead, and some industrial chemicals and pesticides.

Your risk of miscarriage also increases with each child you bear and if you get pregnant within three months after giving birth.

What are the signs that i'm having a miscarriage?
Spotting (finding spots of blood on your underpants or toilet tissue after urinating) or bleeding is sometimes the first sign of miscarriage. Keep in mind, though, that spotting is common early in pregnancy and may or may not be a sign of a problem with the baby. About half of the time, it's a symptom of a miscarriage, an ectopic pregnancy, or a molar pregnancy. If you have any spotting or bleeding, call your doctor or midwife right away so she can determine whether your spotting indicates a potential problem. (if your blood is rh-negative, you'll need a shot of rh immunoglobulin within two or three days after you first notice bleeding.) you may also have abdominal pain, which can feel crampy or persistent as well as mild or sharp. Or you may just feel low back pain or pelvic pressure.

You may have light bleeding and cramping for a few weeks. You can wear sanitary pads but no tampons during this time and take acetaminophen for the pain. The bleeding and cramping may get worse shortly before you pass the "products of conception" — that is, the placenta and the embryonic or fetal tissue, which will look grayish and may include blood clots. If you can, save this tissue in a clean container because your caregiver may want to examine it or send it to a lab for testing to try to find out why you miscarried. In any case, she'll want to see you at this point, so call her to let her know what's happened.

Some miscarriages are discovered only during a routine prenatal visit, when the doctor or midwife can't hear the fetal heartbeat or the uterus isn't as large as it should be at your stage. (often the embryo or fetus stops developing a few weeks before you have symptoms, like bleeding or cramping.) if your practitioner suspects that you've had a miscarriage, she'll order an ultrasound to see what's going on in your uterus and possibly a blood test.

What should I do if I suspect i'm about to miscarry?
Call your doctor or midwife immediately if you ever notice unusual symptoms such as bleeding or cramping during pregnancy. Your practitioner will examine you to see if the bleeding is coming from your cervix and check your uterus. She may also do a blood test to check for the pregnancy hormone hcg and repeat it in two to three days to see if your levels are rising as they should be.

If you're having bleeding or cramping and your practitioner suspects you have an ectopic pregnancy, you'll have an ultrasound right away. If there's no sign of a problem but you continue to spot, you'll have another ultrasound at about 7 weeks. At this point, if the sonographer sees an embryo with a heartbeat, you have a viable pregnancy and your risk of miscarrying is now much lower, but you'll need to have another ultrasound later if you continue to bleed. If your dates are correct and the sonographer sees an empty gestational sac, that means you have a blighted ovum. If the sonographer sees an embryo that's the right size but has no heart beat, that means the embryo didn't survive. If the sac or the embryo is smaller than expected, though, it might just be too early — meaning that you're less than 7 weeks along — and you'll need to have another ultrasound again later.

If you're in your second trimester and an ultrasound shows your cervix is shortening or opening, your doctor may decide to perform a procedure called a cerclage, where she stitches your cervix closed in an attempt to prevent miscarriage or premature delivery. (this is assuming your baby appears normal on the ultrasound and you have no signs of an intrauterine infection.) however, this procedure is not without risk, and not everyone agrees on what might make you a good candidate for it.

If you're showing signs of a possible miscarriage, your doctor or midwife may prescribe bedrest in hopes of reducing your chances of miscarrying. (unfortunately, though, except in the case of a weakened or short cervix, there's no evidence that bedrest will help.) she may also suggest you forgo sex while you're having bleeding or cramping.

What should I do if my practitioner tells me i've lost the pregnancy but I still haven't passed the tissue?
If there's no threat to your health, you may choose to let the miscarriage happen on it's own timeline. (more than half of women spontaneously miscarry within a week of finding out that the pregnancy has stopped developing.) or you may decide to wait a certain amount of time to see if it happens before having a procedure to remove the tissue. This is called a d&c, which stands for dilation and curettage. (when curettage is done using vacuum aspiration to remove the tissue, it's sometimes called a suction curettage.)

on the other hand, you may decide to just have the tissue removed if you find that it's too emotionally trying or physically painful to wait for it to pass. (in some cases, you may be able to use medication to speed up the miscarriage process, although there may be side effects such as nausea, vomiting, and diarrhea, and you may end up needing to have the tissue removed anyway.) you'll definitely need a d&c if you have any problems, such as significant bleeding or signs of infection, that make it unsafe to wait for a miscarriage. And your practitioner may recommend the procedure if this is your second or third miscarriage in a row, so that they can test the tissue to see if they can find a genetic cause.

Whether you miscarry on your own or have a d&c, you'll have mild menstrual-like cramps afterwards for up to a day or so and light bleeding for a week or two. Use pads instead of tampons and take ibuprofen or acetaminophen for the cramps. Avoid sex, swimming, douching, and using vaginal medications for at least a week or two and until your bleeding stops. If you begin to bleed heavily (soaking a sanitary pad in an hour), have any signs of infection (such as fever, achiness, or foul-smelling vaginal discharge), or feel excessive pain, call your practitioner immediately or go to the emergency room. If your bleeding is heavy and you begin to feel weak, dizzy, or lightheaded, you may be going into shock. In this case, call 911 right away — don't wait to hear from your caregiver and don't drive yourself to the er.

What does a d&c involve?
The procedure doesn't usually require an overnight stay unless you have complications. As with any surgery, you'll need to arrive with an empty stomach — no food or drink since the night before. You'll lie on an exam table much as you would for a pap smear.

Most obstetricians prefer to use suction curettage (or vacuum aspiration), since it's thought to be slightly quicker and safer than a traditional d&c, though some will use a combination of the two procedures. For either procedure, the doctor will insert a speculum into your vagina, clean your cervix and vagina with an antiseptic solution, and dilate your cervix with narrow metal rods (unless your cervix is already dilated from having passed some tissue). In most cases, you'll be given sedation through an iv and a local anesthetic to numb your cervix.

For a suction curettage, the doctor will pass a hollow plastic tube through your cervix and suction out the tissue from your uterus. For a traditional d&c, she uses a spoon-shaped instrument called a curette to gently scrape the tissue from the walls of your uterus. The whole thing may take about 15 to 20 minutes, and removing the tissue takes less than 10 minutes.

Does having a miscarriage mean i'm likely to miscarry again?
No. Most first miscarriages are considered random events. Although you're likely to be worried about the possibility of another miscarriage, fertility experts don't consider a single early pregnancy loss to be a sign that there's anything wrong with you or your partner. Some practitioners will order special blood and genetic tests to try to find out what's going wrong after two miscarriages in a row, particularly if you're older than 35 or have certain medical conditions. Others will wait until you've had three consecutive losses. In certain situations, such as if you had a second trimester miscarriage or an early third trimester premature birth from a weakened cervix, you might be referred to a high-risk specialist after a single loss so she can carefully manage your pregnancy.

When can I try to conceive again?
You may have to wait a bit. Whether you miscarry spontaneously or have a d&c, you'll generally get your period again in four to six weeks. Some practitioners say you can start trying to conceive again after this period, but others recommend that you wait until you've been through another menstrual cycle so that you have more time to recover physically and emotionally. (you'll need to use birth control to prevent conception during this time since you may ovulate as early as two weeks after you miscarry.)

i can't seem to get over having miscarried. How can I cope?
Though you may be ready physically to get pregnant again, you may not feel ready emotionally. Every womancopes with the grief of early pregnancy loss in her own way, and some women find it takes months before they're interested in trying to conceive again. Losing a baby is tragic no matter when it happens. Give yourself time to mourn. Ask your caregiver where to get counseling or find support groups. You can also find support on our bulletin board trying after a miscarriage.