Miscarriage or spontaneous abortion refers to the loss of a pregnancy before the 20th week of pregnancy. It is estimated by the American College of Obstetricians and Gynecologists (ACOG) that, “as many as 26% of all pregnancies end in miscarriage and up to 10% clinically recognized pregnancies. The difference between the two percentages is because many miscarriages happen very early in the pregnancy, before the woman is even aware she was pregnant. The risk of miscarriage decreases after 12 weeks.
As OB-GYNs, we understand there is not necessarily comfort in numbers. We share those statistics is to give you hope and let you know most of our patients have rainbow babies, aka healthy normal babies after a loss.
Our goal is to explain the risk factors and provide you with the physical care and emotional support you need to grow your family when you are ready.
The Most Common Cause of Miscarriage
According to the American Pregnancy Association (APA), the most common cause of miscarriage in the first trimester is a genetic abnormality in the embryo. About 50 percent of miscarriages are associated with extra or missing chromosomes which result from errors that occur by chance as the embryo develops.
Other Potential Risk Factors for Miscarriage
Certain factors could increase the risk of having a miscarriage including:
- The mother’s age is a risk factor. The older the mother is, the higher the risk of miscarriage. At age 35, there’s a 20% risk of having a miscarriage, while that risk goes up to 80% at the age of 45.
- A history of previous pregnancies ending in miscarriages
- Suffering from chronic illnesses such as uncontrolled diabetes or thyroid disease
- Having weak cervical tissues or some other uterine problems also makes the risk of pregnancy loss higher
- Using illicit drugs, alcohol, and cigarettes during pregnancy
- Being either overweight or underweight
- While most prenatal tests are safe, some can be invasive and pose a miscarriage risk, such as amniocentesis and chorionic villus sampling
“We also think it is important to share that physical activity, exercise and sex are considered safe during pregnancy and do not cause a miscarriage,” explained OB-GYN Dr. Thomas D. Horst.
Signs and Symptoms of a Miscarriage
Common symptoms of a miscarriage include:
- Vaginal spotting or bleeding
- Pain or cramping in your abdomen or lower back
- Fluid or tissue passing from your vagina
Most women who have vaginal spotting or bleeding in the first trimester go on to have successful pregnancies.
How an OB-GYN Diagnoses a Miscarriage
Vaginal spotting or cramps during pregnancy does not definitively mean you are having a miscarriage. However, it is a sign that you should go see your gynecologist.
“Light bleeding during the first trimester is very common and can be attributed to the implantation of the embryo in the womb. Most women who have spotting during their first trimester go on to have a normal pregnancy and a live birth, “explained OB-GYN Dr. Horst. “But with any sign of bleeding, you should see your OB-GYN, just to rule out any abnormal possibilities.
The most common tests and practices used to diagnose if you have had a miscarriage include:
- A pelvic exam to check for potential cervical dilation
- Ultrasound to check the progress of the embryo’s development
- Blood tests to check for pregnancy hormone (HCG) levels
- Tissue tests to assess whether you have passed miscarriage tissue
- Chromosomal tests to identify whether your or your partner’s chromosomes are an issue.
Different Types of Miscarriage Diagnosis
We often simply say, “I had a miscarriage,” but there are many types of miscarriages:
- Chemical pregnancy: Chemical pregnancies very often occur before you even know you are pregnant and are most likely the result of a chromosol abnormality.
- Missed miscarriage: In a missed miscarriage, the fetus implants but never develops. Often the body does not expel the tissue so a D & C is required.
- Threatened miscarriage: Vaginal bleeding without a dilated cervix can be a sign of a threatened miscarriage. If the cervix opens, there is an increased possibility of a miscarriage.
- Septic miscarriage: Essentially, any kind of uterine infection can lead to a septic miscarriage.
- Inevitable miscarriage: If you’re pregnant, but your cervix is dilated, and you’re bleeding, pregnancy loss is inevitable.
- Incomplete miscarriage: In the event of passing only partial miscarriage tissue, with some remaining in the uterus, the diagnosis is an incomplete miscarriage.
- Complete miscarriage. Opposite to incomplete pregnancy loss, complete miscarriage occurs when a woman passes all pregnancy tissues through the vagina. This usually happens within the first 12 weeks of pregnancy.
Treatment for a Miscarriage: Is there a way to stop the process once it has started?
In our South Miami and Doral offices, we are often asked if there is a way to stop a miscarriage.
Unfortunately, there is no treatment that can stop a miscarriage after it has already started. However, we can limit blood loss and prevent infection.
If there is no pregnancy tissue left in the womb, no treatment is required.
If there is residual tissue, you have three options:
- Expectant Management– Your OB-GYN may suggest waiting for the pregnancy tissue to pass through your body naturally.
- Medical management– Some women prefer to take medication to speed up the process. The medication, which stimulates the uterus to shed the pregnancy tissue, is usually effective within 24 hours. Some medications are given orally and some are given vaginally.
- Surgical management- For those who are experiencing heavy bleeding or show signs of infection, your OB-GYN may recommend a suction dilation and curettage. more commonly known as a D & C. During this minor procedure, your OB-GYN will dilate the cervix and actively remove the remaining pregnancy tissue from the uterus.
When to Call Your Doctor
If you experience severe cramping that doesn’t stop, heavy bleeding, fever, or an abnormal vaginal discharge, you should call your physician.
Physical and Emotional Recovery After Miscarriage
There is no one-size-fits-all timetable for your body to recover. Your recovery may depend on how far along you were in your pregnancy. Some women recover within a few days; for others, it may take a few weeks, particularly if it was a late miscarriage. Generally, your period should resume within four to six weeks. You can start using contraceptives immediately after the pregnancy loss, but it is preferable to avoid having sex, douche, or use tampons for the first two weeks after a miscarriage since your uterus is more prone to infection.
The emotional toll after experiencing a miscarriage can be more challenging than the physical recovery. You may experience a multitude of emotions, from shock to sadness and even guilt, which may be compounded by the hormonal shift of not being pregnant. Coping with a pregnancy loss is very individual and we often forget to give ourselves the time and space to heal. Some of our patients have found it comforting to join a support group. Others seek individual counseling with a trained therapist.
What About Future Pregnancies?
It may be four to six weeks before you start having your period. Physically, you may be able to try to conceive again. But before you jump into another pregnancy, consider your emotional readiness. While the reality is that while most women have a healthy baby after miscarriage, sometimes waiting a cycle or two can be emotionally beneficial.
We are here to support you and talk you through the process, helping you weigh the pros of cons of waiting vs. trying to conceive right away. Book your appointment with Dr. Horst today and let’s begin your journey to have another baby together.
