Any woman who has gone through a miscarriage can attest to how upsetting the experience can be. Women who are also dealing with infertility can find the emotional pain of dealing with a miscarriage to be particularly overwhelming, leaving them with a lot of miscarriage questions. While suffering a miscarriage can make a woman feel alone and isolated, dealing with a pregnancy loss is actually very common.
What is a Miscarriage?
The term miscarriage refers to the loss of a fetus up to the 20th week of pregnancy. After the 20th week, loss of the fetus is known as a stillbirth. It is estimated that between 15% and 20% of all recognized pregnancies end in miscarriage. The risk of miscarriage is typically highest during the first 12 weeks of pregnancy. A blighted ovum accounts for 30% of miscarriages that occur prior to the eighth week of pregnancy.
While there is nothing abnormal about experiencing one miscarriage before achieving a successful pregnancy, some couples may deal with multiple miscarriages. Recurrent pregnancy loss affects 0.5% to 1% of all pregnancies. If you are experiencing recurrent miscarriage, it is important to make an appointment for a medical evaluation. Repeated losses may indicate fertility problems that should be investigated.
Typically, the most obvious signs of miscarriage are bleeding and abdominal cramping. Although some light vaginal bleeding is common during the first trimester, heavy bleeding is not. Other miscarriage symptoms include:
- severe abdominal pain
- chills or running a fever
If you notice any of these symptoms of miscarriage, contact your healthcare provider right away or head to your nearest hospital emergency room.
The most often cited reason for a miscarriage is genetic abnormalities with the fetus, which is believed to account for as much as 60% of all miscarriages. These abnormalities are not thought to pose any problems for future pregnancies.
Other less common causes of miscarriage include:
- Uterine infection
- Use of alcohol, cigarettes, recreational drugs and certain medications
- Poor production of progesterone early in pregnancy
- Uterine abnormalities
- Fibroids (can occasionally interfere with implantation)
- Immunological factors (thought to possibly account for as much as 25% of all repeated miscarriages)
In general, if a woman has only had one miscarriage, it is unlikely that any medical evaluation to determine the cause will be initiated. This is because as much as 90% of women go on to have a normal, healthy pregnancy after a single miscarriage. If you have had two or more consecutive miscarriages, though, your healthcare provider will probably want to investigate the issue.
To determine the miscarriage cause, a pelvic exam will likely be done. During this time, your healthcare provider will examine the size and shape of your uterus as well as take a sample from the cervix and vagina to test for infection. Blood tests for both partners will also be ordered to see if any chromosomal abnormalities or hormonal imbalances in either partner can be detected. Finally, if possible, the miscarried fetus will be evaluated for chromosomal abnormalities or any other reasons that can give insight as to why the miscarriage occurred.
While there is no surefire way to avoid a miscarriage, there are numerous steps you can take to lower your risk.
- Follow a healthy diet and exercise regularly
- Quit smoking and cut out alcohol before you start trying to conceive
- Avoid using recreational drugs
- If you are using prescribed medications, speak with your doctor about how these medications may interfere with your fertility and discuss the option of switching if necessary
- Begin taking folic acid supplements before you are pregnant
Women with chronic conditions, such as diabetes or thyroid problems, should have these disorders under control before becoming pregnant. Poor management of a chronic illness can contribute to recurrent pregnancy loss.
In women who have experienced multiple miscarriages, treatment may be possible for the underlying cause. Genetic counseling in those who have been found to have a chromosomal problem is a possibility. Structural problems with the uterus may be fixed through surgery, although this won’t necessarily guarantee a successful pregnancy. It is possible that some other factor which was missed is actually contributing to the repeat miscarriages.
When necessary, the use of certain medications, including heparin, baby aspirin and IVIg therapy, can be helpful. If porr progesterone production is a factor, progesterone supplements may be administered.
Although no treatment can assure a pregnancy, achieving a successful pregnancy after miscarriage is entirely possible. Discussing your desire for children with your health care provider before you start trying to conceive can help you assess your risk for miscarriage.