SafeMotherhood
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YOUR PREGNANCY - 0-12 WEEKS

Early miscarriage

A miscarriage is defined as the unintended loss of a pregnancy before 24 weeks. However, most miscarriages happen between the 6th and the 10th week of pregnancy. This information is to help you cope if you have an early miscarriage.

Some facts

Sadly, between 10% and 15% of women with confirmed pregnancies suffer a miscarriage. Miscarriage is more frequent in women over 30, and in women who are pregnant for the third or subsequent time. In the majority of cases, the pregnancy miscarries either because the fertilised egg has not developed properly, or because the baby is severely malformed.

The fact that the pregnancy is in its early stages does not mean that women or their partners suffer less when a miscarriage happens. Women who do not have any children are especially likely to feel depressed and may question their ability to have a successful pregnancy.

Risk factors

Doctors generally cannot tell you why you had a miscarriage. However, there are some factors which increase the risk. These are:

• Smoking
• Vaginal infections
• Previous miscarriage
• Hormonal problems (such as having irregular periods)
• Some blood disorders
• Catching an infection such as German measles in the early weeks of pregnancy.

Signs of miscarriage

During the first three months of pregnancy, low back-ache, stomach cramps, and bleeding from the vagina may be signs of a miscarriage. You are likely to feel very upset and anxious and you may want to speak to your doctor immediately to try to find out what is happening. Or you may prefer to wait and see. If the bleeding becomes heavy, you feel feverish and unwell, you have pain in your shoulders or fainting episodes, go and see your doctor straight away, or phone your local maternity hospital for advice.

Your GP will take your blood pressure, temperature and pulse, and gently feel your stomach before listening to your baby's heart if you are more than 12 weeks pregnant. She may refer you to hospital for an ultrasound examination which is carried out using a probe placed in the vagina, or by scanning through the abdomen.

Different kinds of miscarriage

Itís helpful to know some medical jargon so that you can understand what your doctor and midwife are saying to you. Doctors used to call a miscarriage an `abortion' and this word is still being used. It can be confusing if you think of an abortion as a deliberate decision taken by a woman to bring her pregnancy to an end. Health professionals have several classifications for `abortion' or miscarriage.

A threatened abortion/miscarriage is when you have some vaginal bleeding and perhaps some uncomfortable stomach cramps. There is no need to go to bed unless you want to, and there are no drugs the doctor can give you to protect your pregnancy. You have to wait and see what happens. You could ask your doctor to arrange an ultrasound scan. If this shows that your baby is a normal size and that his heart is beating, then it is 98% likely that your pregnancy will continue safely.

An inevitable abortion/miscarriage is when bleeding from the vagina is accompanied by painful stomach cramps and the neck of the womb (cervix) starts to open up. The miscarriage may happen quickly or take some time. You are likely to bleed for about 10 days after the miscarriage. If you bleed for longer than this, or you go on having stomach cramps, or you notice a smelly pinkish discharge from your vagina, you should see your doctor as soon as possible. You might still have some tissue from the pregnancy left inside you which could cause infection or haemorrhage.

An ectopic pregnancy is when the fertilised egg implants itself somewhere other than the womb, perhaps in one of the Fallopian tubes, or in an ovary. The baby cannot grow in these circumstances. You may have brownish vaginal bleeding, possibly severe pain in the lower part of your stomach or shoulder, and feel faint. See your doctor immediately. An ectopic pregnancy can be very dangerous. You will need to go to hospital to have the pregnancy removed.

A missed abortion/miscarriage is when the baby dies and remains in the womb. There is a brownish discharge from the vagina. You will probably have an intuition that something is not right. See your doctor and discuss what action to take. You might choose to wait for nature to end the pregnancy. This could happen in a few hours or take several weeks. Or you might choose to have a small operation to empty your womb. This is usually done under general anaesthetic, but you probably won't have to stay in hospital overnight. You might be prescribed a drug called misoprostol which you take while in hospital to make your womb contract and empty itself.

Less than 1% of women suffer from recurrent abortion/miscarriage which is defined as three or more consecutive miscarriages. Generally, there's no obvious reason why a woman is having one miscarriage after another. It's a terribly distressing situation and you should be referred to a Consultant specialising in early pregnancy loss.

Women's feelings

In this country, women expect to have successful pregnancies and healthy babies. We have little or no experience of pregnancy complications which are all too common in other parts of the world. This means that a miscarriage is generally a traumatic experience, although some women seem to accept it as `just one of those things'. Many, however, grieve for their lost babies.

You may be worried that there was something you did or did not do during your pregnancy which made you have a miscarriage. This is extremely unlikely. If you have a follow-up appointment with your GP or the hospital, make sure that you find out whether there could be any possible reason for your miscarriage, and what might happen in future pregnancies.

You might want to get back to work as soon as possible and try to put the miscarriage out of your mind. Or you might feel that you can't face other people and that you need some quiet time to sort yourself out. In this case, take a few days off. Rest. Try to find someone to talk to. What most women need after a miscarriage is to be reassured that they are not alone, and that their feelings are normal.

Support

The National Childbirth Trust and the Miscarriage Association are voluntary organisations run by lay people who can put you in touch with other women who have lost a baby through miscarriage. Your hospital might have a counselling service, or an Early Pregnancy Assessment Unit (EPAU) where midwives are trained to support women who have experienced miscarriage. You generally don't have to have a doctor's referral to contact an EPAU. Just ring and ask for help.

If you feel depressed for a long time following your miscarriage, ask your GP or hospital doctor to refer you to a mental health professional. Many people are reluctant to get involved with mental health services, but seeking help does not mean that you are mad or deranged!

Men's feelings

Men can be strongly affected by miscarriage, especially if they have seen their baby on an ultrasound scan during the pregnancy. Yet their feelings are often unacknowledged. While their partner receives plenty of sympathy, they are left out. Research shows that men may find miscarriage very difficult to cope with and that their need for support is often as great as women's.

The next pregnancy

Following a miscarriage, many women have an overwhelming desire to start another pregnancy as soon as possible. Research shows that a speedy new pregnancy is generally fine although it is a good idea to wait until you have had at least one normal period. You also need to give yourself a little space to recover. Get plenty of rest and make sure you are eating well. Don't forget to consider taking folic acid tablets from before the time you start trying to conceive again. Talk to your GP or pharmacist about this.

You will probably find that you feel very anxious during the first part of your next pregnancy, until you have got past the week when you had your miscarriage. Once you start to feel your baby moving, you may become worried as soon as you haven't felt any movements even for a short period of time. Turn to your midwife for reassurance and don't feel awkward about asking for extra checks. You and your partner deserve lots of support to help you through this difficult time. Remember that most women go on to have a perfectly normal pregnancy following a miscarriage. Good luck!

Contacts

The National Childbirth Trust
Tel: 0208 992 8637

The Miscarriage Association
Telephone helpline: 01924 200799 (Mon-Fri, 9am - 4pm)
Scottish helpline: 0131 334 8883 (answerphone with names of local contacts)

Sources:

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Cuisinier M., Janssen H., de Graauw C. et al. (1996) Pregnancy following miscarriage: course of grief and some determining factors. Journal of Psychosomatic Obstetrics and Gynaecology, 17 (3):168-174

Campbell S., Lees C. Eds. (2000) Obstetrics by Ten Teachers: 17th edition. Ch. 17: Second Trimester Miscarriage. London: Arnold: 263-271

Janssen H.J.E.M., Cuisinier M.C.J., Hoogduin K.A.L. et al. (1996) Controlled prospective study on the mental health of women following pregnancy loss. American Journal of Psychiatry, 153 (2):226-230

Johnson M.P., Puddifoot J.E. (1996) The grief response in the partners of women who miscarry. British Journal of Medical Psychology, 69 (4):313-327

Jones M. (1997) Mothers who need to grieve: the reality of mourning the loss of a baby. British Journal of Midwifery, 5 (8):478-481

Kluger-Bell K. (1998) Unspeakable losses: understanding the experience of pregnancy loss, miscarriage and abortion. London: Penguin Books

Llewellyn-Jones D. (1999) Obstetrics and Gynaecology: 7th edition. Ch. 12: Abortion. London: Mosby: 105-112

Murphy F.A., Hunt S.C. (1997) Early pregnancy loss: men have feelings too. British Journal of Midwifery, 5 (2):87-90

Royal College of Obstetricians and Gynaecologists (2001) Management of Early Pregnancy Loss.

Walker T.M., Davidson K.M. (2001) A preliminary investigation of psychological distress following surgical management of early pregnancy loss detected at initial ultrasound scanning: a trauma perspective. Journal of Reproductive and Infant Psychology, 19 (1):7-16