Miscarriage

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Approximately 17 to 20% of all pregnancies end in miscarriage. It is a very common experience for couples, but most go on to have a successful pregnancy in the near future.

While the management and description of miscarriage can be very clinical, health practitioners appreciate many couples are not grieving a ‘failed pregnancy’ or a ‘fetus with a chromosomal abnormality’ they are grieving the loss of their baby, which they have begun to imagine and plan a life for. It is important that couples discuss their feelings together and with their doctor. Counseling can be arranged.

Are there different categories of miscarriage?

Yes. There are several different types of miscarriage, including:

  1. Threatened miscarriage: Some bleeding occurs in early pregnancy which settles and the pregnancy successfully continues. An ultrasound is performed to check if the pregnancy is still viable.
  2. Missed abortion: There is no bleeding, however an ultrasound finds the baby’s heart has stopped.
  3. Blighted ovum: There has been an early pregnancy failure, before a fetus has began to form and only the pregnancy sac is present.
  4. Incomplete miscarriage: Bleeding has started and an ultrasound has shown the pregnancy has ended, but is still present in the uterus.
  5. Complete miscarriage. There has been significant bleeding and tissue has passed from the vagina. An ultrasound shows the uterus is empty.

What are the treatment options for miscarriage?

Treatment options vary from waiting for the body to naturally resolve the issue, having a surgical curettage to remove material from the uterus under an anaesthetic, or taking a mifeprostol tablet to induce the material to be expelled from the uterus. Your doctor will be able to explain the various options suitable for you, with their advantages and disadvantages.

What causes miscarriage?

Miscarriage is usually caused by a major chromosomal abnormality in the pregnancy. This simply means there is an error in the genetic code and as the fetus develops it reaches a point where it ceases to grow and develop and dies. Other causes may include a congenital abnormality of the uterus, a blood disorder or an infection of the uterus. However, often the underlying cause of a miscarriage is unknown.

Is there anything I can do to prevent a miscarriage?

Unfortunately there is usually nothing you can do to prevent a miscarriage. Many women feel a sense of guilt that somehow they could have prevented a miscarriage and this can be perpetuated by well meaning friends and family who offer scientifically unfounded theories. Some scenarios which we know do not cause miscarriages include stress, grief, hot baths, exercise and a myriad of other everyday activities.

There is evidence that during major influenza epidemics there is a slight increase in the risk of miscarriage, which may be linked to high fevers; however this is an extremely small number of cases and unfortunately it is virtually impossible to eliminate the possibility of contracting the flu. Having a flu vaccination can protect you from some of the more severe strains of flu and is worth considering if you are planning a pregnancy. Speak to your obstetrician for further advice.

Another factor worth considering is avoiding alcohol during the early phase of pregnancy. A study in the United States indicated one glass of sherry per day almost doubled the risk of miscarriage.

Miscarriage also increases with the mother’s age. Women over the age of 40 have a 50% chance of a miscarriage. It is recommended women not delay another pregnancy after a miscarriage, as it only increases the risk of another miscarriage.

Is there any treatment available to prevent miscarriage?

Unfortunately a baby is generally not able to survive outside the uterus before 24 weeks gestation. They simply do not have the lung development to live. There may be little if anything which can be done to prevent a miscarriage and nature may have to take its course.

What is the chance of having another miscarriage?

Most couples have a successful pregnancy after a miscarriage, however If you experience two or more miscarriages, known as recurrent miscarriage, you should speak to your obstetrician for specialist advice.

Less than one percent of women will have recurrent miscarriage. A specialist may be able to investigate and establish if there is any underlying condition which may cause miscarriage.

When can another pregnancy occur after a miscarriage?

It is possible for another pregnancy to occur during the next ovulation cycle. The next cycle may be delayed by a few weeks following a miscarriage. From a physical perspective, it is important not to delay another pregnancy for too long if maternal age and fertility are an issue.

How can I alleviate my anxiety about another pregnancy?

Your obstetrician can provide valuable assurance and specialist advice during your pregnancy. They may recommend more regular appointments and scans during the early phase of pregnancy to provide assurance on the progress of the pregnancy. It may also help to identify milestones in the pregnancy and decrease likelihood of miscarriage as the pregnancy progresses.

A counselor can provide further emotional support and strategies for coping with anxiety during subsequent pregnancies.