Everything you need to know about miscarriage

What is miscarriage?

It is the loss of pregnancy before the twentieth week, or when the fetus’s weight is less than 500 grams.

Types and symptoms of miscarriages

Inevitable Miscarriage

This is where there are clear symptoms that the pregnancy is ending. These symptoms include

- Severe cramps, similar to period’s cramping but much more painful.

- Vaginal bleeding.

- A discharge of tissues.

Missed (silent miscarriage)

In this type of loss, the pregnant woman doesn’t experience bleeding or cramping, and it is usually discovered during a routine check-up, where the doctor cannot find the fetus’s pulse or that the pregnancy sac is empty.

How common do miscarriages happen?

8 to 20% of known pregnancies (where a woman knows that she is pregnant) are miscarried. While 13 to 26% of unknown pregnancies end in a loss. It is noteworthy that most miscarriages happen in the first trimester of pregnancy, before the 14^th week.

Causes of miscarriage

- Fetal chromosomal abnormalities make up 70% of the causes of miscarriages occurring in the first trimester. And 30% of those which happen after the 14^th week.

- Uterine congenital abnormalities.

- Untreated chronic diseases such as severe diabetes.

- Acute anemia.

- Thyroid issues.

- Spike in Prolactin levels.

- Severe infections that happen for the first time during pregnancy such as Chlamydia, Toxoplasmosis, and Herpes. Having these infections for the second or third time does not endanger a pregnancy or cause a miscarriage since the body has already developed an immunity to them.

- Some autoimmune conditions such as Lupus.

- Clotting disorder, in this case, there is a disorder in the antibodies that causes the Placenta to stop working. If this condition is known, the loss of a pregnancy can be avoided by treating this condition with injections that prevent clotting.

- Smoking, alcohol consumption, drugs, and other harmful substances.

- Exposure to radiation directly aimed towards the pelvis. This usually happens when a woman doesn’t know she is pregnant and does an x-ray or a CT scan of her pelvis. It is worth mentioning that radiation is harmful to pregnancy only if it is directed towards the abdomen or pelvis. This means that dental x-rays are not harmful, nor do they cause miscarriages.

- Some medication.

Miscarriages risk factors

- Age

The older a pregnant mother is the higher risk of a miscarriage. As fetal chromosomal abnormalities increase when a woman is older than 35.

- Previous miscarriages

A woman who had previous miscarriages is at a higher risk to miscarry again.

- Smoking

Women smoking more than 10 cigarettes a day have a greater chance of losing their pregnancy.

Can miscarriages be avoided?

If the cause of the miscarriage is genetic such as chromosomal abnormalities, there is nothing to do to avoid the loss of pregnancy. In such cases, a miscarriage must be seen with a positive perspective, since the continuation of such pregnancy would mean the birth of a baby with chromosomal abnormalities who is likely to suffer from many health issues.

If the cause of miscarriage is a hormonal imbalance or any other known health issue, the miscarriage can be avoided by treating these issues before pregnancy. Therefore, I advise any woman planning to get pregnant to consult her OBGYN to do a thorough check-up and detailed tests to find out whether she is suffering from any health issues that might cause miscarriage, and that can be treated before and during pregnancy.

In the case of recurrent miscarriages, in 50% of cases, the causes remain unknown. In instances when the case is found out, treatment is possible to avoid this unfortunate experience in the future. For example, a miscarriage can happen because of a weakness in the cervix, in this situation, the cervix can be tied through a minor procedure. But I must highlight that there is abuse and misuse of this procedure and sometimes it is performed without it being needed, which can do more harm. I always advise my patients to seek several medical opinions before undergoing any surgery.

When does the bleeding stop after a miscarriage?

Usually, bleeding stops 15 days after the miscarriage happens, it doesn’t last for six weeks as in the case of postpartum bleeding. However, it is hard to tell when will the next period and ovulation happen after a miscarriage.

How are miscarriages treated

- Observation

The doctor doesn’t have to perform any procedure or offer any treatment. Doctors only observe, and asses through ultrasound tests to make sure that the pregnancy sac was completely discharged.

- Medication

Medication is prescribed to completely terminate the pregnancy, with a continuous follow-up through ultrasound.

- Dilation and curettage

This is a minor procedure, done under sedation, to remove pregnancy tissue from inside the uterus. A blood test to measure the pregnancy hormone is done until the hormone is completely gone.

The next pregnancy

Women often ask how long they should wait to try to conceive after a lost pregnancy. If a miscarriage happens without any complications or health issues, there is no need to wait, a woman can get pregnant whenever she wants. However, in the case of recurrent miscarriages, I recommend waiting to have tests done to try to find out the cause to see if this can be avoided.

The effect of a miscarriage on a woman

If the miscarriage happens without complications like severe bleeding, there is no physical effect on the woman’s body. But the effect of a lost pregnancy is mostly psychological. Mental health experts found that the loss of a baby through miscarriage leaves affects the mother for the rest of her life.

I recommend any woman who feels an immense emotional strain due to a lost pregnancy, to speak to a mental health professional to get the counsel and help she needs to better overcome this ordeal. Without undermining the effect, a miscarriage can have on her.

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