Early miscarriage

If you lose your baby in the first 3 months of pregnancy, it is called an early miscarriage.
Most women experience vaginal bleeding but occasionally there may be no symptoms. In this case, the miscarriage may be diagnosed by an ultrasound scan.

A miscarriage or “spontaneous abortion”, refers to the loss of a pregnancy before 20 weeks. It occurs in 15 to 20 percent of all pregnancies.
Most miscarriages occur during the first trimester ( from first day of your last period and lasts until the end of week 12 of your pregnancy ) called early miscarriage but can also occur later on in the pregnancy, called late miscarriage.
Different types of miscarriages can occur at different stages of your pregnancy. The symptoms and treatments will depend on the type of miscarriage.

Chemical Pregnancy

A chemical pregnancy is a very early miscarriage.
Which can occur before you even learn that you’re pregnant. As pregnancy tests have become more sensitive and more common, an increased number of chemical pregnancies have been diagnosed.
Chemical pregnancy is most likely the result of chromosomal abnormalities in the fertilized egg. An egg is fertilized, but is non-viable shortly after implantation, and is never visible on ultrasound.
There may be no signs of a chemical pregnancy. Most women simply begin to bleed around the time of their next period, though their period may arrive a few days late or be slightly heavier.

Threatened miscarriage

Types of miscarriage

When your body is showing signs that you might miscarry, that is called a ‘threatened miscarriage’. You may have a little vaginal bleeding or lower abdominal pain. It can last days or weeks and the cervix is still closed.
The pain and bleeding may go away and you can continue to have a healthy pregnancy and baby.

Inevitable miscarriage

Inevitable miscarriages can come after a threatened miscarriage or without warning. There is usually a lot more vaginal bleeding and strong lower stomach cramps. During the miscarriage your cervix opens and the developing fetus will come away in the bleeding.
There is rarely anything a doctor or you can do to protect the pregnancy except taking prescribed medicines. In the past bed rest was recommended, but there is no scientiﬁc proof that this helps at this stage.

Complete miscarriage

A complete miscarriage has taken place when all the pregnancy tissue has left your uterus. Vaginal bleeding may continue for several days. Cramping pain much like labour or strong period pain is common – this is the uterus contracting to empty.

Incomplete miscarriage

Sometimes, some pregnancy tissue will remain in the uterus. Vaginal bleeding and lower abdominal cramping may continue as the uterus continues trying to empty itself. This is known as an ‘incomplete miscarriage’.
Your doctor will check with USG and decide whether or not a short procedure called a ‘Dilatation of the cervix and Curettage of the uterus’ (often known as a ‘D&C’) is necessary to remove any remaining pregnancy tissue. This is an important medical procedure done in an operation theatre.

Recurrent miscarriage

A small number of women have repeated miscarriages. If this is your third or more miscarriage in a row, it is called recurrent miscarriage or abortion.

Types of pregnancy loss

Other types of pregnancies that result in a miscarriage are outlined below.

Ectopic pregnancy

An ectopic pregnancy occurs when the embryo implants outside the uterus, usually in one of the fallopian tubes. A fetus does not usually survive in ectopic pregnancy.
If you have an ectopic pregnancy, you may not know it at first, until it bleeds. Then you may get severe pain in your lower abdomen, vaginal bleeding, vomiting or pain in the tip of one shoulder. If you have these symptoms, it’s important to seek urgent medical attention.

Molar pregnancy

A molar pregnancy is a type of pregnancy that fails to develop properly from conception. It can be either complete or partial and usually needs to be surgically removed.

Blighted ovum

With a blighted ovum the sac develops but there is no baby inside. It is also known as an ‘anembryonic pregnancy’.
This condition is usually discovered during a scan. In most cases, an embryo was conceived but did not develop and was reabsorbed into the uterus at a very early stage. You should meet your doctor to discuss treatment options.

In most cases, it is not possible to give a reason for an early miscarriage.
The most common cause is thought to be a problem with the baby’s chromosomes (the genetic structures within the body’s cells that we inherit from our parents). If a baby does not have the right number of chromosomes, it will not develop properly and the pregnancy can end in a miscarriage.

Sadly, early miscarriages are very common. Many early miscarriages occur before a woman has missed her first period or before her pregnancy has been confirmed.
In the first 3 months, one in five women will have a miscarriage, for no apparent reason, following a positive pregnancy test.
The risk of miscarriage is increased by: .
- Your age – at the age of 30, the risk of miscarriage is one in five (20%); over the age of 40, the risk of miscarriage is one in two (50%)
- Medical problems such as poorly controlled diabetes
- Lifestyle factors such as smoking, being overweight or heavy drinking.
There is no evidence that stress can cause a miscarriage. Sex during pregnancy is not associated with early miscarriage.

Vaginal bleeding and/or cramping pain in the early stages of pregnancy are common and do not always mean that there is a problem. However, bleeding and/or pain can be a sign of a miscarriage.
If you have any bleeding and/or pain, you should consult your doctor.

An early miscarriage is usually diagnosed by an ultrasound scan. You may be advised to have either a transvaginal scan (where a probe is gently inserted in your vagina) or a transabdominal scan (where the probe is placed on your abdomen) or occasionally both.This is offered routinely at Saavi Women's Hospital.
A transvaginal scan may be recommended as it gives a clearer image.
Neither scan increases your risk of having a miscarriage.
Some women will miscarry quite quickly but for others the diagnosis and ongoing management may take several weeks.

If your ultrasound scan shows that you have miscarried and nothing remains in your womb, you may not need any further treatment.
If the miscarriage is confirmed but some or all of the pregnancy is still inside your womb, your doctor will talk to you about the best options for you. You may choose to use medicines or to have an operation.

This is successful in 90 to 95 out of 100 women and avoids a minor operative procedure.
Medication consists of Tab. Mifepristone which can be taken orally and Tab. Misoprostol which can be taken through oral and/or vaginal route. The medication helps the neck of the womb (cervix) to open and lets the remaining pregnancy come away. It will take a few hours and there will be some pain with bleeding or clotting (like a heavy period). You will be offered pain relief and anti-sickness medication. Some women may experience diarrhoea and vomiting.
After the treatment, you may bleed for up to 3 weeks. If the bleeding is heavy, you should contact your hospital.
You will be advised to do follow-up ultrasound after 2 – 3 weeks to make sure that uterine cavity ( womb ) is empty. If the treatment has not worked, you will be given the option of having a procedure.

A procedure may be carried out under general anaesthesia.
Procedure will usually take place within a few days of your miscarriage but you may be advised to have surgery immediately if:
- You are bleeding heavily and continuously
- There are signs of infection
- Medical treatment to remove the pregnancy has been unsuccessful.
The procedure is safe but there is a small risk of complications including heavy bleeding, infection. The risk of infection is the same if you choose medical or surgical treatment.

Emotional recovery

A miscarriage affects every woman differently and can be devastating for her partner too. Some women come to terms with what has happened within weeks; for others, it takes longer. Many women feel tearful and emotional for a short time afterwards. Some women experience intense grief over a longer time.

Returning to work

When you return to work depends on you and how you feel. It is advisable to rest for a few days before starting your routine activities but returning to work within a day or two will not cause you harm if you feel well enough. Most women will return to work in a week, but you may need longer to recover emotionally.

Having sex

You can have sex as soon as you both feel ready. It is important that you are feeling well and that any pain and bleeding has significantly reduced. ( usually after 2-3 weeks of surgical procedure ).

You can try for a baby as soon as you and your partner feel physically and emotionally ready. Usually after 3 months.

You are not at higher risk of another miscarriage if you have had one or two early miscarriages. Most miscarriages occur as a one-off event and there is a good chance of having a successful pregnancy in the future.
A very small number of women have a condition that makes them more likely to miscarry. If this is the case, medication may help.

Like anyone else planning to have a baby, you should:
- Take folic acid every day from when you start trying until 12 weeks of pregnancy to reduce the risk of your baby being born with a neural tube defect (spina bifida)
- Be as healthy as you can – eat a balanced diet and stop smoking
- Not drink alcohol as this may increase your chance of miscarriage