Miscarriage

Put simply, miscarriage is when the foetus does not develop normally in the early stages of the pregnancy. Miscarriage is one of the most common problems women experience in the early stages of a pregnancy.

By far the most common reason for early failure is a spontaneous genetic abnormality in the embryo. It can be seen as a natural event from the abnormal DNA to stop the continued development of the embryo. Rarely is there an underlying contributing factor in the mother or father. This is an important point for anyone experiencing this loss to remember.

Overall miscarriage occurs in 25% of known pregnancies and are more common with advancing maternal age. Most miscarriages will occur before you reach seven weeks. Some occur between 8 and 12 weeks gestation. In a few cases miscarriage can occur at 12-16 weeks. It is quite rare for a miscarriage to occur after 16 weeks gestation.

Your risk of miscarriage is approximately equal to how old you are. For example, women approx. thirty years old have a 30% risk, whilst those over 40 years of age have a 50% chance of miscarrying.

Not all bleeding or pelvic pain signals a miscarriage, and likewise, not all miscarriages have bleeding or pain prior to diagnosis. So the answer is, you may not know you are miscarrying. This is particularly the case if you are only 4 or 5 weeks pregnant or may not know you are pregnant and a miscarriage may be put down to a heavy period or unusually timed period.

If the pregnancy hasn’t yet reached six weeks gestation, then sequential blood tests of the level of pregnancy hormone BHCG might be useful to determine the likely viability of the pregnancy. After six weeks gestation an ultrasound is the most sensitive assessment of the current wellbeing of the pregnancy. A pregnancy that has failed to develop may be diagnosed on ultrasound.

If the pregnancy is very small on ultrasound assessment or the pregnancy hormone is very low, it is likely that the pregnancy will pass spontaneously in the next two weeks. This is associated with heavier vaginal bleeding than a regular period, but is usually not risky for the woman.

Bleeding may get as heavy as soaking a pad per hour for a short time, and a few blood clots may be passed with associated pain. If it gets significantly heavier then medical assistance may be required.

If the bleeding is not too heavy and before the pregnancy is 12 weeks gestation, please contact your obstetrician or gynaecologist but you can stay at home and rest to see if the bleeding subsides.

If the bleeding continues or gets heavier or your lower abdominal pain worsens please contact your obstetrician as soon as possible and go to hospital.

If a pregnancy is more than 6-8 weeks a curette (or cleaning) of the uterus under full anaesthetic may be required. This is a very common and relatively simple procedure that requires day surgery. The details of the procedure will be explained to you prior. Following the procedure, pain and bleeding will be minimal for a few days.

Your period should return in approximately the same time as your natural cycle Cie. Usually four weeks.)

Many couples will find miscarriage a shock, and may take some time to cope with this finding. Feelings may extend beyond this, and if troubling you could benefit from extra help that is available. You are not alone and there are many people and organisations that exist to support you through this difficult time.

Yes, you may try again for another pregnancy after your first normal period has passed.

Some couples may have an underlying concern that they may not be able to have a successful pregnancy. The chance of a couple having something wrong that will contribute to a higher chance of recurrent miscarriage is low. Typically, we would investigate extensively for this following three consecutive miscarriages.

In order to minimise chances of recurrent loss, decrease caffeine, decrease alcohol, don’t smoke.

No. Morning sickness is no indicator of miscarriage or recurrent miscarriage. In fact, there are many symptoms of early pregnancy that may seem scary, but aren’t necessarily an indicator of miscarriage. 

It is perfectly normal to read a lot into the uncomfortable physical signs of early pregnancy. 

However, symptoms of pregnancy, like morning sickness or vaginal bleeding, are not always signs of an impending miscarriage. For instance, vaginal bleeding can occur in up to 50% of normal healthy pregnancies.

If you are at all concerned, please contact us in our rooms or if out of office hours contact Dr Skinner on his paging service.

Repeated miscarriages are emotionally and physically draining. It’s important to know that it is rare that a recurrent pregnancy loss is due to underlying problems in the mother or father.

If you repeatedly miscarry, there are a number of tests which can be performed. Dr. Guy can talk you through each one, the likelihood of it being the cause for you, and what other factors there might be at play.

These tests involve a series of blood tests looking for a number of immune based problems. 

As a doctor who has been working as an obstetrician for many years and has seen a number of pre-pregnant and pregnant women, there are a few things you can try if recurrent miscarriages have been an issue for you. 

Aspirin, progesterone, enoxaparin injections and prednisolone can all be used under the supervision of a doctor to try to aid in your pregnancy journey.

A very uncommon condition of Robertsonian DNA translocation can be a cause of a recurrent miscarriage. This problem is identified as one of the parents having their cells DNA pieces mismatched across their large DNA chains. 

When their respective eggs or sperm are created, the DNA amount on individual chains is more likely to be in excess or depleted. This can doom the embryo to early failure. 

Fortunately, new DNA analysis techniques available in IVF embryo creation can selectively find the embryos with the correct DNA profiles. Therefore reducing the miscarriage risk.