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Miscarriage

miscarriage


Miscarriage is the loss of a pregnancy at any time up to the 24th week. A loss after this time is called a stillbirth. Most of the miscarriages occur before 13 weeks of pregnancy. The vast majority of women who miscarry go on to have a successful pregnancy next time. Recurrent miscarriages (three or more miscarriages in a row), occur in about 1 in 100 women.

What causes miscarriage?

It is thought that most early miscarriages are caused by a one-off chromosomal fault. This is usually an isolated genetic mistake, and rarely occurs again. Such genetic mistakes become more common when the mother is older - that is, over 35 years old.

There are other less common causes of miscarriage. These include: hormonal imbalance, abnormalities of the womb, weakness of the cervix and certain infections like listeria and rubella (German measles). Alcohol abuse, cigarette smoking, illicit drug use and obesity may also increase the risk of miscarriage.
Investigations into the cause of a miscarriage are not usually carried out unless you have three or more miscarriages in a row. This is because most women who miscarry will not miscarry again.

Some myths about the cause of miscarriage

  1. Miscarriage is not caused by lifting, straining, working, constipation, straining at the toilet, stress, worry, sex, eating spicy foods, or normal exercise.
  2. There is also no guarantee that waiting for a certain length of time after a miscarriage improves your chances of having a healthy pregnancy next time.

What is a threatened miscarriage?

It is common to have some light vaginal bleeding sometime in the first 12 weeks of pregnancy. This does not always mean that you are going to miscarry. Often the bleeding settles and the growing baby is healthy. This is called a threatened miscarriage.

What are the symptoms of miscarriage?

The usual symptoms of miscarriage are vaginal bleeding and lower abdominal cramps. You may then pass some tissue from the vagina, which often looks like a blood clot. In many cases, the bleeding then gradually settles. The time it takes for the bleeding to settle varies. It is usually a few days, but can last two weeks or more. For most women, the bleeding is heavy with clots, but not severe - it is more like a heavy period. However, the bleeding can be severe in some cases.

In some cases of miscarriage, there are no symptoms. You may have no pain or bleeding. This type of miscarriage may not be found until you have a routine ultrasound scan. This may be referred to by doctors as a missed miscarriage.

Do I need to go to hospital?

You should always report any bleeding in pregnancy to your doctor. It is important to get the correct diagnosis, as miscarriage is not the only cause of vaginal bleeding.  It is usual to have an ultrasound scan. This helps to determine whether the bleeding is due to:

  1. A threatened miscarriage (a heartbeat will be seen inside the womb).
  2. A miscarriage (no heartbeat is seen).
  3. Some other cause of bleeding (such as an ectopic pregnancy - no pregnancy inside the womb).

Do I need any treatment?

For many years it was common to do a small operation to clear the womb following a miscarriage or partial (incomplete) miscarriage. This is called a D&C. The logic was that this would make sure all pregnancy tissue was gone and prevent infection or prolonged bleeding. However, recent evidence shows that an operation is not needed in most cases.
In some cases you may be offered medical treatment for your miscarriage. That is, you may be offered medication to take either by mouth or to insert into the vagina. The medication helps to clear the womb and can have the same effect as an operation. You do not usually need to be admitted to hospital for this. You may continue to bleed for up to three weeks when medical treatment is used.


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