A new film about Marilyn Monroe suggests that she suffered her first miscarriage because of
a fall. Can this really happen? The answer is a little nuanced. Stay tuned and I will explain.
A miscarriage is the loss of a pregnancy that has been growing in the uterus at
some point during the first 20 weeks. A pregnancy is commonly divided into three
parts called trimesters. The first trimester lasts until about the 13th week of pregnancy.
The second trimester lasts until about the 26th week of pregnancy. Somewhere around 92
to 99% of all miscarriages occur in the 1st trimester. At that point the growing
pregnant uterus is still very small and is surrounded by the bones of the pelvis. If a
pregnant person falls and hits her abdomen, it would not touch the uterus. Therefore,
falls that occur in the first trimester are very unlikely to be a cause for miscarriage.
Some people might mistakenly think that a fall caused a miscarriage however. Why? Many people
don't realize they are pregnant before the 6th week of pregnancy. Many miscarriages at this
time go unrecognized. Over the next few weeks, a lot of miscarriages are happening. In fact,
about half of all remaining miscarriages occur between week 6 and week 8. If they
happen to have a fall during that time and then later have a miscarriage, they might attribute
the miscarriage to the fall even though they might have gone on to have a miscarriage without a fall.
In the second trimester, the uterus starts to emerge from the pelvis and can be felt
by pressing on the abdomen. At 20 weeks, the pregnant uterus has reached the belly button.
A fall during this time, might cause a direct impact on the uterus which might increase the
risk for a miscarriage. It would have to be a pretty hard fall however. The further along
in the pregnancy a person is, the greater the chance for causing some trauma to the uterus.
If a pregnancy is lost after the 20th week, we no longer call it a miscarriage. A fetus that
exits the uterus at that time is called a premature delivery. Most of the time,
a fetus that is delivered between 20 and 24 weeks will not survive.The longer the
time after 24 weeks that the fetus is delivered, the greater the chance for survival. But again,
deliveries at this time are not referred to as miscarriages.
A fetus that has died while still in the uterus after the 20th week of pregnancy
is called an intrauterine fetal demise or IUFD. Although rare, it is possible for a
fall after 20 weeks to cause a fetal demise. One of the main causes for an IUFD after a fall is
called a placental abruption. This is when the placenta separates from the wall of the uterus.
The larger the area of the placenta that has separated from the uterus, the less is left to
support the fetus and the greater the chance that the fetus will not survive. A fall can
do this but it is much more likely after severe trauma such as a car accident or domestic abuse.
So what about that Marilyn Monroe movie? They don't say specifically how far along in the
pregnancy she was. Could she be somewhere early in the 2nd trimester between 13 and
20 weeks? Perhaps. She is walking when she trips and falls and she lands in the soft
sand. I wouldn’t have thought that her uterus would have sustained much trauma from this but
it is not impossible. The large amount of bleeding suggests a large abruption which would be unusual
from a soft fall like this. Uterine trauma that is sufficient to cause this would also
have caused a lot of abdominal pain. She does not have any pain initially. As a miscarriage expert,
I would say that the medical accuracy of this scene from the movie is poor.