hi everyone we are the doctors bjorkman an ob gyn
and pediatrician couple going week by week through pregnancy with all of you
our goal for the next 30 plus weeks is to bring you high quality
medical information about all things pregnancy
while sharing with you what it's like for us as physicians to be
coming parents for the first time so for us this is week five of pregnancy and
while we are thrilled about finally getting pregnant we felt
this week it was really important to discuss something
that can be heartbreaking and an all-too-common
occurrence in pregnancy and that is miscarriage yeah so october is
pregnancy and infant loss awareness month and this was
recently devastatingly highlighted by chrissy teigen and john lyogen's
loss of their own pregnancy so them sharing their story was incredibly
powerful and so with that we thought it was also
important for us to take this opportunity to shed a little bit more
light on miscarriage and pregnancy loss
so with that in mind know that the rest of this episode is
all about miscarriage and pregnancy loss and that can be triggering or upsetting
for some viewers so when you are ready for that
information whether now or in the future come back
because after this we are going to talk about what
miscarriage is what to expect and other common questions women and couples
have about experiencing a miscarriage
so this is going to be a heavy episode but we
feel that it is so important to cover miscarriage and pregnancy loss this week
so before we dive into the science and the medicine we just want you to know
that if you are someone who has suffered a pregnancy loss
you have our hearts you are not alone and you are loved
i know that i have been with women and held the hands of women
as they went through a pregnancy loss and
the grief is unimaginable and the sorrow and despair is just
palpable and there's nothing you can do besides
be there and it's really hard so our hope with
this episode is to answer any questions you might
have about miscarriage to bring awareness to this really
heartbreaking event and also to give you the information to
understand what miscarriage and pregnancy loss actually is
and so that you can be able to get the support you need if you are someone
going through a miscarriage also hopefully along the way we're able
to give you a little reassurance that the odds are in the favor
of having a healthy and normal pregnancy a miscarriage is
any pregnancy loss that occurs prior to 20 weeks gestation
any loss that happens after that we describe
as a stillbirth a fetal death or preterm labor
miscarriage occurs in up to one in four pregnancies
in the case of pregnancy loss prior to 20 weeks or what's called a miscarriage
there's a couple terms that your doctor may use to describe them
the first is spontaneous abortion now this term may be confusing because of
the term abortion but it simply means pregnancy
loss not an elective termination so an sab is simply the spontaneous loss
of pregnancy these may be accompanied by bleeding
cramping and passage of tissue missed abortion mav or missed
miscarriage this is a pregnancy that seems to be
going along just fine but then at the time of ultrasound
it is noted that the baby has stopped growing and no longer has a heartbeat
a blighted ovum or an embryonic gestation
this is by test positive pregnancy but at time of ultrasound all that
is seen is an empty sac without a developing baby
there are also ectopic pregnancies which are a pregnancy that fails to implant in
the uterus they can end up in the cervix in the
fallopian tube or even out in the abdomen
without the support of the uterus these pregnancies are non-viable
and may require medication or a surgical procedure to help remove them
a biochemical pregnancy or chemical pregnancy
these are pregnancies that develop enough to start to secrete that hormone
we talked about back in week three hcg however they fail to continue to grow at
that time and then pass with what may seem like a heavy period
these happen so early that you may not even know you were pregnant before they
pass late miscarriage is a pregnancy loss
between 13 and 20 weeks gestation remember if it happens after that 20
week mark it's termed a stillbirth or fetal demise
so something i know you're wondering as i thought about it myself
is what is your risk of miscarriage and we know that two of the big factors
are maternal age and how far along you are in your pregnancy when it comes to
maternal age the risk of pregnancy loss is almost the
same for all women less than 35 years of age
being about somewhere between 10 and 15 percent or one in eight pregnancies
however that risk doubles for women aged 35 to 40
to one in four pregnancies and then doubles again for women age
40 to 45 happening in one of two pregnancies
the biggest issue at play here is the increased risk of chromosomal
abnormalities that occurs more frequently as the
oocytes or eggs age as chromosomal abnormalities account
for about 50 of early pregnancy loss the other
factor that is predictive is the gestational age of your pregnancy
and we can break it down for you week by week what your risk is
the reassuring thing is after a fetal heartbeat is seen on
ultrasound just generally your risk of a miscarriage
drops to about four percent once you hit the eight week mark and have seen that
fetal heartbeat on ultrasound your risk drops to 1.6
and for women by the time you get to 14 weeks of pregnancy
your risk of a miscarriage is less than one percent
we want to show you this graph to highlight two big things
the first is to again show that the risk of pregnancy loss significantly
decreases after the end of the first trimester
the other is as is unfortunately true in many areas of medicine
the outcomes for black women are significantly worse than that of white
women there are many things that play in this
study but again highlights our need to continually work towards improving
disparities in medicine so it's kind of a weird time of
pregnancy right five weeks pregnant and i've known i'm pregnant for a couple
weeks and i kind of want to tell people and i kind of don't
and i think that stems from this fear of miscarriage you know it's really common
one in four pregnancies and so i think there are two camps in terms of
deciding if you want to share and when you want to
share and the first is those who say i'm comfortable sharing because i would
be comfortable sharing my miscarriage and there's the group of people who want
to keep their early pregnancy private when the risk of miscarriage is highest
because they would want to deal with that grief and processing of the
miscarriage quietly and on their own between you
know them and their partner i think ultimately i ended up sharing
early because i knew that i would want the support of family and friends
because i have just seen how deep and profound
that grief and loss and despair can be and knew i would want my tribe
to help me get through that but you kind of just have to figure out what
your heart would want and what is right for you
and whatever that is is right another question that many women have is
what to expect with an actual miscarriage it's
interesting that with miscarriage being so
common so few women and couples know what to expect
the answer for why this is probably has to do with a lot of how bad we as a
society are about talking about pregnancy loss
and so with that we want to fight back against that a little bit more tonight
by sharing some information with you about what to expect with
pregnancy loss so as we said most miscarriages occur
before eight weeks and with those early first trimester
losses it usually starts with bleeding which
can become heavy bleeding um cramping that can be very very in
surprisingly intense as well as some passing of tissue i know
sometimes women are worried like oh my gosh am i going to see
a baby but that's very rare for that to happen
and that risk is really only there later late in the first trimester or second
trimester reasons to call your ob gyn if you think
you are having miscarriage are your bleeding is so heavy that you are
soaking a pad front to back side to side a big heavy
maxi pad for more than two hours if that bleeding
is making you dizzy or lightheaded if the pain is so
intense that you just aren't able to cope at home with
over-the-counter medication or if you have a fever above 100.4
call your ob and there are other times when medical intervention or a procedure
may be necessary this can happen with ectopic
pregnancies missed abortions or even in spontaneous
abortions that don't complete on their own
and so with this please please reach out to your ob provider if you feel you're
having signs and symptoms of miscarriage it's week five we've only known we've
been pregnant for two weeks and already are dreaming about the life this
baby is going to live gosh and really already love this baby
already which i don't know maybe it's a little
different for some of you but for me just feels so tangible and real
and as we've been doing this episode i've been thinking about just how
devastating loss at this stage would be or at any
stage in predicting and so i guess as one human to another um if
that's something you're going through gosh my heart hurts for you
um and you have our support and know that you are not in this alone
also if you're looking for information in addition to this episode
our good friend dr laura shaheen who's an infertility doctor
wrote a great book called not broken it is
easy to read evidence-based we'll have a link for you guys in the description
below if you're looking for something more
so for the rest of this episode we want to go through some questions that i get
asked kind of frequently as an ob gyn about miscarriage
so the first question is if someone has one miscarriage
are they at an increased risk to have another so
the chances that a woman has two consecutive miscarriages
is less than two percent and the chances that a woman has
three miscarriages in a row is less than one percent
after miscarriage how soon could someone try to have a baby again
so we used to kind of tell patients you know maybe they should wait a few cycles
but there's absolutely no data to support that as soon as you
get your period again you are fine to start trying
in the next cycle if you feel emotionally ready you may be physically
ready but you also want to make sure that your heart is ready for that too
if someone has a pregnancy loss do they need to get any certain testing
so after one miscarriage we generally don't start a work up we kind of say
it's just a chance thing and bad luck however
after the second miscarriage we start talking about
running some blood tests to see if there is some underlying problem
the thing is we usually don't find an underlying problem but we talk about
kind of the pros and cons of doing that testing
after two okay is there anything someone can do to
decrease their risk of having a miscarriage
this is a really important thing and i'll say it
six times miscarriage is not your fault there is nothing
you can do to prevent it or stop it you did not work out too hard you did not
eat something wrong your dog didn't jump on your belly
and cause your miscarriage it's some bad luck most
of the time and it is not your fault so
that's going to be it for us tonight if there's any questions
you have that we didn't get to please feel free to let us know
if you've made it through this far in this episode maybe there's a good chance
that this is something that you're going through yourself
please know that we are there for you with you you have our support
and know that this is okay to talk with people about feel like you don't have
anyone talk to your ob provider send us a message please know that you
do not need to be alone for this we will see you next week bye guys
we're doctors but not your doctors anything we've said in this video is for
education or entertainment purposes only it is not medical advice any specific
medical questions you have should be directed to your provider