Miscarriage is common with one out of every five pregnancies ending in miscarriage.
Miscarriage can be a very sad and scary experience. For something so common it's often not
not talked about. That can leave many unanswered questions and misunderstandings about miscarriage.
I hope to answer some of these questions right now this video will discuss seven common questions
about miscarriages including why they happen and what treatments are available.
Let's start with one of the most commonly asked questions - why do they happen?
It's important to understand that miscarriage is not the fault of the person carrying the pregnancy and there's usually nothing
that could have been done to prevent it. The vast majority of miscarriages in the first trimester
unfortunately are inevitable. This is because for the majority of early pregnancy losses,
the embryos by random chance have abnormalities in their chromosomes. Now, chromosomes are the
structures that have DNA which provide a blueprint for the body.
Often abnormalities in this blueprint are not compatible with life and lead to the miscarriage.
There may be other reasons why a miscarriage happens including genetic factors or rare abnormalities in the uterus, but these
are very uncommon and we don't really consider those until someone's had multiple miscarriages.
Which leads to another common question - can a miscarriage happen again?
It is normal to have anxiety about miscarrying again. For people who have miscarried once the chances of having
another miscarriage are the same (about one in five). What this means is that for most cases the reason
for the miscarriage is uncertain. The chance of miscarriage does rise slightly after someone
has had two miscarriages and after the third the chance of having another one is more than one in three.
However this is very rare and estimated to happen in only one in a hundred people. This leads
us to our next question - when should someone seek additional testing about the causes of miscarriage?
As I mentioned, miscarriage is extremely common so additional testing such as genetic testing is not
usually done after a single miscarriage, although there are some reasons that additional testing
may be done, like a miscarriage later in pregnancy, additional testing is most often done after three
or more pregnancy losses. Many healthcare providers may consider some testing after two miscarriages
in a row. And you can talk to your provider about additional testing or if you've had
more than three total. The next question we'll talk about is what are some risk factors of miscarriage?
Although miscarriage is often not preventable there are some risk factors that increase a
person's chance of miscarrying. These include smoking, having a pregnancy less than three to
six months after a pregnancy, history of previous miscarriages, and diabetes. The rate of miscarriage
does also increase with age due to the increased risk of chromosomal abnormalities.
Now that we've answered questions about what miscarriages are, let's talk about the diagnosis and the
treatment for miscarriages. To best understand the diagnosis and treatment options it's important to
understand the different types of miscarriages or also called spontaneous abortion.
There are three types of miscarriages: threatened, incomplete or inevitable, and missed. Threatened miscarriage
is when there is bleeding in early pregnancy but the pregnancy is growing and progressing normally.
Incomplete or inevitable miscarriages are when there is bleeding and the cervix has dilated or
opened and the body has begun the miscarriage process. Missed abortions or embryonic demise
are when an embryo fails to develop in the first place or when a heartbeat is not detected but is expected.
What are the symptoms of a miscarriage and how is a miscarriage diagnosed?
The symptoms can vary depending on the type of miscarriage they range from minimal bleeding to a mild abdominal
cramping or heavier bleeding and pain that is sometimes described like labor or contractions.
It is sometimes the case that vaginal bleeding and cramping can occur but the pregnancy goes
on to develop normally. In many of the cases of threatened miscarriage where there is
bleeding but there is a detectable heartbeat on ultrasound, the pregnancy could continue normally.
This means that continued follow-up is necessary. Now given those differences in the type of
miscarriage an ultrasound and exam are necessary for diagnosis and your provider may also recommend
blood tests to check your blood type or check for anemia. The next question we will address is
How is miscarriage managed?
There are three approaches to treating miscarriage
the treatment that is used depends on the type of miscarriage, the amount of bleeding, and a person's preference.
The first option is called expectant management or watchful waiting.
In this option there is no immediate treatment instead you wait and let the miscarriage complete naturally.
This can take four to eight weeks and is unfortunately not always successful.
It is most effective for incomplete miscarriages but can be used for all types of miscarriages.
The second treatment option involves taking medications known as mifepristone and misoprostol.
These are most effective when used together, and for missed miscarriages or incomplete miscarriages
are more than 80 percent effective without any additional treatment.
This medication shortens the time to completion of the miscarriages to about two days.
The final option is an office procedure known as uterine aspiration.
It's also called a suction curettage or a D&C. This is the treatment of choice if there is heavy
bleeding, but it is a safe and effective option for any type of miscarriage. In a uterine aspiration
gentle suction is used to remove the pregnancy tissue from the uterus. After completion of your
miscarriage your period should return within four to six weeks light bleeding can be normal
for several weeks after your miscarriage. If you have concerns about your symptoms after
a miscarriage you should contact your health care provider.
The final question we will address is: after a miscarriage when can you try for pregnancy again?
Recommendations vary for when to try again but there is no minimum wait time to reduce the risk of it happening again.
There are however some studies that show that becoming pregnant less than seven months after miscarriage
may increase your chance of anxiety or depression during the pregnancy. What this essentially means
is that it's okay to try again when you feel ready to try again. Miscarriage can be a very difficult
experience. I hope this video was able to answer some questions you may have about miscarriage.
If you have any additional concerns or questions please reach out to your provider.