- Pregnancy at 1-3 Weeks
- Pregnancy at 4 Weeks
- Pregnancy at 5 Weeks
- Pregnancy at 6 Weeks
- Pregnancy at 7 Weeks
- Pregnancy at 8 Weeks
- Pregnancy at 9 Weeks
- Pregnancy at 10 Weeks
- Pregnancy at 11 Weeks
- Pregnancy at 12 Weeks
- Pregnancy at 13 Weeks
- Pregnancy at 14 Weeks
- Pregnancy at 15 Weeks
- Pregnancy at 16 Weeks
- Pregnancy at 17 Weeks
- Pregnancy at 18 Weeks
- Pregnancy at 19 Weeks
- Pregnancy at 20 Weeks
- Pregnancy at 21 Weeks
- Pregnancy at 22 Weeks
- Pregnancy at 23 Weeks
- Pregnancy at 24 Weeks
- Pregnancy at 25 Weeks
- Pregnancy at 26 Weeks
- Pregnancy at 27 Weeks
- Pregnancy at 28 Weeks
- Pregnancy at 29 Weeks
- Pregnancy at 30 Weeks
- Pregnancy at 31 Weeks
- Pregnancy at 32 Weeks
- Pregnancy at 33 Weeks
- Pregnancy at 34 Weeks
- Pregnancy at 35 Weeks
- Pregnancy at 36 Weeks
- Pregnancy at 37 Weeks
- Pregnancy at 38 Weeks
- Pregnancy at 39 Weeks
- Pregnancy at 40 Weeks
Understanding Miscarriage
The term 'miscarriage' refers to a pregnancy that is lost before 24 weeks of gestation. Miscarriage occurs after approximately 50 per cent of conceptions. In many cases it is not recognized because it happens very early on, within a fortnight of conception, and is interpreted as a late period. Miscarriage is clinically diagnosed in only 15 per cent or so of pregnancies.
Types of miscarriage
There are several types of miscarriage, and these are classified according to the manner in which they occur. Threatened miscarriage In this situation, bleeding occurs at some point during the first few months of pregnancy but there is minimal pain, the cervix remains closed and an ultrasound scan confirms a viable pregnancy.
In more than 90 percent of cases the pregnancy will continue normally and a repeat scan to check the fetal heart will provide reassurance for the mother.
Inevitable miscarriage This involves a considerable amount of bleeding and the cervix will be open. There are two types:
- Complete miscarriage in which the products of conception are completely expelled.
- Incomplete miscarriage in which some of the products of conception are retained. In rare cases, they will become infected (septic) and the infection may spread, causing peritonitis and septicaemia.
- Delayed (missed) miscarriage is commonly diagnosed when an early pregnancy scan identifies a fetus but no fetal heart is seen on the monitor. In this case there are often very few symptoms to indicate that the baby has died.
Causes
Over 50 percent of miscarriages in early pregnancy are a result of the baby having abnormal chromosomes. Less common are maternal factors, such as:
- Infection, for example, listeriosis, cytomegalovirus or rubella
- An underlying medical disorder, for example, thyroid disease or systemic lupus erythematosus
- Smoking
- Alcohol
- Late age of the mother
Treatment
In some cases, miscarriage can be allowed to progress on its own with no further intervention. If treatment is required or requested, this can be either by the use of drugs to encourage the uterus to expel the products of conception or by an operation (called an evacuation of retained products of conception, or ERPOC).
Treatment
In some cases, miscarriage can be allowed to progress on its own with no further intervention. If treatment is required or requested, this can be either by the use of drugs to encourage the uterus to expel the products of conception or by an operation (called an evacuation of retained products of conception, or ERPOC).
Recurrent miscarriage
This term is used when three or more consecutive miscarriages occur. This happens in 1 per cent of women and will need further investigation to try to identify the underlying cause.
Causes
Possible causes of recurrent miscarriage include:
- Genetic abnormality in either parent
- Abnormality of the uterus (for example, bicomuate uterus)
- Chronic illness, for example, thyroid disease or diabetes (see page 80)
- Polycystic ovary syndrome (see box, right)
- Raised levels of testosterone or luteinizing hormone (LH)
- Cervical incompetence (see above)
- Antiphospholid syndrome. This is a very rare disorder in which antibodies from the mother are directed at the placenta, causing blood clotting and other damage.
Prevention
Up to 80 per cent of women who have had recurrent miscarriage will go on to have a successful pregnancy with just supportive treatment, such as an early scan followed by serial scans for reassurance. Often no specific therapy is necessary. In the rare case of antiphospholid syndrome (see above), evidence shows that taking aspirin and heparin early in pregnancy can improve the outcome of the pregnancy.
Trying again
There are no strict rules about when to try for another baby after a miscarriage. Many women are advised to wait for a few months, mainly so that their cycle can return to normal and to make it easier to know how pregnant they are when they manage to conceive.
Support groups
After the sadness of a miscarriage, women need both emotional and physical care. The hospital or doctor can give advice on counselling, and support groups.
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Polycystic ovary syndrome PCOS is common (affecting 1 in 10 women at some stage) and is characterized by multiple small cysts within the ovary (seen on ultrasound scans) and features such as period problems, reduced fertility, excessive hair growth and acne. Many women with PCOS are also overweight.
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