What Is A Miscarriage
A miscarriage is the loss of a zygote or embryo before reaching the 20th week or fifth month of a pregnancy. The medical term for a miscarriage is spontaneous abortion. However, a naturally occurring spontaneous abortion is an entirely different process to the intentional surgical removal of a foetus that requires a surgeon to perform an operation.
Miscarriages can be a heartbreaking experience for both parents, and they are an unfortunate part of life for every species that reproduces. Humans are no exception to Mother Nature’s whims and decrees. It would not be possible for the planet to support every single pregnancy that was ever conceived.
As many as 50% of all pregnancies will end in a miscarriage. That sounds like an alarming statistic, but the reality is that number takes into account the pregnancies that occur before a woman misses a menstrual period, or even suspects they are pregnant. In Fact, they never know that they were, for a brief moment in time, pregnant before the miscarriage took place. Most people think of a miscarriage as being a fully formed baby in the womb, not the very beginning stages of dividing cells.
Some women will never suspect for a moment that an egg was fertilised and they were technically briefly pregnant before the miscarriage naturally occurred to prevent the zygote implanting to become an embryo and then developing into a foetus and finally a baby ready to be delivered.
Between 15%-25% of recognised pregnancies, those that returned a positive HCG test will end in a miscarriage.
What Chemical Is Used To Test For Pregnancy
A pregnancy test can tell whether you are pregnant by checking for a particular hormone in your urine or blood. The hormone is called human chorionic gonadotropin (HCG). HCG is made in a woman’s placenta after a fertilised egg implants in the uterus. It is normally made only during pregnancy, and is why you can’t get a ‘false pregnancy result’ saying you are pregnant when you are not.
If you test too early for a pregnancy, before the chemical has had enough time to build up and become detectable, you may show that you are “Not Pregnant” when you technically are. It simply means you tested too early to detect the HCG hormone confirming the pregnancy.
Low levels of HCG may be detected in your blood around 3 to 5 days after conception. As technology progresses, so do the pregnancy test kits’ ability to detect the HCG hormone in smaller quantities, meaning that earlier detection can be confirmed from as little as three days after conception in some cases but not all.
Pregnancy test kits come with two indicator sticks for that reason. If you test around day five (5) and get a negative reading, then use the second test around day ten (10). If both results are negative, you are unlikely to be pregnant. If the second test is positive, you are, without a doubt, pregnant.
If the first test was positive but the second test was negative, you might have had a chemical pregnancy and already miscarried the zygote without knowing.
More than 80% of miscarriages happen within the first three months of pregnancy. Miscarriages are less likely to happen after 20 weeks. When they do, doctors call them late-term miscarriages. Genetic flaws prevent and arrest the correct foetal development, and the body naturally terminates the unviable foetus.
What Is A False Positive Pregnancy Result
It is possible to have a positive pregnancy test even if you aren’t physically pregnant with an implanted zygote in the womb. This is called a false positive.
False positives are caused by a chemical pregnancy, as explained above. A chemical pregnancy occurs when a fertilised egg, known as the zygote, cannot implant or grow very early on. This can happen for many reasons, and the microscopic zygote will exit the womb as normal daily vaginal discharge. Most women will not even notice this has happened. The rare few who do may notice a white sticky ball similar to a tiny opaque tapioca pearl with a jelly-like consistency.
What Is A Phantom Pregnancy
A phantom pregnancy happens when a woman believes she is pregnant and has pregnancy symptoms but is not physically pregnant. The condition is referred to as a false pregnancy or pseudocyesis. Causes are believed to be deep psychological longing manifesting in a physical form in such a way as to convince the woman she is pregnant by giving her symptoms that mimic early gestation pregnancies, like morning sickness and phantom baby movements. Phantom pregnancies are rare, but in the cases that do present, often after the woman has tragically lost a previous pregnancy to miscarriage.
What Are The Symptoms Of A Miscarriage
- Belly pain
- Severe cramps
- Bleeding that goes from light to heavy
- Worsening or severe back pain
- Fever with any of these symptoms
- White-pink mucus
- Tissue that looks like blood clots passing from your vagina
Contact your doctor immediately if you experience or display any of these symptoms and believe you are pregnant. They will tell you whether to come to the office or go to the emergency room for the appropriate treatment and aftercare.
Miscarriage Risk Factors And Causes
Most miscarriages happen in the first three months (12 weeks), also referred to as the first trimester. When the dividing and developing cells have a fatal genetic coding issue, Mother Nature hits the eject button, and a miscarriage takes place. While emotionally challenging and heartbreaking for the parent/s, the viability of the embryo was compromised, meaning it could never have grown into a healthy full-term baby. All mammal species experience miscarriages and stillbirths, that includes dolphins and apes.
Other increased risk of miscarriage factors include:
- Domestic violence or physical assault
- Immune system responses
- Medical conditions in the mother, such as diabetes or thyroid disease
- Uterine abnormalities
- Hormone problems
- Physical problems in the mother
- Drinking alcohol
- Using street drugs
- Exposure to radiation or toxic substances
Higher risk categories for A miscarriage
- Conception over age 35
- Have certain diseases, such as diabetes or thyroid problems
- The woman has had three or more miscarriages
- Cervical insufficiency.
A miscarriage can occur when the mother has a weak cervix. Doctors call this a cervical insufficiency. It means the cervix can’t hold the pregnancy contained within the womb. This type of miscarriage usually happens in the second trimester when the foetus is larger and moves around the womb.
There are typically few symptoms before a miscarriage caused by cervical insufficiency. You may feel sudden pressure, your water might break, and tissue from the baby and placenta could leave your body without much pain.
Doctors usually treat an insufficient cervix with a circling stitch in the next pregnancy, usually around 12 weeks. The stitch holds your cervix closed until the doctor removes it around the time of delivery.
If your OBGYN finds that you have cervical insufficiency, they might add the stitch to prevent a miscarriage from occurring pre-emptively.
A threatened miscarriage occurs when you are bleeding, but there is no immediate threat of a miscarriage because your cervix hasn’t dilated. Your pregnancy will likely continue without any problems with strict bed rest.
You are bleeding and cramping. You will be experiencing contractions. Your cervix is dilated. A miscarriage is taking place and cannot be prevented with medication.
Some tissue from the baby or the placenta leaves your body, but some stays in your uterus.
All the pregnancy tissues leave your body. This type of miscarriage usually happens before the 12th week of pregnancy.
The embryo dies or was never formed, but the tissues stay in your uterus. See the above link for incomplete miscarriage for more information on treatment and procedures.
You lose three or more pregnancies in a row during the first trimester. This type of miscarriage only affects about 1% of couples trying to have a baby.
How To Diagnose A Miscarriage
Your doctor will conduct the following:
- A pelvic exam. They will examine you to see if your cervix has started to dilate.
- An ultrasound test. This test uses sound waves to check for a baby’s heartbeat. If the results aren’t clear, you may go back for a repeat test a week later.
- Blood tests. The doctor uses them to look for pregnancy hormones in your blood and compare them to past levels.
- They may also test your iron levels for anaemia if you have been bleeding heavily.
- Tissue tests. If tissue leaves your body, the doctor may send it to a lab to confirm that you had a miscarriage. It can also help make sure there wasn’t another cause for your symptoms.
- Chromosome tests. If you have had two or more miscarriages, the doctor might order some genetic tests to see if you or your partner’s genes have a genetic flaw that prevents a healthy embryo developing to full-term gestation.
- Pelvic ultrasound
- Hysterosalpingogram, An X-ray of the uterus and fallopian tubes
- Hysteroscopy. The doctor uses a thin, telescope-like device inserted through your vagina and cervix to look inside your uterus.
You probably won’t need further treatment if the miscarriage is complete and your uterus is empty.
However, you have no way of knowing that and will require a physical pelvic examination to ensure there are no remaining tissues that could cause an infection.
Sometimes not all the tissue detaches. If that happens, your doctor might do a dilation and curettage (D&C) procedure. They’ll dilate your cervix and gently remove any remaining tissue.
Another option, suitable in some cases but not all, is medications that cause any tissue left in the uterus to be expelled from the body.
If the miscarriage occurs later in the pregnancy and the foetus died in the womb, the doctor will induce labour and delivery using medication to force the birth of the stillborn foetus in the same way a natural delivery would have occurred.
When the bleeding stops, you should be able to return to your normal activities.
If your blood type is Rh negative, the doctor may give you a blood product called Rh immune globulin (Rhogam). This prevents you from developing antibodies that could harm your baby or any future pregnancies.
You may get blood tests, genetic tests, or medication if you have a history of two or more miscarriages. If you’ve had two miscarriages in a row, use a form of birth control and talk to your doctor about tests to find the cause.
Symptoms Following A Miscarriage
Bleeding and mild discomfort are common symptoms after a miscarriage. Contact your doctor immediately if you have heavy bleeding with fever, chills, or pain. These may be signs of an infection.
Besides the physical effects, you may also feel a range of emotions, from sadness and guilt to grief and worry about future pregnancies. What you are feeling is normal. Let yourself and your partner grieve for your loss.
If you’re up to it, talk to people in your life who are supportive, like your partner, a friend, or a family member. You can also talk to a professional mental health counsellor. Pregnancy loss support groups may also be valuable to you and your partner. Ask your doctor for more information about these resources.
Remind yourself that everyone heals at a different pace and in different ways. Some people may choose not to talk about the situation, keep it repressed, and move on with life. Do not try to force them to confront their grief and talk about it. They will process and heal in their own time and their own personal way. Men who lose a child through miscarriage are often forgotten about or overlooked as they internalise their grief and pain.
The difference between the sexes in how they process their emotions can lead to heated arguments and communication problems that result in break-ups and divorces. Losing any pregnancy at any stage, especially a late-term miscarriage, takes time to heal from for all concerned.
Pregnancy Following A Miscarriage
You can fall pregnant after a miscarriage. Approximately 85% of women who have one miscarriage go on to have normal pregnancies and births.
Having a miscarriage does not mean you have a fertility problem. Sometimes forces beyond human control are at play, and the conception was deemed to be the wrong time and place in your destiny.
Studies show two per cent of women who have one miscarriage may go on to have repeated miscarriages (three or more). Researchers believe this is related to a rare hyper-autoimmune response in which the body treats the pregnancy as an invading parasite, and like any parasite that invades the body, it is killed off and disposed of by the immune system.
The same can be said for the rare women who cannot conceive due to the acidity levels being too high in the vagina to support sperm, instead killing it off quickly before it has time to travel to the egg in the fallopian tube for fertilisation to take place.
If you have two miscarriages in a row, you should stop trying to conceive, use a form of birth control, and ask your doctor to do tests to figure out what’s causing the miscarriages.
Conceiving After A Miscarriage
Discuss the timing of your next pregnancy with your doctor. Some experts say you should wait a certain amount of time (from one menstrual cycle to 3 months) before you try again. While this is not a widespread practice, to prevent another miscarriage, the doctor may suggest treatment with progesterone. This hormone helps the embryo implant and supports early pregnancy in your uterus.
Taking time to heal both physically and emotionally after a miscarriage is important. Above all, don’t blame yourself. Counselling is available to help you handle your loss.
Can You Prevent A Miscarriage
Most miscarriages happen as the direct result of physical trauma or because there is a problem with the pregnancy in the first trimester. You cannot prevent them from occurring. Treatment options may be available if your doctor conducts testing and finds a problem in third term miscarriages. However, the general rule of thumb is that Miscarriages cannot be prevented.
If you have an illness, treating it can improve your chances for a successful pregnancy. One step you can take is to get as healthy as possible before trying to have a baby. Studies show that women who are in a healthy BMI range of 20-23 are the most likely to have successful, full-term pregnancies.
Women who are underweight generally have issues with their menstrual cycle that prevent or add risk to any conception. Women who are overweight also have an increased risk for miscarriage and gestational diabetes if type 2 diabetes is not already a risk factor in play. Ideally, you would:
- Maintain a healthy weight.
- Get regular exercise.
- Eat a healthy, well-balanced diet.
- Don’t smoke, drink alcohol, or take illegal drugs.
- Discuss any prescribed medication and side effects with your doctor, as some medications are not recommended for women who are pregnant or who seek to conceive.
- Cut back on caffeine.
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