Miscarriage: What You Need To Know

First – what’s the definition of a miscarriage?
“A miscarriage is defined as a spontaneous loss of pregnancy before 24 weeks. When the pregnancy is unsuccessful after 24 weeks, this is described as a stillbirth. At 24 weeks, the foetus is described as viable, meaning it’s more likely than not that the baby will survive outside of the womb. There are, of course, many babies who have survived at 23 weeks but only with intensive support for several months. The term miscarriage implies there is a ‘correct’ way to carry a pregnancy, but in the vast majority of cases, miscarriage cannot be helped or avoided.” – Dr Penelope Law, consultant obstetrician and gynaecologist at The Portland Hospital

Are there different types of miscarriage?
“Miscarriage is an umbrella term – it’s classified based on factors such as whether there was evidence of a pregnancy on an ultrasound scan, when the pregnancy loss occurs, whether the losses are repeated or one-off events and whether there are symptoms associated with the loss or not. These classifications help us to understand not just the type of pregnancy loss but also the possible reasons for the loss…

Chemical pregnancy loss: This type of loss is categorised as such when a miscarriage occurs after a positive pregnancy test (either urine or blood test-based) but before a pregnancy sac can be seen in the womb on the ultrasound scan, which is usually prior to five weeks of pregnancy.

Early miscarriage: This is based on the gestational age of the pregnancy. An early pregnancy loss is when a pregnancy is lost prior to 12-14 weeks.

Late miscarriage: A loss is categorised as late when the loss occurs between 14-24 weeks.

Recurrent miscarriages: If you experience three or more repeated losses prior to 24 weeks of pregnancy, these are referred to as recurrent miscarriages. 

Missed miscarriage: Sometimes, women don’t have any symptoms, and a miscarriage is incidentally diagnosed at either the first scan or at times there is a silent miscarriage between two scans.

Complete miscarriage: When all the pregnancy tissues come away from the womb completely and the cavity of the womb is empty, this is classed as a complete miscarriage. In such pregnancies, there is no need for medical intervention or treatment.

Incomplete miscarriage: This is when only part of the pregnancy tissue is passed and part of it is still inside the cavity of the womb. This can be associated with pain and bleeding and requires medical intervention and treatment.” – Professor Ranjit Akolekar, consultant in fetal medicine and founder of The Pregnancy Clinic 

Who is at risk?
“Research shows the risk of miscarriage is greater in older women and increases quite significantly after the age of 40. This is because as we age, so do our eggs, causing a greater chance of DNA errors, which can lead to miscarriage. The risk of miscarriage is also higher for those with some type of pre-existing illness, such as lupus or rheumatoid arthritis. Having a BMI of over 30 also puts you at risk – either directly due to a heavier weight and a potentially higher blood sugar level, or due to the likelihood of polycystic ovaries. Smoking is also associated with miscarriage.” – Penelope  

Why does it happen?
“Early pregnancy losses generally occur prior to ten weeks and are associated with chromosomal abnormalities, inherited or acquired clotting problems in the mother, deficiency or imbalance of hormones, or at times an immunity mismatch between the couple. With regard to genetic defects as a cause of miscarriage, it is important to understand that although the word ‘genetic’ implies or can mean inherited, the vast majority of such genetic defects leading to miscarriage are not inherited and occur just within the embryo in that pregnancy, with an unlikely chance of happening again. Late pregnancy losses occur due to either abnormalities in the shape of the womb, weakness in the birth canal (cervix), or mothers with medical problems such as diabetes. Most miscarriages have nothing to do with the mothers’ health or actions before or during pregnancy.” – Ranjit

What are the signs of a miscarriage?
“Miscarriage can be silent or associated with symptoms such as cramping and vaginal bleeding. A silent miscarriage, for example, has no symptoms, while for those who experience abdominal pain and bleeding, you may pass the entire pregnancy, resulting in a complete miscarriage, or experience an incomplete miscarriage with ongoing pain and bleeding. The amount of bleeding experienced depends on the stage of pregnancy and whether it’s an incomplete or complete miscarriage – bleeding after 12 weeks tends to be heavy whereas miscarriages prior to this stage are generally less heavy. Similarly, if you miscarry prior to seven weeks you are more likely to pass clots, whereas after this stage you’ll pass clots as well as pregnancy tissue. If you are experiencing pain when miscarrying, you can use pain relief such as paracetamol.” – Ranjit 

How long does it take?
“Symptoms of a complete miscarriage, which include passing clots and pregnancy tissue, can settle within a few hours. Incomplete miscarriage, when products are only partially passed, can take 12-24 hours. Pregnancies less than 12 weeks are likely to miscarry completely within 12-24 hours whereas miscarriages that happen after 12 weeks may take longer. All women should be advised that whenever there is bleeding and passage of products in early pregnancy, which is suggestive of miscarriage, an ultrasound scan should be carried out to firstly, confirm the diagnosis of miscarriage and secondly, to check whether the miscarriage is complete or incomplete; complete miscarriage is when the womb is empty without any evidence of any pregnancy tissue whereas with an incomplete miscarriage, there is still some pregnancy tissue in the womb. If the size of the pregnancy tissue is small and below a certain measurement, you may be given medication to facilitate the passage of these pregnancy products, which takes a few days. If, however, there is more tissue left in the womb, then a short surgical procedure is carried out under an anaesthetic – this usually takes around 20 minutes.” – Ranjit 

How is miscarriage confirmed?
“The only way to diagnose a miscarriage is an early pregnancy ultrasound scan. In early pregnancy, the diagnosis of miscarriage is made if the pregnancy sac is beyond a certain size without evidence of any embryo or fetus; alternatively, if there is evidence of an embryo or fetus then the diagnosis is made based on absence of evidence of a fetal heartbeat.  If the findings are uncertain i.e. the pregnancy sac is below thresholds for diagnosis of miscarriage, a repeat ultrasound scan is usually arranged after a week or ten days.” – Ranjit 

How long does it take the body to recover?
“If you miscarry in the first six weeks of pregnancy, your body should return to normal very soon after the bleeding has stopped, and depending on your cycle, your periods should return within around six weeks. If the miscarriage occurs after this stage of pregnancy, you may continue to experience cramps and bleeding for up to a week, with periods returning within six to eight weeks.” – Ranjit 

How long should you wait before trying again?
“You can try to conceive again after your next period, as long as you are emotionally and mentally ready.  All women are different, and most women take longer to process their loss emotionally and so might want to leave it longer before trying again.” – Penelope 

If you’ve miscarried once, how likely is it to happen again?
“If you have previously had a miscarriage, your chance of having a second is only marginally raised to 26% from 25%. There are, however, a minority of women who will go on to have three or more miscarriages, and around 15% of those will be found to have a subclinical clotting syndrome in their blood. These women may be offered a combination of aspirin and heparin during their pregnancy which has been shown to improve outcomes and lead to them having healthy babies. If you’ve experienced three miscarriages or more, speak to your GP, who may be able to refer you to a specialist miscarriage clinic.” – Penelope 

If you do fall pregnant after miscarrying, is there anything you can do before the 12-week scan?
“An early pregnancy scan from around six weeks is an option, although this would need to be done privately. This scan can confirm that the pregnancy is in the correct location – i.e. inside the womb – and that the fetus is developing normally.” – Ranjit 

 Why is miscarriage not more widely spoken about?
“Miscarriage is no longer a taboo subject, as most people welcome discussing it when the issue is raised, however it can still make people feel uncomfortable. The British stiff upper lip is very much a thing, and it’s surprising how deep this can be rooted in peoples’ brains. Plus, historically we’ve been encouraged not to tell anyone they are pregnant until after the first scan at 12 weeks, just in case they miscarry. This line of thinking has done unbelievable damage, as people now feel bound by this societal rule. As the rule states, ‘don’t tell anyone just in case you lose the baby’, it has reinforced that baby loss isn’t something to be discussed. There are other reasons too, but the culture we live in definitely encourages people to remain silent when it comes to child loss.” – Zoe Clark-Coates, founder of The Mariposa Trust 

How can you get through painful dates?
"Dates and milestones, such as the day you miscarried, can be painful to navigate. What I would say is the dread of the date is often worse than the reality. When you have journeyed through loss, you remember your baby every single day – meaning grieving isn’t reserved for special occasions. Take time to grieve and make sure you have the space to express your feelings. Try to plan something you enjoy on a day that you know will be tricky, and if you want to do something to mark a birthday or death anniversary, consider planting a tree or doing some fundraising in honour of your little one. Remember it’s healthy to cry and be real about your pain.” – Zoe  
 

For more information visit DrPenelopeLaw.com, ThePregnancyClinic.com and TheMariposaTrust.org.
 

DISCLAIMER: Features published by SheerLuxe are not intended to treat, diagnose, cure or prevent any disease. Always seek the advice of your GP or another qualified healthcare provider for any questions you have regarding a medical condition, and before undertaking any diet, exercise or other health-related programme.