Miscarriage also called spontaneous abortion. Miscarriage is the loss of a non-viable fetus before 16 weeks of gestation. The medical term for miscarriage is ‘spontaneous abortion’. If the pregnancy ends after a gestation period of sixteen weeks, it is no longer referred to as a miscarriage, but a ‘premature birth’.
The higher the age of the pregnant woman, the higher the risk of miscarriage. Women who have had more than one miscarriage are more likely to miscarry again in a subsequent pregnancy.
Lets see more details about Miscarriage also called spontaneous abortion.
Symptoms of miscarriage
There is a threat of miscarriage (‘abortion imminent’) in the event of blood loss in the first 16 weeks of pregnancy. Often this is accompanied by a feeling of cramping in the lower abdomen resembling menstrual pain. However, if you have these complaints, this does not necessarily mean that you will actually have a miscarriage.
In half of the women with these complaints, the blood loss disappears spontaneously and the pregnancy continues normally. The blood loss in this group is caused by a cause other than a miscarriage. In the other half of the women, the miscarriage continues within a few days.
Persistent miscarriage/spontaneous abortion
When the miscarriage continues, the cramping in the lower abdomen increases; this cramp can radiate to the back and/or the thighs. This pain can resemble contractions and is caused by the contraction of the muscles in the uterus.
This is accompanied by significant blood loss from the vagina, often more than with a period. After a few hours, the fruit comes out with the amniotic sac. This looks like a vesicle filled with clear fluid, covered by a sturdy membrane with pink flakes on top.
This is not always easy to see because of the blood clots. If you are not sure whether there is a blood clot or an amniotic sac, you can gently pull the tissue apart with your fingers. When you see a blister filled with clear fluid, the amniotic sac has come out. If there is no blister, it was just a blood clot. Depending on the gestational age, you can also recognize the fruit. Often the fruit is smaller and looks different than you may have seen in photo books.
Some women notice that their pregnancy symptoms decrease even before blood loss or pain occurs. Nausea decreases or disappears, as does the dense breasts. It also happens that, during the routine ultrasound examination in the twelfth week of pregnancy, it is discovered that the fetus is no longer alive. Within a few days to weeks, the fruit and the amniotic sac will come out in the above manner.
How does a miscarriage/spontaneous abortion occur?
A miscarriage can have several causes:
- No fruit
Sometimes no fruit has developed at all and there is only an empty amniotic sac.
- Serious deviations
A miscarriage is usually caused by abnormalities in the fetus itself. These are usually serious abnormalities that are not compatible with life. A miscarriage thus appears to be the result of a natural selection system of the body. The abnormalities in the fruit are located in the hereditary material that is stored in the chromosomes. The abnormality arose during fertilization or later cell divisions and is therefore usually not hereditary. You, therefore, have no increased risk of having another miscarriage during a subsequent pregnancy.
- Higher age
Older mothers have an increased risk of miscarriage. At a higher age, the chance of developing chromosome abnormalities is greater.
- To smoke
Smoking can negatively affect the condition of the blood vessels in and to the placenta. A malfunctioning placenta can lead to the death of the fetus. This is one of the causes that you can influence yourself. It is therefore highly recommended not to smoke during your pregnancy. You can also ask your doctor for help in giving up smoking.
- Chromosome aberration
You or the child’s father may have a chromosome abnormality that does not affect you or he yourself, but which may lead to serious abnormalities in the child that are incompatible with life. In that case, the pregnancy will end in miscarriage.
- An abnormal shape of the uterus
A shot in the uterus that makes the space in the uterus too small or a doubly formed uterus that is too small can cause a repeated miscarriage.
Polyps, adhesions that have developed after a previous ‘curettage’ can also cause a miscarriage. A curretage is a small procedure in which the cervix is stretched and scraped empty with a kind of spoon or sucked empty with a thin tube through which the fruit and the amniotic sac come out.
Too small a space in the uterus prevents the placenta from developing properly. A good placenta is necessary for the development of the fruit. Daughters of mothers who took DES (diethylstilbestrol, an artificial female hormone widely prescribed to pregnant women between 1947 and 1976 to prevent miscarriage) during pregnancy are more likely to have uterine abnormalities.
Due to a clotting disorder, the blood tends to clot more quickly. If you have a clotting disorder, it can cause problems with the blood flow to the placenta and lead to a miscarriage. It is rare that coagulation abnormalities are not discovered until repeated miscarriages occur. The coagulation disorder has generally already caused complaints earlier in life.
- Too much of Luteinizing Hormone (LH)
LH is a hormone that is involved in the development of ovulation. Some people have too much of the hormone LH for no known reason. How excess LH leads to miscarriage is not well known.
Is it serious and what can you expect?
Vaginal bleeding during the first sixteen weeks of pregnancy can be the start of a miscarriage, but it does not necessarily lead to it. In half of the pregnant women, this blood loss is indeed followed by a miscarriage. In the other half the pregnancy continues normally and there is no increased risk of abnormalities of the fetus.
There is no treatment to prevent an impending miscarriage. Rest has no added value either. The cause of the miscarriage lies in the non-viable fruit. If the midwife or obstetrician has determined that your heart is not beating and miscarriage is bound to follow, you can do one of the following:
- wait until the miscarriage continues spontaneously;
You can also choose to wait a number of weeks, and if this wait takes too long, you can switch to a curettage. Together with your midwife or gynecologist, you and your partner can make a choice that suits you and your situation.
Waiting for a miscarriage You can choose to wait until the moment when the miscarriage spontaneously continues and the fruit is expelled. You can do this waiting for and going through the miscarriage at home.
One reason for waiting may be that you like to stay in your own environment and wait and go through the miscarriage there. Waiting and waiting has no negative consequences for your body or for a possible next pregnancy. However, it can be emotionally tough.
Usually, the miscarriage continues within one to two weeks. For the pain during the miscarriage you can, if you wish, get pain relief from your doctor or midwife. After the miscarriage, the stomach ache disappears almost immediately. You may still have blood loss for a few days as with a period. If you have severe blood loss or abdominal pain or develop a fever after the miscarriage, it is wise to contact the midwife or gynecologist again.
The other option is to opt for a ‘curettage’. The cervix is stretched and the uterus is scraped empty with a kind of spoon or sucked empty with a thin tube through which the fruit and the amniotic sac come out. This procedure is performed in the hospital by the gynecologist. The procedure itself takes five to ten minutes. Usually, the procedure is performed under a short anesthetic. Local anesthesia of the vagina and cervix is sometimes also possible.
Curettage is often chosen if you have a lot of emotional difficulty in carrying on with the ‘useless’ pregnancy, if remnants have been left during a spontaneous miscarriage or if there is very heavy blood loss during the spontaneous miscarriage.
- Physical recovery
Physical recovery after a miscarriage usually goes quite smoothly. You may have red blood loss for a few days, which then turns into brown discharge.
It is best to wait with intercourse until the blood loss has completely disappeared. Usually a new period follows six weeks later. When you and your partner are ready, there is no objection to getting pregnant again after the blood loss has stopped. The miscarriage has no consequences for this new pregnancy.
A miscarriage often evokes many emotional feelings in you, your partner or in your immediate environment. Anger, disbelief, guilt, sadness and emptiness are common emotions after a miscarriage. They are part of the period of grief that can follow a miscarriage. Sometimes this grief can be so intense or last so long that it turns into a ‘postpartum depression’, or a depression after childbirth. You can read more about this in the doctor’s information leaflet ‘Depression after childbirth’.
- Getting pregnant again
You and your partner are the only ones who can determine when you are ready to conceive again. From a medical point of view, it is wise not to have intercourse again until the blood loss has stopped. During a subsequent pregnancy, you may feel more anxious and less worried and you are afraid that another miscarriage will occur. Yes, but the chance that the pregnancy will go well is much greater than the chance that the pregnancy will end in miscarriage again.
When to go to the doctor?
If you have blood loss during the first 16 weeks of pregnancy, this may indicate an impending miscarriage, but this does not have to be the case. In half of the pregnant women the pregnancy continues normally, the other half actually has a miscarriage. In case of blood loss during pregnancy, it is advisable to contact your doctor, midwife or gynecologist who will supervise the pregnancy. They will examine you and refer you to the gynecologist in the hospital if necessary.
When you see your doctor or midwife, they will likely examine you physically and look at the cervix with a duckbill (‘speculum’).
It will be checked whether the cervix that is normally closed during pregnancy has opened up. If so, it indicates an impending miscarriage. If it is suspected that there is an impending miscarriage, your doctor or midwife will discuss the policy to be followed with you.
In general, a wait-and-see policy will be followed. You can then just go home again. Time will tell whether there will indeed be a miscarriage or not. You can decide to have an ultrasound done together with your doctor or midwife. This ultrasound can determine whether or not the fruit is still alive, but will not affect further policy.
What can you do about it yourself?
In principle, you cannot do anything yourself to prevent an impending miscarriage from continuing. However, it is wise to live as healthily as possible to prevent abnormalities in the fetus as much as possible (see: ‘General advice and precautions’).
- Persistent miscarriage
If the miscarriage continues and the cramps become more painful, it is important to pay close attention to your breathing. This allows you to relax your body as much as possible. Even if it is difficult and you do not want to lose your fruit at all, you cannot stop it.
So try to surrender to the pain. Concentrate on your breathing. Breathe in slowly through the nose and long out through your mouth. You can also do exercises that are suitable for dealing with contractions. If the pain is severe and intolerable for you, you can ask your doctor or midwife for a painkiller.
- After the miscarriage
After the miscarriage, there are a number of things you can do to accommodate the loss (see “General Advice and Precautions”).
General advice and precautions
A miscarriage is usually caused by abnormalities in the fetus itself. You cannot prevent a miscarriage. However, it is wise to live as healthy as possible in order to prevent abnormalities in the fetus as much as possible.
You can do this by:
- not to smoke
- not to drink alcohol
- eat a healthy and varied diet
- not to use medicines
But even if you live a healthy life, it is still possible that you will have a miscarriage. However, you cannot do more than healthy living to prevent a miscarriage.
- View the fruit
You can look at the fruit together with your partner when it is born. The fruit looks different than you may have seen in photo books. It may also no longer be completely intact because it has not been alive for several days to weeks. If you wish, you can take a picture of the fruit so that you can look back at it later. Even if you receive a curettage, you can ask if it is possible to see the fruit. However, this is not always possible.
- Take time to mourn
After going through a miscarriage, all kinds of emotional feelings can come to you and your partner. The period of grief and its intensity varies from person to person, often also between you and your partner. The duration can vary from a few weeks to more than a year. First there is often disbelief, followed by denial, rebellion and anger, later there is room for grief and finally there is acceptance in some way.
Many women also experience a feeling of emptiness or feel inferior because they have not been able to carry on with the pregnancy. Guilt and looking for a cause within oneself is common. Although very understandable, this guilt is not necessary because a miscarriage is caused by abnormalities in the fetus.
For some it is also comforting to know that the fetus would not have been viable or to know that a new pregnancy is very possible.
- Dealing with reactions from the environment
The environment often does not fully understand what you are going through and comes up with well-intentioned advice that can seem very hurtful or full of misunderstanding. This can make you feel left out. Still, try to accept as much as possible that some people mean well, but can be quite clumsy in their formulations. It may happen that people no longer dare to tell you that they are pregnant or that they suddenly start talking in a whisper about their children in your presence. Others may make well-meaning comments that can make you feel even more lonely: “You are still young, you can get pregnant again in no time, I know someone who has had three miscarriages, it can always be worse, I know someone who has had her hair for eight months. lost your child, now you are not attached to it yet, it is part of it. ”
If you find this hurtful, it is best to make it clear that you do feel sad and that you do not appreciate such comments. You can also indicate what you do need, so that it becomes easier for your environment to support you.
- To talk
It is wise to talk about your feelings with your partner, friends, your midwife, or family doctor. It can also help to talk to people who have experienced the same thing. There are also organizations where you can come into contact with fellow sufferers who can sometimes best sense what you are going through. Try to accept that your partner may be going through a different grieving process than you are. This can lead to tension, but try to talk about it as much as possible. It can also be very pleasing to write your feelings in an article.
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