Miscarriage: Symptoms, Diagnosis, Treatment And Aftercare

Miscarriage can be defined as any spontaneous pregnancy loss before the twentieth week. Though it is a difficult, painful event, miscarriage is not at all uncommon. Research reveals that between 10 and 25 percent of all clinically recognized pregnancies end in miscarriage. If we included very early pregnancies, the figure might even be as high as 50 percent.

One in four women will experience a miscarriage, and some suffer from repeated pregnancy loss. Because miscarriage is a startlingly frequent occurrence, all women of reproductive age should be familiar with its basics. This article will cover the symptoms of miscarriage, as well as its diagnosis, any treatment that might be needed, and how to care for yourself after a pregnancy loss.

Miscarriage: Why?

The risk of miscarriage is greatest during the first 12 weeks of pregnancy, and chromosomal abnormalities within the baby are the most common cause of pregnancy loss within this period. Other causes of miscarriage include hormonal problems, injury during pregnancy, maternal age, and lifestyle factors such as smoking and drinking.

The specific cause is not usually explored, unless a woman suffers multiple miscarriages. We do know that the risk of miscarriage increases with age, and that a woman who has already had a miscarriage has a slightly increased risk of suffering another one.

Miscarriage Symptoms

Medical professionals will class miscarriages in accordance with the stage during which they occur as well as other circumstances. There are however, essentially two different categories all women should be aware of: miscarriages that progress naturally and have symptoms, and "missed miscarriages" which do not progress naturally and have no clear symptoms.

The first type of miscarriage comes with some obvious symptoms:

• Bleeding from the vagina, including tissues

• Abdominal pain, often in a rhythmical fashion — as one would expect with labor

• A sudden lack of previously experienced pregnancy symptoms

It should be noted that mild vaginal bleeding during pregnancy can be caused by problems other than miscarriage too, including a sensitive cervix or placenta previa (placenta covers the cervix). Fairly heavy, often clear red bleeding that comes with pain and involves passing tissues usually indicates a miscarriage. It is also important to be noted that normal vaginal discharge is slightly clear and whitish and it is perfectly normal during pregnancy.  

Read More: Miscarriage Facts Every Woman Should Be Familiar With

Keep in mind that ectopic pregnancy, where the embryo implanted outside of the uterus, has similar symptoms as miscarriage. Ectopic pregnancy can easily become life-threatening. As such, it requires immediate treatment. Women who have symptoms of miscarriage or ectopic pregnancy will receive an ultrasound scan to confirm the diagnosis. 

In the case of a missed miscarriage, the fetus passes away but does not begin to leave its mother’s body. Some women will notice sudden weight loss or a decrease in pregnancy symptoms, while others will not have any symptoms. Missed miscarriages are usually diagnosed during routine prenatal appointments, where the healthcare provider will not notice any signs of a fetal heartbeat.

Miscarriage Treatment And Aftercare

Managing Your Miscarriage Naturally

An actively progressing first-trimester miscarriage may or may not be managed medically, depending on your location and sometimes depending on your own individual choice. 

Your healthcare provider may ask you to save the tissues that you lose, but not always. You will certainly be asked to come in for an appointment after some time has passed. The timing depends on your location again. I was asked come back after two weeks following my miscarriage in one European country, and after four weeks in another.

When should you call your healthcare provider before the agreed follow-up appointment? If you show signs of infection:

• A raised temperature

• A tender abdomen

• Flu-like symptoms

• Foul-smelling vaginal discharge/blood

Also call your healthcare provider or go to the emergency room if you are losing a lot of blood and are feeling faint. You may be hemorrhaging. Around one percent of miscarrying women will need a blood transfusion. The pain you will inevitably experience can be managed with over-the-counter painkillers, but women who have a hard time coping can always call their doctor.

Missed Or Incomplete Miscarriage

Missed or incomplete miscarriages require medical management. An incomplete miscarriage is one that started naturally but did not complete; pregnancy-related tissues remain inside the uterus, where they threaten to create an infection. A missed miscarriage is one that did not start up at all, despite fetal demise. 

A dilation and curettage — more commonly referred to as a D&C — is the go-to procedure for incomplete and missed miscarriages. The procedure is usually carried out under general anesthesia, but can also be done with a local anesthetic.

After the procedure, you may receive painkillers to cope with your discomfort. You should also call your healthcare provider if you start bleeding heavily, feel faint, or notice the signs of infection described above. You should see your doctor for a follow-up appointment at a predetermined time. 

Missed and incomplete miscarriages may also be managed with medication that kick-starts the emptying of your uterus. Medical management of these miscarriage may involve a combination or oral and vaginal drugs, or only vaginal drugs. Patients may complete their miscarriages in hospital or at home. 

Second-Trimester Miscarriage Treatment

A second-trimester miscarriage is very different from one that occurs within the first 12 weeks. Women who miscarry at this point tend to have a lot more discomfort, as well as less choice in their treatment plan — since treatment is determined by their individual circumstances. 

Medical management of a second-trimester miscarriage is not only possible, but frequent too. The main difference between medical management of a first-trimester miscarriage and a second-trimester miscarriage is that you will almost always have to stay in hospital throughout your miscarriage if you were already in your second trimester.

In some cases, a dilation and evacuation is carried out for second-trimester miscarriages. This procedure is similar to a D&C, but a little more invasive. Not every doctor is able to carry this procedure out, nor is it right in all circumstances.

Taking Care Of Yourself After Miscarriage

Miscarriage is a sad event that affects every woman differently. You may feel a little sad but also ready to move on, or your miscarriage may send you into full-blown grief mode.

Some women (and their partners, too), will benefit from grief counseling following a pregnancy loss. They may also want to deal with fears about a possible next miscarriage in therapy. Many people who experienced pregnancy loss are helped by doing something special to commemorate their lost baby. This is highly individual, but it can range from an actual funeral to planting a tree, writing a poem, getting a tattoo or having a physical reminder of the lost baby in the house — a friend of mine has a little glass angel, for instance. 

Read More: Miscarriage Signs, Symptoms and Treatment in Early Pregnancy

It is generally very safe to try to conceive again very soon after a miscarriage. After a first-trimester miscarriage, you need to wait until your bleeding has stopped and you have had one period before starting again.