7. Miscarriage and Stillbirth
Nearly every pregnant woman thinks about miscarriage during pregnancy, but it occurs in only about 20% of all pregnancies. Miscarriage
occurs when a pregnancy ends before the embryo or fetus can survive on
its own outside the uterus, usually within the first 3 months. After 20
weeks, loss of a pregnancy is called a stillbirth. Many causes of
miscarriage also apply to stillbirth, and in this discussion, we will
use the term “miscarriage” to apply to both. A discussion of stillbirth
Screening tests provide odds of a problem occurring. Diagnostic tests determine if a problem is present.
Some signs of miscarriage include vaginal
bleeding, cramps, pain that comes and goes, pain that begins in the
small of the back and moves to the lower abdomen and loss of tissue. If
you experience any of these symptoms, call your healthcare provider
What Causes a Miscarriage? We don’t usually know, and are often unable to find out, what causes a miscarriage. The most common reason in early miscarriages is abnormal development of the embryo. Experts believe there are many reasons miscarriage occurs, including:
• chromosome problems
• hormone problems
• problems with the uterus
• chronic health conditions
• a high fever in early pregnancy
• autoimmune disorders
• unusual infections
• mother-to-be’s age
• obesity, especially in women with a BMI higher than 35
• cigarette smoking
• drinking alcohol
• trauma from an accident or major surgery
• an incompetent cervix after the first trimester
Use of aspirin and nonsteroidal
anti-inflammatories (NSAIDs) may increase the risk of miscarriage.
Caffeine use before and during pregnancy may increase your risk. Some
experts believe a father-to-be’s age may play a role in the risk of
miscarriage. When a man is over age 35, there may be a greater risk of
miscarriage than for younger men, no matter what the woman’s age is.
Below is a discussion of different types
and causes of miscarriage. It is included to alert you about what to
watch for if you have any symptoms of a miscarriage. If you have
questions, discuss them with your healthcare provider.
Different Types of Miscarriage. If you have a threatened miscarriage,
it appears as a bloody discharge from the vagina during the first half
of pregnancy. Bleeding may last for days or even weeks. There may not be
any cramping or pain. If there is pain, it may feel like a menstrual
cramp or a mild backache. Resting in bed is about all you can do, but
being active does not cause miscarriage. No procedure or medication can
keep a woman from miscarrying.
An inevitable miscarriage
occurs when the bag of water breaks (rupture of membranes), the cervix
dilates and you pass blood clots and/or tissue. Miscarriage is almost
certain under these circumstances. The uterus usually expels the fetus
or products of conception.
With an incomplete miscarriage, the
entire pregnancy may not be passed at once. Part is passed while part
of it remains in the uterus. Bleeding may be heavy and continues until
the uterus is empty.
A missed miscarriage can occur if
the body retains an embryo that died earlier. There may be no symptoms
or bleeding. The time period from when the pregnancy failed to the time
the miscarriage is discovered is usually weeks.
If you suffer a miscarriage, research shows you have a 90% chance of having a healthy pregnancy the next time you get pregnant.
About 1 to 2% of all couples will experience a recurrent or habitual miscarriage.
This usually refers to three or more consecutive miscarriages. Studies
show that 60 to 70% of couples who have recurrent or habitual
miscarriages eventually have a successful pregnancy.
A chemical pregnancy occurs when
tissue forms that produces the hormone (HCG) that makes a pregnancy test
positive. However, the tissue embryo dies very soon, so there actually
is no pregnancy.
If You Have Problems.
If you have problems, notify your healthcare provider immediately!
Bleeding often appears first, followed by cramping. Ectopic pregnancy
must also be considered. A quantitative-HCG test may be useful in
identifying a normal pregnancy, but a single test report doesn’t usually
help. Your healthcare provider needs to repeat the test over a period
of several days.
Ultrasound may help if you are more than 5
gestational weeks into your pregnancy. You may continue to bleed, but
seeing your baby’s heartbeat may be reassuring. If the first ultrasound
is not reassuring, you may be asked to wait a week or 10 days, then
repeat the test.
The longer you bleed and cramp, the more
likely you are having a miscarriage. If you pass all of the pregnancy,
bleeding stops and cramping goes away, you may be done with it. However, if everything is not expelled, it may be necessary to perform a dilatation and curettage (D&C) to empty the uterus. It’s better to do this so you won’t bleed for a long time, risking anemia and infection.
Some women are given progesterone in an
effort to help them keep a pregnancy. Medical experts do not agree on
its use or its effectiveness.
If you have pets, take over their care
during your partner’s pregnancy. Change the cat’s litter box (she
shouldn’t do this while pregnant). Walk the dog (the pull on the leash
might hurt her back). Buy food and other pet supplies (to save her back
from the strain of lifting big food bags). Make and keep vet
Rh-Sensitivity and Miscarriage. If you’re Rh-negative and you have a miscarriage, you will need to receive RhoGAM. This applies only if you are Rh-negative. RhoGAM is given to protect you from making antibodies to Rh-positive blood.
Stillbirth is the death of a fetus after 20 weeks of pregnancy. Various
reasons are cited for stillbirth, including being older, having had
more children and carrying more than one baby. Nearly 50% of all
unexplained stillbirths may be related to problems in the fetus.
If you’re obese before pregnancy, it
increases your risk of stillbirth. Other causes may include high blood
pressure, diabetes, lupus, renal disease, thrombophilia, multiples, some
infections and placenta and cord accidents.
Having a stillborn baby can be a traumatic
experience for you, and it can take time to recover from it. You and
your partner will probably have many questions and concerns. To help you
find answers to your questions, discuss them with your healthcare
If You Have a Miscarriage or Stillbirth.
Having a miscarriage or stillbirth can be difficult. Some couples
experience more than one miscarriage, which can be very difficult to
deal with. In most cases, repeated miscarriages occur due to chance or
“bad luck.” Most healthcare providers don’t recommend testing to find a reason for miscarriage unless you have three or more pregnancy losses in a row.
Don’t blame yourself or your partner for
the loss of a pregnancy. It’s usually impossible to look back at
everything you’ve done, eaten or been exposed to and find the cause.
If a miscarriage or stillbirth occurs,
give yourself plenty of time to recover physically and emotionally. In
the past, we have advised a couple not to try to get pregnant
immediately and to allow 3 or 4 months for a woman’s body to return to
its normal cycle and for hormone levels to return to normal. However,
some experts now believe a couple doesn’t have to wait a few months to
try again. They believe it’s safe for a woman to try to get pregnant
again as soon as she has a menstrual period. Talk to your healthcare
provider if you have questions.
As a couple, you might want to
allow yourselves time to recover emotionally. This may take longer than
the actual physical recovery.
8. Your Nutrition
It’s hard to eat nutritiously for every meal. You may not always get the nutrients you need, in the amounts you need. In each meal during pregnancy, try to include a
whole-grain product, fruits and/or veggies, a lean protein and a healthy
Your prenatal vitamin is not
a substitute for food, so don’t count on it to supply you with all the
essential vitamins and minerals you need. Food is your most important
source of nutrients!