Pregnancy Week by Week : Week 8 (part 2) - Miscarriage and Stillbirth

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 follows.

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 immediately.

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.

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.

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. 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 provider.

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 fat.

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!