Miscarriage
A miscarriage happens when your pregnancy is not developing normally and may stop growing completely. Miscarriages can cause bleeding, and the tests to investigate bleeding will indicate if you have had or may soon have a miscarriage. The pregnancy tissue may pass out of your body. Besides bleeding, you may feel period-like pain and cramps.
What causes a miscarriage?
If a pregnancy was not going to be viable, you will like to miscarry. You may have had a miscarriage because the chromosomes in the embryo were abnormal. The pregnancy does not develop properly in these cases. Nothing could have been done to prevent this.
You may also have a miscarriage if you had a high fever (but minor infections are typically not harmful). There are very small risks of miscarriage with tests like amniocentesis.
Who is at a greater risk of a miscarriage?
Miscarriages are more common in:
Older women as the risk of chromosomal abnormalities is more common
Women who smoke or drink in the first 12 weeks of pregnancy (this is why you should quit smoking and drinking before you fall pregnant as you may not know when you conceive)
Women with uncontrolled diabetes, fibroids or thyroid problems
Women with medical conditions affecting blood clotting
How can I prevent a miscarriage?
Miscarriages can happen to all women, even the very healthy. However, being healthy will increase your chances of a healthy pregnancy. During pregnancy you should:
Avoid alcohol and smoking
Moderate your caffeine intake
Avoid contact with anyone with a serious infectious illness
Take paracetamol if you have a fever
How do I know if I have had a miscarriage?
If you have had bleeding or pain during your early pregnancy then this needs to be assessed.
This can be further assessed by:
Ultrasound
Blood tests ( HCG level)
What are the different types of miscarriages?
Threatened – This is associated with some bleeding and pain but pregnancy is still continuing
Missed – The pregnancy has stopped growing but the pregnancy tissue is still in the uterus, possibly including an amniotic sac
Incomplete – Some of the pregnancy tissue has passed but some is still inside the uterus
Complete – All the pregnancy tissue has passed
What happens to the pregnancy after a miscarriage?
If you have an incomplete or missed miscarriage the tissue will eventually pass naturally. An incomplete miscarriage can take a few days and a missed miscarriage may take 3-4 weeks. During this time you may have spotting or bleeding. When the tissue does pass you will have heavier bleeding and period-like cramps. There is also medication available that can make passing the pregnancy tissue faster.
You will likely have bleeding with clots and cramps when you are passing the pregnancy tissue. You can take paracetamol for pain and use pads (not tampons) for bleeding.
Once the pregnancy has passed these symptoms should stop. If the bleeding continues and is heavy you may need treatment. You need immediate medical attention if you have:
Dizziness or fainting
A fever or chill
Severe abdominal or shoulder pain
Increased bleeding (going through two or more pads per hour) or have passed golf ball sized clots
Unpleasant smelling vaginal discharge
If you have heavy bleeding or signs of an infection, particularly with a missed miscarriage you may need a dilatation and curettage (D&C) to remove the remaining pregnancy tissue. This is a procedure performed as an inpatient under general anaesthetic.
What is an ectopic pregnancy?
In a normal pregnancy, conception begins when the egg and sperm meet in the fallopian tube. The fertilised egg then travels down into the uterus where it develops.
In an ectopic pregnancy the fertilised egg starts growing in the wrong place. This is commonly inside the fallopian tube. More rarely an ectopic pregnancy can be found in other positions like the ovary, cervix, scar tissue from a previous C-section, or in other parts of the belly.
As the pregnancy starts to grow it will stretch the fallopian tube which is very painful. This can cause pain in the lower belly or vaginal bleeding. This can also cause the tube to tear or burst which requires urgent surgery to deal with serious internal bleeding. Sometimes an ectopic pregnancy will shrink and resolve on its own.