Miscarriage and Stillbirth
Miscarriages are when the pregnancy terminates before the sixth month and are estimated to occur in about 10 to 20 per cent of pregnancies. It is hard to find an exact figure because many women miscarry before they even realise they are pregnant, and pass it off as a very heavy period.
The majority of miscarriages happen in the first three months of pregnancy and affect about one in five pregnancies. At least half of all miscarriages in the first trimester are caused by chromosomal abnormalities, which prevent the foetus from developing normally. Later miscarriage, usually in the second trimester, is more likely to be a result of the placenta not functioning properly.
The symptoms of miscarriage are vaginal bleeding accompanied by lower backache and severe stomach cramps, a bit like period pain.
Lots of women experience vaginal bleeding in early pregnancy and go on to have a normal pregnancy and healthy baby. Experts are not sure why this happens, but it affects roughly one in four women.
Once the uterus starts to expel the pregnancy there is little that can be done to save it. An ultrasound will probably be required to establish what stage you are at, or if you are miscarrying at all. You will either have an external ultrasound where a transducer (looks a bit like a microphone) is placed on your lower abdomen. If the pregnancy is very early you may have to have an internal ultrasound where a probe is inserted into your vagina. Neither procedure hurts or is harmful to your baby.
There are three types of miscarriage:
A complete miscarriage, where the uterus expels the foetus and placenta entirely, and an ultrasound scan shows that the uterus is completely empty.
A missed miscarriage, where the foetus and placenta die but remain in the mother’s womb for some time before being expelled. There might be very minor symptoms such as a brownish discharge. An ultrasound can check whether the foetus’ heart has stopped beating, or for an empty sac inside the uterus.
An incomplete miscarriage, where a miscarriage happens but some of the products of conception are left inside the mother.
What treatment will I receive if I miscarry?
If you start to bleed at any time during the second or third trimester, call your maternity unit and go there as soon as possible. If you are bleeding in your first trimester, call your doctor and stop any sexual activities and exercise. Your doctor will probably refer you to an early pregnancy unit at the hospital, or gynaecological department, and you will be given an ultrasound to see whether a miscarriage is imminent.
If a miscarriage is inevitable, there is little doctors can do to stop it. You may be given the option to see if the pregnancy is expelled from your body naturally over the next few days- a doctor may offer you tablets to help speen up the process. Some women are offered a procedure known as ERPC (evacuation of retained products of conception) which is a minor operation offered under anaesthetic, to clean out the uterus. It involves dilating the cervix and scraping tissue away from the lining of the uterus.
Experts believe that an incompetent cervix is the cause of 20-25 per cent of miscarriages in the second trimester. It is a condition where the cervix opens under the pressure of the growing baby and can cause miscarriage or premature delivery.
It can be caused by a genetically weak cervix, damage during a previously difficult birth, previous surgery on the cervix, and a cone biopsy for surgical cancer or laser therapy.
How will I know if I have an incompetent cervix?
It is usually diagnosed if a woman has previously had a miscarriage in her second trimester, or through internal examinations and ultrasound.
What is the treatment?
The treatment for an incompetent cervix is a procedure that sews the cervix closed to reinforce it. It is usually performed between 12-16 weeks of pregnancy to prevent any problems when you go into labour. The stitches are removed before the estimated delivery date, or as labour starts. The chances of carrying a baby to term with this procedure have proven to be very successful.
This is a serious condition where the pregnancy develops outside the womb, usually in the fallopian tubes. An Ectopic pregnancy is not capable of surviving and will normally spontaneously miscarry. The most common symptoms are vaginal bleeding, abdominal pain which can be quite severe and sometimes shoulder or rectal pain.
An ectopic pregnancy can be life-threatening if it ruptures and causes internal bleeding so if you experience bleeding or pain, contact your GP or midwife.
What is the treatment?
If an ectopic pregnancy is suspected Laparoscopy (key hole surgery) can be performed on the abdomen to remove the ectopic pregnancy. An alternative medicine called Methtrexate is now being used, which decreases the growth cells in an ectopic pregnancy.
A blighted ovum is a type of pregnancy loss and is often referred to as a missed miscarriage, or a silent miscarriage. In your notes, a Doctor may have written it as an anembryonic pregnancy.
After conception, the egg (ovum) travels down the fallopian tube and implants in your uterus (womb) as normal. However, it is not known why the baby doesn’t develop and as there are no symptoms of this happening, it is usually not until your first antenatal scan that you find out there is something wrong. If you have a blighted ovum, a scan will show an pregnancy sac but no embryo. It can happen to anyone and really does happen for an unknown reason, with most women going on to have a successful pregnancy next time.
Having a miscarriage at any stage of pregnancy is very hard to cope with. Every miscarriage is different and there is no right or wrong way to feel about it. We thought it might be useful for you to have some downloadable leaflets on all aspects of experiencing a miscarriage, from medical information to your feelings and further investigations. These leaflets have been provided by the Miscarriage Association.
Stillbirth refers to the death of a baby after the 24th week of pregnancy who did not show any signs of life at any time after being born. In the UK, around one in every 1,000 babies is stillborn, but the risk is much higher for multiple pregnancies and babies whose mother’s smoke or who are over 35. The exact cause for stillbirths remain uncertain as it can be a number of different factors, but congenital abnormalities during pregnancy are a common cause.
The mother normally stops feeling her baby moving for a few days, and this can be confirmed with an ultrasound to listen for the baby’s heartbeat. Labour usually spontaneously starts after a couple of days but some women wish to be induced immediately or want to deliver their baby by caesarean section.
Is there anything I can do to prevent a stillbirth?
Attend all your antenatal check ups, as they can pick up on anything abnormal straight away. It is imperative that you and your partner stop smoking before you are pregnant. Smoking reduces the amount of oxygen in your blood stream, and your baby takes oxygen from your supply, so by smoking you are depriving your baby of essential oxygen to help it grow. Passive smoking can be just as harmful so if you and your partner smoke, stop immediately.
You can also keep an eye on your baby’s movements. Babies start to move from about 17-22 weeks onwards, and move roughly ten times a day. (Ten times is a rough estimate and some babies move more or less). Some babies are active babies and some are not so try not to panic if you can’t feel your baby moving for a while, or if it moves less then ten times a day.
You will get to know how active your baby is (especially at night) and will notice if the movement slows down at all. It may be useful to keep a chart of your baby’s movements if you are worried.
Report any pain or bleeding to your doctor or midwife, as this is often the first sign of something more serious.