Antinatal Care Frequently Asked Questions about Miscarriage Can an Early Pregnancy Unit tell me why I had a miscarriage? If I’ve had one miscarriage does that make me likely to have another miscarriage? What is a threatened miscarriage? What’s an inevitable miscarriage? What’s an incomplete miscarriage? What’s a complete miscarriage? What’s a missed /delayed miscarriage? Can I be having a miscarriage if I still feel pregnant? I’ve been told I’ve lost the pregnancy. What happens next? Is there a risk of infection if I decide to wait for a miscarriage to happen naturally? Which type of treatment involves the least bleeding? How do I choose which treatment to have? What if the option I want isn’t available? What is anti-D? How can I help someone who’s just had a miscarriage? How can I support the partner of a woman who’s just had a miscarriage? Can an Early Pregnancy Unit tell me why I had a miscarriage? One in four pregnancies ends in miscarriage and we often don’t know why, particularly when the miscarriage was early. The vast majority of miscarriages happen because of some kind of abnormality with the developing pregnancy and these abnormalities occur randomly. If a woman has three miscarriages the early pregnancy unit can arrange for tests to see if there is particular reason and can then offer appropriate treatment. Sometimes women feel they must be to blame somehow and that they must have done something wrong while they were pregnant, but this is seldom the case. If I’ve had one miscarriage does that make me likely to have another miscarriage? Miscarriage is common. It is estimated that as many as half of very early pregnancies miscarry around the time of the first missed period. About one in four pregnancies miscarry in the first 12 weeks of pregnancy. The chance of having another miscarriage in the next pregnancy is the same. Even after two miscarriages the chances are that the next pregnancy will be fine. What is a Threatened miscarriage? This is when there’s bleeding in early pregnancy, but the cervix (the entrance of the womb) is still tightly closed. A heartbeat is seen on the scan and the chances are that the pregnancy will continue. What’s an Inevitable miscarriage? This is when there’s bleeding in early pregnancy and the cervix (entrance of the womb) is found to be open. The pregnancy will more than likely be lost. What’s an Incomplete miscarriage? This is when a miscarriage has occurred, but there’s still some pregnancy tissue left in the womb. What’s a Complete miscarriage? This is when the pregnancy has been lost and the womb is now almost empty. What’s a Missed / Delayed miscarriage? This is when a pregnancy stopped developing some weeks before, but there was no bleeding or just a small amount of dark brown blood. Some women notice their symptoms of pregnancy suddenly seem to have stopped, but if there haven’t been any symptoms, this sort of miscarriage is sometimes discovered for the first time during a routine booking scan in the antenatal clinic. Can I be having a miscarriage if I still feel pregnant? You can still feel pregnant because pregnancy hormones can continue to be released for a time after the pregnancy has been lost. This is why a scan is needed to tell whether the pregnancy is continuing. I’ve been told I’ve lost the pregnancy. What happens next? There are usually three options. Your doctor will advise you is one of these is more suitable in your case, but often it’s for you to decide which option you prefer. 1) Natural miscarriage (also known as conservative management) Here your body is left to sort itself out and the pregnancy will eventually miscarry. It’s hard to predict exactly when it will happen. For most women it happens in less than two weeks, but occasionally it can take longer. You may have heavy bleeding with clots and period-pain-like cramps. During the actual miscarriage, it can be as much as one sanitary pad an hour for several hours. About two hours after the tissue passes the pain and heavy bleeding usually settle down. You will be given a number to call if you have any concerns. Afterwards you will usually be offered another ultrasound scan to make sure your womb is empty. Is there a risk of infection if I decide to wait for a miscarriage to happen naturally? The risk of infection is small, but these are the symptoms to look out for. - feeling unwell - flu-like symptoms - a high temperature or fever If you have any of these symptoms contact your Early Pregnancy Unit and if you have an infection they will give you antibiotics. 2) Surgery This is an operation usually carried out either under general anaesthetic (you are asleep) or under a local anaesthetic with some sedation. If you choose surgery you will be assigned a time to the hospital. Sometimes your surgeon will also be doing emergency surgery that day which could mean you have to wait for your operation. Arrangements vary from hospital to hospital, but the staff will explain how the system works at yours and will organize your appointments for you. During the operation the opening of the cervix is gently stretched and an instrument is passed into the womb to remove the pregnancy tissue. This takes 5-10 minutes. Although complications are rare any surgery involves some risks: • Occasionally this surgery can cause infection or bleeding • Very rarely one of the instruments could make a small hole (perforation) in your womb • Occasionally the womb doesn’t get emptied completely and the piece of tissue left behind can lead to heavy bleeding or an infection. Then you may need to have the womb emptied for a second time and take a course of antibiotics. As long as you are well enough you will be able to go home a few hours later. 3) Medical Management This is where you’re given medication to help pass the pregnancy tissue. There are two sets of drugs used. Some early pregnancy units use both, others just use one. One is an anti-progesterone which tells the body it’s no longer pregnant by blocking the hormone progesterone. You can go home after you’ve taken the tablet and carry on as normal. One in twenty women miscarry at this point before the next set of drugs is taken. Most women come back to the clinic two days later to be given a drug which causes the womb to cramp, causing any remaining tissue to come out. You might spend the day in hospital and miscarry there or some units will let you go home. If you go home you will be given a number to call if you have any concerns. In 80% of cases the combination of these drugs will cause the womb to empty, but if it does not staff will help you to decide on another option. Which type of treatment involves the least bleeding? The bleeding seems to last for two to three weeks whichever of the three types of treatments you choose, but it does get much lighter after 7 to 10 days. . But during the actual miscarriage itself (while the tissue is passed out) there can be severe cramps and heavy bleeding with clots. There can be so much that you need one new sanitary pad an hour for several hours. At this time it can be good to get someone to be with and if you have children to get someone to look after them for you. How do I choose which treatment to have? Sometimes there will be a medical reason why one treatment suits you best. More often it’s down to personal preference. Some women prefer to let nature takes its course and would rather be at home. Others choose surgery or medical management so that they can know when it will happen and that it will be over and done with. There’s not one way that’s better or worse. Often it comes down to the practicalities of your life The choice often depends on practicalities such as whether you can take time off work, are due to go on holiday or whether you have small children to look after at home. What if the option I want isn’t available? You can go back to your GP and ask if you can be referred to an early pregnancy unit which can offer you your chosen course of action. What is anti-D? This is an injection that a few women will need depending on their blood group (Rhesus negative), how many weeks pregnant they are and the amount of bleeding they have had. If you need this injection the staff at the Early Pregnancy Unit will tell you. Anti-D is injected to avoid the woman developing anti-bodies which might interfere with a future pregnancy. How can I help someone who’s just had a miscarriage? Women vary a lot in their emotional responses to miscarriage. It’s not unusual to feel very sad, to search for explanations, to blame yourself and to feel resentful of people who appear to have had babies easily. Many women grieve in the same way that they would after a bereavement. Sometimes those around them can find it hard to understand why they are so upset and to show empathy, but these feelings are very real. Sometimes women start to feel a bit better after a few weeks, but then feel particularly anxious and unhappy again 6 to 8 weeks later – often when their first period returns or they have started to try to get pregnant again. All these responses are perfectly normal. The best way of supporting women through this difficult time is to listen sympathetically and not to minimize the way they feel. For many women and their partners this is much more than a loss of a foetus. It’s the loss of the future they had imagined for themselves. Although the miscarriage won’t be forgotten, most women do feel better after a time. If depression and anxiety become so bad that a woman finds it hard to carry on with everyday life then it’s a good idea to seek advice from your GP. Your local Early Pregnancy Unit will be able to tell you about local counselling services and other sources of help available. How can I support the partner of a woman who’s just had a miscarriage? Partners can often feel helpless because things of gone wrong and there was nothing they could do to prevent it. As well as trying to care for their partner they also have their own feelings to deal with. This was their loss too. Some men try to stay strong for their partners which can make it appear that they’re not upset about the loss. To avoid such misunderstandings it’s important for the partners to talk about how they’re feeling. Friends and family often save their concern for the woman, which again can be hard for men to deal with. So if you know a man who’s just experienced a miscarriage it’s important to ask him how he’s coping too. Often men find that if they raise the subject with other men they know who have children they’ll find that some of those men have experienced miscarriages too. For further information, please refer to the Miscarriage Assocation web site by folowing this link. Miscarriage Assocation

Other Articles • Your pregnancy week-by-week • Frequently Asked Questions about Miscarriage • Ectopic Pregnancy • Molar pregnancy • Medical Terms Explained