Miscarriage

What is a miscarriage?

A miscarriage refers to a pregnancy loss before 24 weeks. 85% of miscarriages are early.

An early miscarriage is when a pregnancy is lost at 12 weeks or earlier. 

A late miscarriage is when a pregnancy is lost after 12 weeks to 24 weeks.

Why did I have a miscarriage?

Often there can be no cause found.

For early miscarriages, it is thought to be a problem with the baby’s chromosomes or abnormal fetal development – the older the mother is, the higher this risk is. 20% of pregnancies end up in early miscarriages and it is usually not related to what you could have or did/did not do.

For late miscarriages, there can be many causes e.g. abnormally shaped uterus, incompetent/short cervix, antiphospholipid syndrome, polycystic ovary syndrome (PCOS), placenta failure, infections, poorly controlled medical conditions e.g. diabetes or thyroid disease, smoking or alcohol use.

Am I having symptoms of a miscarriage?

Some women with a miscarriage may experience no symptoms at all. Some women with a miscarriage will experience abdominal cramps and/or vaginal bleeding (some may not have any symptoms) – however not all women with these symptoms are necessarily having a miscarriage. You should contact your gynaecologist if you have these symptoms. 

What tests do I need? 

Your gynaecologist will need to perform a vaginal examination and a ultrasound scan. In some cases, you may be required to do some blood tests.

I have been diagnosed with a miscarriage. What are my options now?

That depends on whether you have an early or late miscarriage, and what symptoms you are currently having. 

Early miscarriage

1.Wait and see

You may need to wait for some time before the bleeding starts. You should expect some cramps (these may be painful enough for you to need painkillers) and the bleeding to be heavier and longer than your usual periods (up to 2-3 weeks). Your gynaecologist will schedule a follow-up visit to check the process has been complete. If your uterus is not empty, you may need to go on to medical or surgical options. 

2. Medicines 

This has a success rate of 85%. Misoprostol is a tablet taken orally that induces abdominal cramps and bleeding in a few hours. You may need to take more than 1 tablet every few hours. You should have some painkillers on standby. The bleeding should reach a peak within a day or two and you may pass some tissue out, after which your bleeding and cramps should decrease significantly. Side effects include fever, nausea, diarrhea and vomiting. Your gynaecologist will schedule a follow-up visit to check the process has been complete. If your uterus is not empty, you may need to go on to surgery. 

3. Surgery 

This has a success rate of 95% and involves cleaning out the uterus under anaesthesia in day surgery. Surgery is typically done if that is your preference, if the above 2 options have failed, or in cases of heavy prolonged bleeding or infection. Oral or vaginal tablets will be needed before the operation to soften the cervix. This operation is safe and commonly done, with a low rate of complications which your gynaecologist will discuss with you. 

Late miscarriage

As the pregnancy is now bigger, you will need to be admitted to the hospital, where vaginal tablets will be inserted every few hours. This will induces abdominal cramps and bleeding and may feel like a mini-labor, with before the pregnancy is passed out. You may experience fever, nausea, vomiting and diarrhea. 

20% of women may need surgical evacuation of uterus if the process is not complete.

What happens after my miscarriage? 

After your miscarriage process has finished, you may experience light bleeding for the next 1-2 weeks. You should expect your next period to come in a month’s time (depending on how regular your periods were before getting pregnant). 

You can have sex and try for your next pregnancy as soon as you and your partner feel ready – the earliest will be after your next period – but do remember to give yourself some time to grieve as a going through a miscarriage can be difficult.

If you wish to wait for some time before you attempt another pregnancy, you should use a reliable birth control method. 

When should I be worried?

Contact your gynaecologist early if you:

• Are soaking pads every hourly, or are continuously passing out clots 
• Have a high fever   
• Have severe abdominal cramps  
• Have smelly vaginal discharge 
• Are feeling unwell 

Am I at a higher risk of a miscarriage next time? 

If you have had 1 or 2 early miscarriages, you are not at a higher risk of another miscarriage. You are more likely than not to have a successful pregnancy the next time. Do remember your pre-conception care. If you have had more than that, speak to your gynaecologist as you may require further checks. 

If you have had 1 late miscarriage, you will need further checks to establish the reason behind your miscarriage – depending on the cause, there may be things you can do before or during your next pregnancy to reduce the chance of this happening again.