3.org/TR/xhtml1/DTD/xhtml1-strict.dtd"> Understanding Miscarriage

Understanding Miscarriage


The term 'miscarriage' refers to a pregnancy that is lost before 24 weeks of gestation. Miscarriage occurs after approximately 50 per cent of conceptions. In many cases it is not recognized because it happens very early on, within a fortnight of conception, and is interpreted as a late period. Miscarriage is clinically diagnosed in only 15 per cent or so of pregnancies.

Types of miscarriage

There are several types of miscarriage, and these are classified according to the manner in which they occur. Threatened miscarriage In this situation, bleeding occurs at some point during the first few months of pregnancy but there is minimal pain, the cervix remains closed and an ultrasound scan confirms a viable pregnancy.

In more than 90 percent of cases the pregnancy will continue normally and a repeat scan to check the fetal heart will provide reassurance for the mother.

Inevitable miscarriage This involves a considerable amount of bleeding and the cervix will be open. There are two types:

Causes

Over 50 percent of miscarriages in early pregnancy are a result of the baby having abnormal chromosomes. Less common are maternal factors, such as:

In rare cases, miscarriage is caused by a congenital abnormality of the uterus or cervix. A miscarriage in mid-pregnancy may be due to the cervix dilating unusually early (cervical incompetence), possibly caused by previous cervical surgery, for example a large cone biopsy after abnormal smear tests.

Treatment

In some cases, miscarriage can be allowed to progress on its own with no further intervention. If treatment is required or requested, this can be either by the use of drugs to encourage the uterus to expel the products of conception or by an operation (called an evacuation of retained products of conception, or ERPOC).

Treatment

In some cases, miscarriage can be allowed to progress on its own with no further intervention. If treatment is required or requested, this can be either by the use of drugs to encourage the uterus to expel the products of conception or by an operation (called an evacuation of retained products of conception, or ERPOC).

Recurrent miscarriage

This term is used when three or more consecutive miscarriages occur. This happens in 1 per cent of women and will need further investigation to try to identify the underlying cause.

Causes

Possible causes of recurrent miscarriage include:

Prevention

Up to 80 per cent of women who have had recurrent miscarriage will go on to have a successful pregnancy with just supportive treatment, such as an early scan followed by serial scans for reassurance. Often no specific therapy is necessary. In the rare case of antiphospholid syndrome (see above), evidence shows that taking aspirin and heparin early in pregnancy can improve the outcome of the pregnancy.

Trying again

There are no strict rules about when to try for another baby after a miscarriage. Many women are advised to wait for a few months, mainly so that their cycle can return to normal and to make it easier to know how pregnant they are when they manage to conceive.

Support groups

After the sadness of a miscarriage, women need both emotional and physical care. The hospital or doctor can give advice on counselling, and support groups.

Polycystic ovary syndrome

PCOS is common (affecting 1 in 10 women at some stage) and is characterized by multiple small cysts within the ovary (seen on ultrasound scans) and features such as period problems, reduced fertility, excessive hair growth and acne. Many women with PCOS are also overweight.