What’s covered?

What does a Miscarriage look like?

The occurrence of miscarriages is more common than you may think, with one in every five women experiencing a miscarriage at least once in their lifetime. The majority of miscarriages are known to occur during the first 12 weeks of pregnancy. The chances of losing your baby are much lower beyond 12 weeks in the case of a healthy foetus. Often women may experience what is termed a chemical pregnancy. Chemical pregnancies are miscarriages that occur even before their period and women, therefore, remain unaware of their miscarriage.

No matter how far along you are in your pregnancy, even if you are just a few weeks, a miscarriage can be hard to deal with. Therefore it is advisable to have a support system around you that you are comfortable confiding in.

What is a miscarriage?

Spontaneous natural abortion or the loss of pregnancy before 23 weeks is termed a miscarriage. A miscarriage is the most common cause of losing your pregnancy with 80% of women experiencing a loss during their 1st trimester. It has been observed that almost 26% of pregnancies end in a miscarriage.

Cause of miscarriage

Abnormality in the development of a foetus as a result of chromosomal irregularities is the most common cause of miscarriages. This is something that cannot be controlled by you or your partner, as it occurs naturally. Very rarely, a miscarriage can be caused by something done by you like lifting heavy objects for long, strenuous work or prolonged standing.

In some cases, underlying health issues may result in a miscarriage. Some health problems and lifestyle factors associated with miscarriages include:

Health conditions

• Uncontrolled Diabetes
• Obesity
• Kidney disease
• Lupus
• Hypertension
• Thyroid disorders or other hormonal problems
• Abnormalities in the shape of your uterus, the presence of fibroids, polycystic ovarian disorders (PCOD), or a weak cervix may also result in miscarriages.

Lifestyle Factors

• Smoking
• Increased consumption of coffee
• Malnutrition

Infectious Diseases

Certain infectious diseases may also lead to a miscarriage. It is best to consult your doctor as quickly as possible if you have acquired one of the following infectious diseases:

• HIV
• Malaria
• Bacterial infection of the vagina
• STIs caused by chlamydia, gonorrhoea
• Rubella
• Cytomegalovirus

You may also want to watch out for food poisoning caused by eating raw or poorly cooked meat or eggs, and unpasteurized milk and dairy products.

Medicines

It is best to avoid certain medications like ibuprofen, misoprostol, methotrexate, and retinoids as they have an increased of causing miscarriages.

The Age Factor

The age of a woman also plays a role in the risk associated with a miscarriage. As a woman ages beyond 35, the chances of a loss of pregnancy are higher. After the age of 40, almost 74% of pregnancies may end up in miscarriage.

In many situations, the cause of a miscarriage remains unclear. Many individuals try to find the cause of their miscarriage. It is best that you avoid blaming yourself as miscarriages rarely happen because of something you did. The chances are next to nil.

Signs and symptoms of a miscarriage

What does a miscarriage look like?

Miscarriage symptoms generally vary from person to person. It often depends on which stage of pregnancy you are in when the miscarriage occurs.

Some of the common symptoms of miscarriage include:

• Vaginal bleeding
• Abdominal cramps
• Excessive blood clots, along with loss of tissue from the vagina

Vaginal bleeding

This is the most common symptom of a miscarriage. Vaginal bleeding may initially start with light bleeding or spotting. For some women, a miscarriage may start with heavy bleeding. During a miscarriage, bleeding may often have a pink or bright red, to brownish-red colour. The red blood is indicative of fresh blood loss, whereas brownish blood may have remained in the uterus for a while.

How long will you have vaginal bleeding?

Vaginal bleeding may last for over a week or two. The heavy bleeding usually lasts for a few hours, which is followed by spotting. You may also have bleeding that stops for a day or two before you start to have bleeding again, which may last for a few days. Bleeding may be heavier if you are further along in your pregnancy. An early pregnancy loss will have comparatively lesser vaginal bleeding due to the foetus size being smaller. Although bleeding may last for a few days, you may have spotting for a longer period of around two weeks. Vaginal discharge during a miscarriage could be as dark as blackish purple in colour or may also be pinkish brown.

For some women, their miscarriage may be diagnosed on ultrasound, and tissue remnants may still be present in the uterus. Your doctor may prescribe a medication to encourage the passage of the foetus and tissue remnants. Vaginal bleeding may start within a few days, and last for around two weeks.

Important terms

Threatened abortion

In this type of miscarriage, a pregnant woman may experience vaginal bleeding. On clinical examination, your doctor may find the entrance to your cervix to be closed. On further investigation, an ultrasound may reveal a viable foetus.

Inevitable abortion

Inevitable miscarriages occur when a pregnant woman experiences vaginal bleeding and a clinical examination reveals an open cervical entrance. This indicates that tissue remnants and foetal products will soon pass from the vagina. A viable foetus may or may not be present. It is diagnosed with the help of a transvaginal ultrasound scan.

Complete abortion

This type of miscarriage involves the complete loss of foetal tissue and its products along with vaginal bleeding initially. On an ultrasound scan, no remnants of tissue are seen.

Missed Abortion

A missed miscarriage is very common and may occur even before your next period. It involves blood loss from the vagina. There may be a loss of tissue and other foetal products from the vagina along with blood and blood clots. A Clinical examination may reveal a closed entrance of the vagina. Further investigation with the help of a transvaginal scan may reveal the presence of tissue remnants related to conception. In a missed abortion, a viable foetus will not be present.

All being said, spotting or minor vaginal bleeding during the first trimester is considered normal for most women. Many women have some small amount of bleeding throughout the early pregnancy. So, light bleeding during the first three months of pregnancy may not always be a sign of miscarriage. However, it is best to consult your GP in such situations.

Abdominal Cramps

Although, most women are familiar with abdominal and pelvic cramps during various stages of their menstrual cycle. Cramps associated with miscarriage symptoms may feel different. The pain may be more intense owing to the increased dilation of your cervix.

Excessive blood clots and loss of tissue from the vagina

During pregnancy, your uterus undergoes many changes to accommodate the growing foetus. Your womb also develops in accordance with the foetus. It is for this reason that you lose much more than the blood you usually experience during a normal period. Vaginal bleeding during a miscarriage may also contain excessive blood clots which may sometimes be darker red in colour. You may also have a loss of tissue and other conception-related products from the vagina.

Other signs of a miscarriage include sudden loss of fluid from the vagina or not experiencing the usual symptoms of pregnancy such as tender breasts, and feeling sick or nauseous anymore.

Ectopic pregnancy

An estimated 1-2% of pregnancies in the world, may end up being ectopic pregnancies. An ectopic pregnancy occurs when the embryo fertilizes outside the uterus, most likely in one of the fallopian tubes. The occurrence of an ectopic pregnancy is a medical emergency and you must be quick to reach out to your doctor.

Symptoms of Ectopic Pregnancy include:

• Light vaginal bleeding or spotting
• Dizziness
• Fainting
• Severe abdominal pain which is usually on one side and may persist for long
• Vomiting
• Diarrhoea
• Shoulder pain

Diagnosis of a miscarriage

Once you consult your GP, they may recommend a few tests to be done. A miscarriage may be evaluated based on your symptoms, clinical pelvic examination, and additional investigations with the help of an ultrasound scan. You may be asked to undergo a blood test to check your levels of human gonadotropin hormone (HCG). Your HCG levels start to fall and become lower during a miscarriage. You may be required to repeat your blood tests after two days, to check if your hormone levels are continuing to reduce.

The ultrasound scan is usually performed transvaginal as it gives a more detailed report of your pelvic region. Although the transvaginal ultrasound scan is generally not a painful procedure, it may cause a mild degree of discomfort. During the scan, your doctor may look for remnants of tissue and conception products as in the case of a missed abortion. In the case of a threatened abortion, your doctor will also be able to detect a viable foetus in the uterus.

Management of a miscarriage

There are three modes of treatment for managing a miscarriage. Depending on the stage of pregnancy, amount of bleeding, medical comorbidities, and infection risk, your doctor may recommend the appropriate treatment option for you. The three modalities for managing miscarriage include:

1. Expectant management

Expectant management involves assessing your miscarriage with the help of a scan and waiting for the natural passage of tissue and products of conception. This method is usually considered for early pregnancy loss. Most women who undergo an early miscarriage tend to naturally lose intrauterine contents within a few weeks.

2. Medication

In some cases, your scan may reveal the presence of tissue related to pregnancy. But the cervical os may still be closed. In such situations, your doctor may prescribe a medication like misoprostol to dilate the cervix and encourage the passage of intrauterine contents. Your miscarriage may then progress with initial bleeding from your vagina within a few hours. You may also have abdominal cramps and bleeding may last for a few weeks. Complete expulsion of intrauterine contents may be achieved within 3 days. Misoprostol is available in tablet form and may be consumed orally or sublingually. It is more often administered vaginally in the form of a pessary.

3. Surgical Intervention

In some cases of miscarriages, complete expulsion of intrauterine contents may not be achieved even after two weeks. Surgical intervention may therefore be required. Surgery may also be the preferred treatment mode in case of excessively heavy bleeding, increased risk of infection, or other medical comorbidities such as heart disease or anaemia. Surgical intervention is achieved with the help of Dilatation and Curettage (D&C). This procedure may be performed either under local or general anaesthesia. Your doctor will widen the opening of your cervix to allow for the careful passage of the curette and complete passage of intrauterine contents. The contents within the uterus may then be gently scraped off with the help of a curette or a suction device to remove the contents of conception from the uterus.

Palliative care

It is best to avoid using tampons during a miscarriage. It is best to use sanitary pads that are softer and have increased absorbing ability.

You may take a pain relieving medication that contains paracetamol or ibuprofen to deal with abdominal cramps.

It may be better for you to avoid having intercourse at such times, as it could be painful.

Most women go on to have successful pregnancies even after a miscarriage. You may discuss with your doctor regarding how long you should wait before you can try to conceive again. Your doctor may sometimes ask you to wait for one to three cycles before you can again start to try for pregnancy. Recurrent miscarriages, although rare, may affect 1 in 100 women. With appropriate assessment and treatment, women go on to have healthy pregnancies even after recurrent miscarriages.

Dealing with the grief associated with a miscarriage can be stressful and takes your toll on your mental, emotional and physical health. It is best to talk about your feelings and seek help from the right person. It is always a great idea to rebuild your strength with a healthy diet and regular physical exercise.