Episode 47: September 15, 2011
by Sanaz Majd, MD
One of the most difficult and saddening visits I encounter are with my patients who’ve experienced a miscarriage. I have found that no matter the situation, whether the pregnancy was planned or not, whether the patient was initially happy or unhappy at the news of the pregnancy, the miscarriage can be emotional, distressing, or even devastating for many women. For some, it may bring a mixed bag of emotions, including relief.
All of these emotions are normal.
Studies show that up to one third of all pregnancies end in an unfortunate miscarriage. And 25% of all women have experienced one. It’s such a common occurrence, and that’s why I’d like to spend today’s episode discussing this difficult topic from a medical standpoint.
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Causes of Miscarriage
A miscarriage is defined as a pregnancy loss prior to 20 weeks of gestation. And over 50% of all miscarriages are caused by chromosomal abnormalities in the fetus. There are numerous abnormalities that can arise in the genes of a fetus, for instance, Down’s Syndrome. However, babies with Down’s are able to survive the pregnancy. But there are many other chromosome combinations that are NOT compatible with life, and the fetus is not able to fully form. This causes a miscarriage.
Other less common causes include:
Maternal infections (such as syphilis or toxoplasmosis from handling kitty litter)
Maternal anatomic deformities (such as in congenital anomalies of the uterus or an incompetent cervix)
Maternal health problems (such as lupus, or uncontrolled thyroid disorder)
Exposure to toxins (such as illicit drugs, alcohol, or cigarettes)
Notice that daily routine activity, intercourse, and exercise are not on the list of common causes. I say this because I hear so many women erroneously blame themselves for a miscarriage – “If only I hadn’t walked so much that day,” or “I wish I would have rested more.” Daily routine activity is not a cause of miscarriage, and it’s important to realize that you were not at fault. Bed rest and vitamin supplementation have not been proven to prevent miscarriages.
Symptoms of Miscarriage
The most common symptom that often scares women in their first trimester is vaginal bleeding. Even though 25% of all pregnant women experience some form of vaginal bleeding or spotting, not all vaginal bleeding is from a miscarriage. However, it should always be taken seriously and your doctor should be contacted immediately.
Here are some other red flags for possible miscarriage that all pregnant women should be aware of during the first trimester:
Abdominal pain or cramping
Sensation of a pelvic “drop”
Diagnosis of Miscarriage
Your doctor will likely perform a pelvic exam and speculum exam, in addition to ordering a possible blood test and/or ultrasound. A blood test measuring “HCG” (Human Chorionic Gonadotropin) levels every two days will show a steady decline through time. A lack of fetal heartbeat on a fetal heart monitor is also another indication, as is an absent heartbeat or gestational sac on an ultrasound.
Management of Miscarriage
There are various ways to manage a miscarriage once it’s been diagnosed. Doctors no longer jump to the “D&C” (Dilitation and Curettage) that is performed in the operating room. Nowadays, most women can simply just “wait it out” and pass the miscarriage without surgery or medications (but under medical supervision of course). Unfortunately, it may take several weeks for complete passage to occur.
The other option is to use a prescribed medication called “misoprostol” that is inserted vaginally. This causes a more rapid passage, but also some cramping and bleeding within several hours of taking it.
Aspiration (or removal) of the miscarriage contents in the doctor’s office is another way to manage a miscarriage. This is done as an alternative to a D&C in those with excessive bleeding.
Just remember, it’s absolutely normal to feel sadness, grief, relief, or any combination of emotions after a miscarriage. If you need help getting through this difficult time, please make sure you discuss this with your doctor.
Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.