Miscarriage is the term used to describe the loss of a foetus within the first 20 weeks of pregnancy. It's sometimes referred to as pregnancy loss or spontaneous abortion (medical terminology).
When miscarriages do occur, it is often during the first trimester of pregnancy (12 weeks). The causes include:
- Chromosomal abnormalities that result in abnormal development of the fertilised egg
- The egg not implanting properly (as is the case with ectopic pregnancies)
- Thyroid disorders, which can result in an overproduction of hormones that make implantation unfavourable
- Uncontrolled diabetes
- Lifestyle factors such as smoking, alcohol and drug abuse
- Physical conditions like uterine abnormalities, for example, polyps
- Certain immune disorders are also thought to play a role although there is debate around this issue.
What are its symptoms?
Miscarriage symptoms include the following:
- Vaginal bleeding: This may be light or heavy, persistent or irregular
- Blood clots or tissue that is grey in colour passing from the vagina
- Abdominal pain: This normally occurs after bleeding, and comes in the form of cramps or a feeling of pressure in the pelvic area. The pain may start a few hours or a few days after bleeding
- Lower back pain
- Disappearance of pregnancy signs that were being experienced, for example, nausea or breast tenderness
Please note that brief, light spotting is normal during early pregnancy, but if you experience persistent bleeding accompanied by pain, see your doctor.
How is it diagnosed?
It’s possible that a miscarriage may be first suspected during a routine prenatal visit, when the doctor can’t hear the baby’s heartbeat or notices the uterus is not developing as it should. An embryo or foetus may stop developing a few weeks before symptoms of bleeding and cramping occur.
If miscarriage is suspected, diagnosis would include an ultrasound and foetal heart scanning. Your doctor may do a blood test, known as an hCG (human chorionic gonadotropin) blood test – hCG is the hormone produced during pregnancy.
What are your treatment options?
If miscarriage occurs, there are a number of treatment options:
- Expectant management: This is the ‘wait and see’ approach where no active treatment is sought. The pregnancy tissue passes naturally – this may take a few days or as long as three to four weeks.
- Dilation and curettage (D&C): During this surgical procedure, which is performed under anaesthetic, the remaining pregnancy tissue is removed.
- Medication: Medicine can be given to speed up the process of passing the pregnancy tissue.
These options can be discussed with your doctor. In some cases, a woman may feel the ‘wait and see’ approach is the best, as it gives her the time to grieve.
It's important to be aware of the following symptoms that may indicate infection, and medical treatment should be sought immediately:
- Severe abdominal or shoulder pain
- Passing large clots or increased bleeding
- Fever and/or chills
- Dizziness and/or fainting
- Diarrhoea or pain when passing stools
Can it be prevented?
It’s reported that miscarriage occurs in roughly 15% of pregnancies. While it is difficult to predict which pregnancies will not go to full term, there are a number of risk factors to be aware of. These include:
- A history of three or more miscarriages
- Uncontrolled diabetes
- Exposure to dangerous chemicals or certain medications
- Certain bacterial or viral infections in pregnancy
- Obesity
- A blood-clotting disorder
- Alcohol use, cigarette smoking and drug use
- Age: Studies suggest that women over 35 have an increased risk of miscarriage as the incidence of chromosomally abnormal eggs increases.
Discuss any concerns you may have with your gynaecologist, who can advise you on preconception and prenatal care.
For more info
For assistance with bereavement, contact the South African Depression and Anxiety Group.
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