More about missed miscarriages

Missed miscarriages are uncommon, occurring in about one-percent of all pregnancies, but when they happen, they can be devastating.

Why do missed miscarriages happen?

The majority of missed miscarriages occur in the first 12 weeks of pregnancy. This type of pregnancy loss often happens as a result of chromosomal abnormalities with the embryo, for example if the embryo has too many or too few chromosomes. Abnormalities like these make it impossible for the body to continue the pregnancy. In other cases, a missed miscarriage occurs for unknown reasons.

What are the symptoms?

Women who experience a missed miscarriage usually don’t have typical miscarriage symptoms like bleeding or pain. In most cases, the miscarriage goes undetected until a woman’s next appointment. Some women still experience pregnancy symptoms, which can happen if the placenta continues releasing the hormones that cause pregnancy symptoms. Unfortunately, the presence of pregnancy symptoms can make a missed miscarriage diagnosis that much more surprising.

How is a missed miscarriage diagnosed?

Most women discover that they have miscarried at their regular check-up, when the provider notices an underdeveloped embryo or a lack of fetal heartbeat in the ultrasound. To make sure there isn’t a heartbeat, the provider will send the woman to a radiologist for confirmation. The provider will also probably take a blood test to measure hCG levels (the hormone that is produced during pregnancy). If these are low and there’s no heartbeat to be found in the ultrasound, the provider will diagnose a missed miscarriage.

How is a missed miscarriage treated?

With a missed miscarriage, the body still has to expel pregnancy tissue, so after a diagnosis the next step is determining a way to remove this tissue. A provider might recommend any of the following for treatment.

• Wait and let the tissue expel naturally: Women may choose this option if they want to let the pregnancy end on its own, or if they don’t yet want to take medical or surgical action. This is usually not an option after eight or nine weeks, however.
• Medical treatment: Women can take a drug called misoprostol that helps the body expel the tissue. This might be preferable for women who are very early in their pregnancy, or for women who prefer treatment that is less invasive than a D&C.
• Surgical treatment: A provider might recommend a dilation and curettage (D&C) if a missed miscarriage occurs after eight or nine weeks. For this procedure, the woman is put under anesthesia, her cervix is dilated, and the provider uses a thin instrument to remove the pregnancy tissue from the uterus.

What comes after treatment?

Women who have been treated for a missed miscarriage should wait one menstrual cycle before trying again to conceive. It’s entirely likely, though, that women who experience a missed miscarriage will want some time to grieve before trying again. Miscarriages can be devastating, and this kind of miscarriage is made more painful by the fact that it often comes as a complete surprise, and sometimes happens for an unknown reason.

It takes some women a long time to recover from the loss, although the healing process is different for everyone. What is the same for every woman in this situation is that due to the traumatic nature of a missed miscarriage, as well as the hormone changes that take place during and after a miscarriage and make a woman vulnerable to postpartum depression, it’s important for women to find a way to process their feelings or reach out to someone who can support them while they grieve.

Sources

• Linda W. Prine, Honor Macnaughton. “Office Management of Early Pregnancy Loss.” Am Fam Physician. 84(1):75-82. Web. Jul 2011.
• “Miscarriages.” KidsHealth. Nemours Foundation, Jun 2015. Web.

What’s a miscarriage and what to do about it

Common physical symptoms of miscarriage include abdominal cramping, abdominal pain, lower back pain, and vaginal bleeding, which can range from spotting to heavy. Many of these symptoms can occur for other reasons during early pregnancy, so it’s best not to jump to conclusions. However, never hesitate to contact your healthcare provider if you are feeling something that doesn’t feel normal. Being familiar with these symptoms will help you know when you should take the following steps.

Call a provider

A healthcare provider can perform certain tests that confirm whether or not somebody is experiencing a miscarriage. The earlier these results come in, the faster the provider can treat whatever is going on, whether it’s a miscarriage or something else. These tests might include a pelvic exam, a blood test, or an ultrasound.

Ask a friend or family member for a ride

It’s unsafe for anyone to drive if they’ve been bleeding extensively. After the appointment, it also might not be safe to drive oneself home, depending on any procedures or medications performed or prescribed. Having a driver will make the situation much more manageable.

Notice the amount and duration of bleeding or spotting

Being able to describe the amount of vaginal bleeding a woman has experienced could be helpful for the provider to form a diagnosis. Bleeding that increases or stays bright red over time might indicate a problem, so if possible, women should try to notice these details and report them to their provider.

Having a miscarriage (or a miscarriage scare) can be so shocking and stressful that it’s understandable if women can’t remember to do certain things while it’s happening. This is completely understandable, but if possible, it can be beneficial for women to ask their provider if they think she should try to save any fetal tissue during the miscarriage. This might sound surprising, but fetal tissue that comes out with vaginal bleeding can be tested in a lab to help identify if there was a particular cause of the miscarriage. While not all women will be able to differentiate between vaginal bleeding and fetal tissue, if possible, it is helpful to save any of this tissue in a clean container and bring it with you to your appointment.

Think about comfort and cleanliness

Many may need need pads or panty liners to control the bleeding during a miscarriage. Tampons should not be used during a miscarriage, as they increase the risk of infection. They might also want to get bed liners for the bleeding, or a hot water pad for cramps. A provider might prescribe pain medication if the cramping or pressure is intense.

Moving forward after a miscarriage diagnosis

It’s often recommended that women abstain from sexual intercourse for a period of time after a miscarriage, usually anywhere from two to four weeks. When the bleeding stops, blood will be drawn to determine when the levels of pregnancy hormones return to zero. This helps her provider know when the miscarriage is complete.

Once a provider confirms that the miscarriage is safely complete, the healing process can begin. There’s no right or wrong way to grieve; there’s also no set date for when to start feeling better after a pregnancy loss. What’s most important is that she feels safe to grieve however she feels most comfortable, and also, that she has the support of friends, family, and her provider to help her through this difficult time.

Thinking about the possibility of miscarriage is difficult, but pregnant women can benefit from knowing the warning signs of certain situations that may happen during pregnancy. Just like fire drills and CPR training are valuable, knowing what to do during a possible miscarriage helps women get faster treatment if the situation ever arises.

Sources

• OBOS Pregnancy and Birth Contributors. “Miscarriage in the first trimester.” OurBodiesOurselves. Our Bodies Ourselves, Apr 9 2014. Web.
• “Miscarriage.” PlannedParenthood. Planned Parenthood Federation of America, Inc., 2016. Web.
• Mayo Clinic Staff. “Miscarriage: Symptoms and Causes.” MayoClinic. Mayo Foundation for Medical Education and Research, Jul 20 2016. Web.
• Robin Elise Weiss. “I’m having a miscarriage: What to do if you’re having a miscarriage.” VeryWell. About Inc., Jun 8 2016. Web.

What is ectopic pregnancy?

The majority of ectopic pregnancies occur in the fallopian tubes. Early symptoms include vaginal bleeding and lower abdominal pain in the first trimester. They are also dangerous, because if they rupture, the woman risks life-threatening internal bleeding and infection. A diagnosis and treatment can be lifesaving for women with ectopic pregnancies.

Diagnosis

If an ectopic pregnancy is suspected, a woman’s healthcare provider will usually use a combination of methods to make a diagnosis.

• Transvaginal ultrasound: For this test, the provider places a device in a woman’s vagina to get a clear picture of her reproductive organs. This kind of ultrasound is extremely effective for detecting ectopic pregnancy, but it doesn’t always pick up very early ectopic pregnancies. Because of this, sometimes an ultrasound is postponed for a few weeks until the pregnancy is easier to detect.
• Blood test: This helps the provider determine how much hCG (human chorionic gonadotropin, an important pregnancy hormone) is in the woman’s body. If the levels of hCG are lower than normal, this could indicate an ectopic pregnancy.

Treatment

Unfortunately, because ectopic pregnancies are life-threatening due to their risk of rupturing, they do have to be removed as early as it is safe to remove them. A woman’s provider will decide how to treat the ectopic pregnancy after confirming the diagnosis using ultrasound and/or blood tests. Treatment might involve medication or surgery, depending on how early the ectopic pregnancy is diagnosed, risk of rupture, and other considerations.

• Medication: Certain medications stop the growth of an ectopic pregnancy. The most commonly used is methotrexate, which is administered through an injection and helps embryonic tissue exit the body. Methotrexate causes symptoms that are similar to a miscarriage, with the most common symptom being abdominal pain or cramping. Studies haven’t shown a clear time interval that women should wait before trying to conceive again after methotrexate use, but providers may recommend waiting anywhere from three to six months before conceiving, in order to allow the medication to fully leave the body.
• Surgery: A laparotomy is the surgical procedure a healthcare provider might use to remove the developing embryo in an ectopic pregnancy. For the surgery, the provider will make an incision and remove the embryo, as well as repair or remove the fallopian tube if it’s damaged. After surgery, most women experience light vaginal bleeding possibly with some blood clots for at least a few weeks, which is normal. Women will also be instructed on how to keep the incision site clean, and to check for infection.

Future pregnancies

If the ectopic pregnancy is caught early and the fallopian tubes aren’t damaged, it is quite possible for women to have a healthy pregnancy in the future. If the tubes are damaged or removed, however, women may have more difficulty conceiving. If you are having difficulty becoming pregnant again after an ectopic pregnancy, it’s a good idea to meet with a fertility specialist, who can help you determine your next steps.

An ectopic pregnancy diagnosis is often accompanied by feelings of sadness, confusion, and grief. Because women with a history of ectopic pregnancy are at higher risk for ectopic pregnancy in the future, women should talk to their healthcare providers if they are considering pregnancy to make sure that it’s safe for them, both physically and emotionally, to start trying again.

Sources

• “Ectopic Pregnancy.” KidsHealth. The Nemours Foundation, 2016. Web.
• Mayo Clinic Staff. “Ectopic Pregnancy: Tests and Diagnosis.” MayoClinic. Mayo Foundation for Medical Education and Research, Jan 20 2015. Web.
• Karla Blocka and Brian Wu. “Quantitative hCG blood test.” Healthline. Healthline Media, Inc., Oct 8 2015. Web.
• “Ectopic pregnancy: Clinical manifestations and diagnosis.” UptoDate. UpToDate, Inc., Sep 2017. Web. Accessed 10/26/17. Available at https://www.uptodate.com/contents/ectopic-pregnancy-clinical-manifestations-and-diagnosis.

Should you try to conceive again after pregnancy loss?

To determine how ready you are to start trying again, ask yourself some questions about how you’re feeling and what you want. Some of these questions could be:

• How is my emotional health? Could I benefit from counseling?
• Have I talked to my healthcare provider about whether my body is physically ready for another pregnancy?
• Does my partner also want to keep trying?
• Right now, could I handle the emotions associated with trying to conceive (TTC)?
• If your next pregnancy will be considered high risk: Am I well enough right now to handle any stress that could accompany the next pregnancy?

It really is all about you

Once you are medically cleared, there’s no right or wrong time to be ready to TTC after a miscarriage. Every woman is different in how she handles the experience, so it’s up to you to determine if you’re emotionally and physically capable of TTC again. There’s nothing wrong with wanting to wait a little longer, but there’s also nothing wrong with being ready to try again earlier than you first expected.

Research suggests that pregnancy after miscarriage might be healthier if women wait less than a year to conceive again. According to Mayo Clinic, women who got pregnant again within six months of a miscarriage actually had fewer complications in their next pregnancy than did women who waited more than six months to conceive. You might not be ready to try again so soon, and that’s perfectly fine. But if you are ready, and your provider has given the go-ahead, know that it’s safe to do so.

What you’ll need

If you decide that you’re ready to try again, you’ll want to ensure that you’re physically and emotionally prepared for anything that comes your way while TTC. It’s a good idea to have all of the following in place.

• An exam from your healthcare provider: He or she will assess if you’re physically healthy and ready to try for another pregnancy.
• Support from a partner, friends, family, or a support group: You may find yourself needing people who can help you through this experience, whether they’re providing a listening ear or a ride to your provider’s office.
• Healthy lifestyle choices: Most miscarriages can’t be prevented, and a big part of healing involves understanding that the loss was no one’s fault. But taking precautions to reduce the risk of another miscarriage is always a good idea; this means not smoking, limiting caffeine and alcohol intake during pregnancy, maintaining a healthy weight and taking prenatal vitamins while TTC.

Staying positive and hopeful

Most miscarriages are followed by perfectly healthy pregnancies. This being said, many women are still nervous about trying to conceive again after a pregnancy loss. As you consider and possibly move forward to start trying again for a pregnancy, take some time each day to remind yourself of your own strength, and to focus on all the love and support that you have in your life right now.

Sources

• Felicia Nash. “Pregnancy after preterm birth or loss.” HandtoHold. Hand to Hold, 2012. Web.
• “Getting pregnant: When is the best time for a miscarriage?” MayoClinic. Mayo Foundation for Medical Education and Research, Mar 17 2016. Web.
• Chaunie Marie Brusie. “Tips for Conceiving After a Miscarriage.” Parents. Meredith Corporation, 2013. Web.

Factors that affect irregular menstruation after miscarriage

The first menstrual period after a pregnancy loss can be different from a woman’s normal period, and it can also be quite delayed. It’s also common for women to notice some spotting for four or more weeks after a miscarriage, so it’s important to recognize what is a menstrual period, and what is intermittent bleeding.

Two factors in particular influence a woman’s period after she has a miscarriage.

• Hormone levels: In the beginning of pregnancy, the placenta starts producing human chorionic gonadotropin (hCG), a hormone that helps the body support a fertilized egg. The purpose of hCG is to stimulate progesterone hormone secretion from the ovary. Progesterone helps maintain a pregnancy and prevents menstruation from occurring. After a miscarriage, hCG production declines because the placenta is no longer present, resulting in a decline in progesterone levels. Menstruation resumes once a woman’s hCG levels are back to zero.
• Length of gestation: If a woman experiences miscarriage early on in pregnancy, she’ll likely start menstruating again sooner than someone who miscarries later in pregnancy. The body needs a certain amount of time to heal depending on how far along the pregnancy was.

What is menstruation like after miscarriage?

Characteristics of menstruation can vary greatly from woman to woman after a miscarriage. The first period after a miscarriage is often heavier than what women normally experience. It also might cause noticeable cramping, and be slightly more clotted than usual. Some women, however, experience a first period after a miscarriage that is lighter than normal and cramp-free.

When can women start trying again?

In the past, healthcare providers have recommended waiting three or so months after a miscarriage before trying to conceive, but recent research supports the idea that it’s healthy to conceive in the cycle after a miscarriage as long as the woman is medically recovered and psychologically ready. Different healthcare providers will have different opinions on when it’s safe and healthy to try to conceive again, so you should ask your provider for their opinion.

Managing emotions during this time

Women cope with miscarriages in a variety of ways, and feeling confused after a miscarriage is very common. Some want to start trying again right away, while others feel extremely apprehensive about another pregnancy. There is no right or wrong way to feel. It is important for women to understand that they are not alone and seeking support from a partner, friends, or family during this time can be very helpful. Women who are more comfortable opening up to a professional may want to consider asking their heathcare providers for mental health counselor recommendations.

It may be difficult to express how you are feeling, but isolating oneself or blaming oneself can make the grieving process more difficult in the long run. Many partners of those who experience pregnancy loss also go through emotional difficulties, which can present in different ways. Having an honest conversation with your partner about how they’re feeling can be a helpful way to get everything out in the open, and allow you to better empathize with one another about the experience.

The bottom line: Things to know

It takes some time to physically recover after a miscarriage. What is considered a ‘normal’ recovery from miscarriage can range greatly – some women do not spot at all afterwards, while others may experience spotting for four or more weeks after. There are also a few different factors that affect when a woman will start menstruating again. Some women start menstruation again as early as four weeks after their miscarriage, while others take longer. Regardless, weekly checkups or a two- or six-week checkup after the miscarriage is usually recommended, depending on the individual situation, to help women and their providers ensure a healthy physical and emotional recovery.

Sources

• Bonnie Gibbs Vengrow. “Irregular Periods after Miscarriage: What You Need to Know.” Parents. Meredith Corporation, 2014. Web.
• Check Pregnancy Staff. “Period After a Miscarriage – 5 Things You Should Know About.” CheckPregnancy.com. Check Pregnancy, Aug 18 2015. Web.
• Fernanda Moore. “Healing After Miscarriage.” Parenting. Meredith Corporation, 2014. Web.

What to know about getting pregnant again

There are many variables that factor into a parent trying to conceive for a second time. Here are some scenarios to consider.

The easy way

Some individuals who had a particularly difficult time conceiving their first child report having a much easier time becoming pregnant the second time around. This could be for multiple reasons, ranging from just a lack of stress about conception, as they already have conceived their first child, to the fact that pregnancy hormones can help with endometriosis, which can hurt fertility. And other times, it’s just plain luck.

The hard way

On the other hand, even if you had a relatively easy time conceiving the first time around, becoming pregnant with your second child could take more time. For one thing, this time you’re trying to conceive as a parent, and your schedule may be much more hectic than it was the first time around. You may be more stressed (which doesn’t help with fertility), you may have less time to relax, and you may have less time alone with a partner. You’re also a bit older than you were the last time you tried, which could have an effect on your fertility.

Secondary infertility – which is difficulty conceiving a second child – is actually fairly common, and rates of this have increased moderately between 1990 and 2010, according to a study in PLOS Medicine in 2012. Secondary infertility is treatable by fertility specialists, who recommend seeking help on a similar timeline as when trying to have a first child: a year if you’re under 35, or six months if you’re older than 35.

Back to basics

Just like the first time around, making sure your general health is strong is a great place to start in boosting your fertility. Sticking to a nutrient-rich diet that includes folate and omega-3s is also a good idea, as is getting a moderate amount of exercise.

And while it’s definitely not impossible to get pregnant while breastfeeding – and many people certainly have great success doing so – nursing when you’re trying to conceive can decrease fertility and could delay conception. So you should consult with your healthcare provider about the best time to get back in the babymaking game and what breastfeeding might mean for your fertility.

How pregnancy loss may affect future conception

Most miscarriages are one time occurrences, and are not indicative of underlying issues. While prior abortions do not usually lead to pregnancy complications, some research does suggest a link between abortions and increased risk of vaginal bleeding, preterm birth, low birth weight, and placental problems. Consult your healthcare provider if you are concerned about the impact of a previous pregnancy loss on your fertility.

Potential miscarriage complications

Most women who miscarry go on to have healthy pregnancies, and less than 5 percent of women have two consecutive miscarriages. If you experience two or more miscarriages, consider consulting a healthcare provider about any underlying causes before attempting to get pregnant again. Tests can include blood tests, chromosomal tests, ultrasounds, and hysteroscopies to detect problems with your hormones, immune system, or uterine system.

While physical recovery from a miscarriage lasts only a few hours to a couple of days, the emotional impact of a miscarriage can continue for several months. Most women get their periods 4 to 6 weeks after pregnancy loss, and you can get pregnant the first time you ovulate after miscarriage. The World Health Organization recommends waiting 6 months before trying again due to the emotional and physical impacts of miscarriage.

Potential abortion complications

During a surgical abortion, the fetus is removed from the uterus using a vacuum device which, in some rare cases, can damage the cervix or uterus. In these cases, further surgery is needed to repair the damage before a woman can conceive again.

Most surgical abortions dilate the cervix, a process that can lead to weakening of the cervix muscles. Especially in women who’ve had more than one abortion, the cervix can open prematurely, known as cervical insufficiency, which can lead to a higher risk of premature birth in a later pregnancy.

Read more

• Previous miscarriage

Sources

• Mayo Clinic Staff. “Pregnancy after miscarriage: What you need to know.” Mayo Clinic. Mayo Clinic, 3/14/2013. Web.
• Sohinee Bhattacharya, et al. “Effect of miscarriage on future pregnancies.” Future Medicine. 5(1): 5-8. Web. 2009.

What’s a miscarriage?

Miscarriage, which is the unplanned loss of a pregnancy before the 20th week, is more common than most people realize. Although miscarriages can be challenging to cope with and hard to make sense of, the good news is that they usually do not impact future chances of conceiving.

Why do they happen?

There are a wide range of circumstances that can lead to miscarriage. Physical trauma like a serious fall or car crash can cause a pregnancy to fail, as could a pre-existing condition like diabetes. Chromosomal abnormalities within the embryo are also responsible for many miscarriages, as they basically prevent the embryo from developing as it should. But, unfortunately, not all miscarriages can be explained so easily, and it seems miscarriage may often be a natural part of life.

What are the chances of getting pregnant again if you’ve had a previous miscarriage?

Although some people may have hormonal imbalances or other conditions that heighten the likelihood of miscarriage, most miscarriages are independent events linked to random chance. According to the Mayo Clinic, less than 5% of people will experience two consecutive miscarriages, and only about 1% will suffer three. If an individual believes they may be more prone to miscarrying, their doctor can perform genetic tests, blood tests, or ultrasounds that can help determine whether a miscarriage was the result of a specific condition. However, doctors suggest that only individuals who have suffered multiple miscarriages take these tests, because the likelihood of consecutive failed pregnancies is so low. Though some couples who are TTC and have suffered a miscarriage may want to give it some time in between attempts to conceive because of the physical or emotional toll of miscarriage, there is no evidence that any waiting period is necessary before trying to conceive again.

Read more

• Does pregnancy loss impact future conception?

Sources

• Mayo Clinic Staff. “Pregnancy after miscarriage: What you need to know.” Mayo Clinic. Mayo Clinic, 3/14/2013. Web.
• “HTSP 101: Everything You Want to Know About Healthy Timing and Spacing of Pregnancy.” USAID. World Health Organization, n.d. Web.