Loss of pregnancy before 20 weeks is called a miscarriage. Spontaneous miscarriage is the most common complication of early pregnancy and the rate decreases as the pregnancy progresses.
- Occurs in 8-20 % of clinically recognized pregnancies:
- 80% of these will occur in the first 12 weeks of pregnancy.
- The rate of loss of unrecognized or “chemical pregnancies” is 13-26%.
- The overall risk of loss after 15 weeks is relatively low.
Causes of Miscarriage
It is difficult to identify what causes all miscarriages, but most pregnancy losses are thought to be because of chromosomal defects that cause errors in growth and development.
- Chromosomal Abnormalities > 60%
- Maternal: Structural abnormalities
- Uterine Fibroids, Septums, adhesions
- Trauma: generally related uterine procedures: amniocentesis, CVS
- Acute Infections
- Blood disorders (Thrombophilia)
The use of birth control pills, over-the-counter remedies, exercise, sex or stress does not cause miscarriages.
Loss of viability of the pregnancy usually occurs between 6-12 weeks. Recognition may not occur until weeks later. The course of treatment that you take will depend on your current condition, desires, the size of your pregnancy and your doctor’s recommendations.
Factors Associated with Miscarriage
- Age: miscarriage risk increases with age. Can be as high as 40% at 40 years old and 80% after 45 years old.
- Previous miscarriage: The rate of miscarriages increases with subsequent pregnancies…20% after one, 28% after two consecutive and 43% after three or more consecutive losses.
- Smoking: Heavy smoking (10 cig/day) increases the risk of loss.
- Alcohol use: Studies have not been consistent in proving that alcohol can cause increase rate of pregnancy loss. One study showed that there was an increase in miscarriages in women who drank more than 3 drinks a day.
- Cocaine use
- Non Steroid Anti-inflammatories (NSAIDS: Ibuprofen, Advil, Motrin): May be associated with an increased risk of miscarriage if used around the time of conception. The prostaglandin in NSAIDs may interfere with proper implantation.
- Caffeine: The risks of miscarriage increase with high levels of consumption….>300mg /day.
Miscarriage at Home
You may first note mild vaginal spotting and / or cramping. This bleeding and cramping will increase at which point you may expel the tissue of the pregnancy. During the miscarriage, you may bleed heavily with large clots, soaking a pad every 10-20 minutes. The cramping may be significant. Tylenol and a heating pad are okay to use at this time. Avoid aspirin and ibuprofen products until the miscarriage is complete. You should call the office or on call doctor if the heavy bleeding does not improve after two hours.
Once you have passed the pregnancy tissue, you will notice a decrease in bleeding and cramping. You may collect the tissue passed and bring it to the office so that it may be sent for pathological identification.
You may call the office or the on call doctor at anytime for direction and advice.
Office Number: 404-299-9724
D&C at the Hospital
A D&C is a surgical procedure performed under anesthesia to remove tissue from the uterus that has not started to or that has not completely come out.
A D&C is an out-patient procedure that lasts for about 15-20 minutes. You usually go home about 1-2 hours after the procedure is completed. Most women return to light duties and activity the next day. Cramping and bleeding are common after a D&C. You may have bleeding for up to 2 weeks after your procedure.
We recommend that you do not put anything in the vagina (no tampons, douching or intercourse) until you are seen again in the office.
Warning Signs After a Miscarriage or D&C
Call you the office if you have:
- Temperature > 100.4
- Nausea and vomiting for > 12 hours
- Increasing pain or bleeding
- Foul smelling vaginal discharge
Coping With the Loss of Pregnancy
Emotional healing can take longer than physical healing. Grief after a pregnancy loss can be a normal response. In the days and weeks after your loss, you may experience a loss of appetite, emotional changes, irritability, sleep disturbances, and inability to focus on daily tasks. This is all normal and should resolve in a few weeks or months.
If you find that you are unable to cope with these feelings, you can make an appointment to talk to a provider in our practice at which time we may make other referrals that best fit your needs.
The Next Pregnancy
Your next period should come within 4-6 weeks of your miscarriage. We recommend that you have protected intercourse until after you have had a normal period. You may continue prenatal vitamins during and after this time. You may also discuss birth control at your post-miscarriage visit if you desire.