Miscarriage

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.

Miscarriages occur in 8-20% of clinically-recognized pregnancies:

80% of these happen in the first 12 weeks of pregnancy
The rate of loss for unrecognized or “chemical pregnancies” is 13-26%
The overall risk of loss after 15 weeks is relatively low

Causes of miscarriage

Though it is difficult to identify what causes all miscarriages, most pregnancy losses are thought to be due to chromosomal defects.

Chromosomal Abnormalities > 60%
Maternal: Structural Abnormalities
Uterine Fibroids, Septums, and Adhesions
Trauma
Acute Infections
Blood Disorders (Thrombophilia)
Unexplained

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, your desires, the size of your pregnancy, and your provider recommendations.

Factors associated with miscarriage

There can be many factors that affect the probability of having a miscarriage. In many cases, there is more than one factor that comes into play. If you know what these factors are, you can be more cautious.

Age: Miscarriage risk increases with age. The risk can be as high as 40% at 40 years old and 80% after 45 years old
Previous miscarriage: The rate of miscarriage increases with the number of previous miscarriages: 20% after one, 28% after two consecutive, and 43% after three or more consecutive losses
Smoking: Increases the risk of loss
Alcohol use: Studies have been inconsistent in proving that alcohol can cause an increased rate of pregnancy loss. One study indicated that there was an increase in miscarriages among 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. You should call the office or the 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 passed tissue and store it in a clean and dry container and bring it to the office so that it may be sent out for pathological identification. You may call the office or the on-call doctor at any time for direction and advice.

Office Number: 404-299-9724 | After Hours Number: 404-487-2450

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 entirely come out.

A D&C is an outpatient 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.

Alternatively, we offer appropriate candidates a procedure called a Mechanical Vacuum Aspiration (MVA). This procedure is similar to the D&C, but it can be done in the office under local anesthesia. Recovery and warning signs are similar to those of the D&C procedure.

With either of these procedures, 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 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 is a normal response. In the days and weeks after your pregnancy 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 these symptoms are severe or that you are unable to cope with these feelings, please call and make an appointment to talk to a provider in our practice. We will be able to help you and make any other referrals you may need.

The next pregnancy

Your next period should come within 4-6 weeks after your miscarriage. We recommend that you use contraception 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 do not desire to become pregnant again.