Miscarriage

How common is miscarriage?

The charity Tommy's estimates one in four women experiences miscarriage at some point, and one in five pregnancies ends in this way.

The most common time for a miscarriage is in the first 13 weeks. This is termed an 'early' miscarriage.

What causes miscarriage?

Because miscarriage is common and most women go on to have a normal pregnancy later, a cause isn't usually sought until a woman has suffered three. Then tests may be done, including examination of tissue samples from the miscarried foetus.

However, it's thought that most miscarriages are the result of a genetic abnormality in the embryo or foetus.

Half of all early miscarriages are caused by a chance abnormality that's unlikely to happen again. Some genetic abnormalities, however, are inherited. If you have repeated miscarriages, this would be investigated as a possible cause.

Other less common causes of miscarriage include:

• Abnormal hormone levels - can affect the body's ability to nurture a pregnancy.
• Problems with the cervix - if it opens too soon it can lead to late miscarriage.
• Problems with the uterus - it may be unusually shaped, divided in two by a thin membrane or there may be fibroids, all of which can restrict space for the foetus.
• Blood clotting disorders - blood flow affects the way early pregnancy is nourished and, later, how the placenta safeguards the foetus.
• Infection - blood infections and food poisoning, such as listeria, can (very rarely) lead to miscarriage.

Other problems that can lead to the end of the pregnancy include:

• Blighted ovum - pregnancy hormones make your periods stop because an egg is fertilised and a sac develops, but the fertilised egg doesn't grow any further (also known as 'anembryionic pregnancy' or pregnancy without an embryo).

• Molar pregnancy - the trophoblast (which would become the placenta) becomes a mass of fluid-filled cells. There may be no embryo, or only the early signs of one. This is very unusual and requires careful monitoring as rarely a molar pregnancy can lead to a cancerous tumour.

• Ectopic pregnancy - the foetus starts to develop outside the womb, usually in one of the fallopian tubes. Symptoms include pain, fatigue and possibly bleeding. Surgery is required to end the pregnancy and prevent further complications.

Later miscarriage and stillbirth

Reasons for late miscarriages and stillbirths include:

• Poor nourishment by the placenta, which means the baby lacks oxygen and doesn't survive.
• An abnormality in the baby's development.

Sometimes babies die suddenly inside the womb without any apparent reason. In such cases, the mother often realises the baby has stopped moving - although you shouldn't assume this is the only reason for lack of movement if it happens to you. Babies vary in their activity levels, and may even sleep for long periods.

If you think your baby has stopped moving, call the hospital. If there's any concern, it may be suggested that you come to the antenatal clinic so they can listen to the baby's heart.

Miscarriage is not caused by lack of rest, lifting, stress, constipation, normal exercise or sex.

Who's at risk of miscarriage?

Although the reason for most early miscarriages isn't understood, you're at higher risk if you're older, have had fertility problems or previous miscarriages, if you're significantly underweight or overweight, if your partner's older, or if you drink alcohol regularly or in large amounts, or if who smoke.

One in four women who becomes pregnant will experience at least one miscarriage and some lose many babies (about one in 100 women suffers recurrent miscarriages).

Many more pregnancies are lost at such an early stage that the mother doesn't even realise she's pregnant. In fact, one estimate suggests 60 per cent of all conceptions, or potential pregnancies, are lost.

Working during pregnancy isn't relevant. A healthy diet appears to lower risk.

Symptoms of miscarriage

A woman experiencing a miscarriage may have any or all of the following symptoms:

• pain, caused by the contractions of the uterus
• bleeding from the vagina
• leaking of amniotic fluid (only happens in later miscarriages)

When the miscarriage takes place, the foetus is lost through the vagina, along with the placenta and membranes.

Occasionally, a 'missed' or 'delayed' miscarriage occurs. This is when the foetus dies but doesn't leave the womb. This may only show up during a routine scan.

Treatment of miscarriage

If you suspect you're about to have a miscarriage, speak to your doctor or midwife as soon as possible.

If you do miscarry, or know for certain a miscarriage is occurring, you may need to go into hospital to ensure all the pregnancy has come away. This is called 'evacuation of retained products of conception' and is done under general anaesthetic.

With a late miscarriage, you may be given medication to start labour or you can discuss letting nature take its course without inducing labour.

Support after a miscarriage

Miscarriage is always a sad event, and both you and your partner will need understanding, sympathy and support. You may want to talk over the possible reasons for the miscarriage with a doctor and ask about becoming pregnant again.

In most cases, there's no reason why you shouldn't go on and become pregnant again fairly soon. However, you may want to wait for your next period so you can tell when you'll be able to conceive.

With a late miscarriage, you might find it helpful to see and hold your baby, if that is possible. If your baby has grown enough and your loss has happened in hospital, you may be helped to dress them. A midwife or doctor may also take a photograph for you to keep. Many parents are glad to have had this opportunity to express their love and sadness.

You may be asked permission for a post-mortem examination. It may help to find out why your baby died. A post-mortem is done carefully and won't affect how your baby looks.

Recovering after a miscarriage

Physical recovery can take a few days. You'll probably start your periods again after four to six weeks.

Your emotional response will be individual to you and you may have a range of feelings. Fathers also grieve after pregnancy loss and may need space for their own feelings.

After a recently published study there has been some debate about when to start trying again, but the general consensus among specialists is still that, as long as you are emotionally ready, for most women there's no physical reason to wait before conceiving again. You may need time and space to come to terms with the emotional effects of the miscarriage. Talk to your GP if you are unsure.

Could I have prevented my miscarriage?

Miscarriage is almost always something that's outside your control. Your doctor may be able to reassure you about this. Don't blame yourself for something you couldn't prevent.

Pregnancy after a miscarriage

If the miscarriage was caused by hormonal or blood-clotting problems, you may be given medication to help prevent this happening again. If there was a problem with the cervix opening too soon, a stitch ('cervical cerclage') may be put in place to keep it closed.

If the miscarriage appears to have happened by chance - even if you've had two - your GP may just reassure you and tell you to try again.

If it looks like there may be an identifiable cause, or you've had more than two or three miscarriages, you may be referred for investigations.

Statistics show that even after three or four miscarriages the chances of a successful pregnancy are still higher than a further miscarriage.

Miscarriage advice and support

• The Miscarriage Association
• Helpline: 01924 200799 (Scotland: 0131 334 8883)
• Website: www.miscarriageassociation.org.uk

• Sands (Stillbirth and Neonatal Death Charity)
• Helpline: 020 7436 5881
• Email: helpline@uk-sands.org
• Website: www.uk-sands.org/