When 29-year-old Michele Wang (name changed) suffered a miscarriage last December, there was nothing that could have prepared her for the loss. Even on her 21st week of pregnancy, she couldn't identify her miscarriage symptoms and subsequently lost her unborn child.
Unfortunately, Wang is not the only one to have this experience. One in every six women in the world suffer from a miscarriage. More often than not, they fail to identify the miscarriage symptoms and continue with their pregnancies, which leads to serious medical complications.
Miscarriage symptoms: Everything you need to know about it
A miscarriage is medically defined as the loss of pregnancy during or before the 20th week. It's usually your body's way of rejecting a pregnancy that wasn't viable from the beginning.
Unfortunately, a miscarriage can be emotionally and physically draining for a woman. You might even blame yourself for it or fail to identify miscarriage symptoms. But know that a miscarriage is nobody's fault. It is, in fact, quite common.
An increased risk of miscarriage is not linked to anyof these listed causes:
- A mother's emotional state during pregnancy, such as being stressed or depressed
- Having a shock or fright during pregnancy
- Exercise during pregnancy; however, it's best to discuss with your GP or midwife about the type and amount of exercise that is suitable for you during pregnancy
- Lifting or straining during pregnancy
- Working during pregnancy – or work that involves sitting or standing for long periods
- Having sex during pregnancy
- Travelling by air
- Eating spicy food
As stated, one in every six woman globally suffers from this loss. In some cases, it is also possible for women to lose their baby even before they know of the pregnancy.
Miscarriage is more common for women over 30. Dr Neema Sharma, senior consultant, obstetrics and gynaecology, Fortis Hospital, Delhi, explains, “In women under 30, one in 10 pregnancies can end in a miscarriage. For women aged 35-39, two in 10 pregnancies can end in miscarriage and in women over 45, more than half of all pregnancies can end in miscarriage.”
What causes a miscarriage?
Typically, miscarriages happen when a fertilised egg is unable to develop naturally inside the uterus. And, while it is natural for the most part, during the first and second trimester, certain changes in the body can lead to a miscarriage.
We spoke to Dr Ritambhra Bhalla, a consultant paediatrician and obstetrician at Fortis Hospital in Mohali, India to better understand the causes.
A miscarriage mainly occurs either in the first trimester or the second trimester. It can be due to the following as explained by Dr Bhalla:
1. Causes of miscarriage during the first trimester
- Chromosomal abnormality. This type of genetic abnormality leads to defects in the formation of the embryo. In such a case, "The couple needs to undergo an evaluation for defects which is generally done if you have three or more losses. A single abortion is considered sporadic and does not warrant genetic evaluation," explains Dr Bhalla.
- Hormonal imbalance. A hormonal balance may be due to thyroid imbalance or even Polycystic ovary syndrome (PCOS). "To prevent this, the hormones have to be controlled as soon as pregnancy is diagnosed," she notes, adding that defective pregnancy hormones are generally corrected by progesterone support.
- Antiphospholipid antibody syndrome. In this syndrome, blood coagulation takes place, which results in defective blood flow. "This causes a compromised supply and ultimately causes the death of the foetus. Treatment includes timely evaluation and putting the patient on blood thinners," says Dr Bhalla.
2. Causes of miscarriage during the second trimester
- Defect in the structure of the uterus
- Bicornuate uterus in which the pregnancy bed is defective
- Incompetence of cervix, when the cervix which holds the pregnancy is weak.
- Defects in the foetus or when it is not compatible to life, as in cases of Down’s syndrome and even the congenital heart defect called Tetralogy of Fallot
- Infections like the TORCH group of infections (Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus, and Herpes infections) which are tested with the TORCH screen or syphilis which can be evaluated through the VDRL test
Once the baby is miscarried, it is crucial that the dead fetus is taken out of the woman's body. That's because it can become poisonous and may become fatal for the woman. Additionally, it may even hinder a future pregnancy.
Therefore, it's crucial to identify miscarriage symptoms.
What are the common miscarriage symptoms?
Honestly, it's not easy to tell when a miscarriage is taking place or did take place. Often times, it doesn't occur as a flash event at once. Rather, it may be the result of a series of events. The experience and physical changes in each woman during a miscarriage is also different.
We spoke to gynecologists to understand the most common miscarriage symptoms, such as:
1. Cramps
This is the most common symptom of miscarriage. It is characterized by a pain in the lower abdomen or the pelvic region.
“Pain in this particular region could feel like a dull ache or even period-like cramping,” says Dr Sharma. She advises that in both cases, it's best that the expecting mother gets an immediate checkup.
In addition, she must also keep a track of any blood spotting throughout her pregnancy as that is also an indication of a pregnancy loss.
2. Bleeding
Vaginal bleeding can be another symptom. Bleeding per vaginum, as it’s called, is light spotting or a brownish discharge. This is also indicative of a miscarriage. In addition, some women may also experience heavy bleeding.
“It could be continuous or irregular with the passage of blood clots or fetal tissue or discharge of fluid from your vagina,” says Dr (brig) R.K. Sharma, head of department, IVF, Primus Super Speciality Hospital, New Delhi.
Although it is crucial to note that for many women light bleeding is common during the first 12 weeks.
3. Abdominal pain
If you experience a sharp pain in the lower abdomen, it could be a sign of miscarriage. However, not all abdominal pains are indicative of a miscarriage.
If you feel discomfort it could also be because of the growing foetus. As the baby grows in your uterus, your body muscles stretch to accommodate it. But if you have one-sided pain, then it’s always better to consult a gynecologist.
4. Decrease in nausea and vomiting of pregnancy
You may think, well, this is a good thing. But that's not always the case.
“You could experience a decrease in pregnancy-related symptoms such as nausea and vomiting of pregnancy (NVP) or breast pain,” says Dr (brig) Sharma. This, he says, is also one of the many miscarriage symptoms.
These signs are associated with an increased risk of pregnancy loss. So, if you do not experience any of these or they abruptly stop, you must consult the gynecologist.
However, remember that some women do not experience natural NVP during the entire tenure of their pregnancies.
5. No movement of fetus
Usually, fetus movement is associated with the growth of the baby inside the womb. It is also a good indicator that pregnancy is going as desired.
Generally, you may experience the kicks any time between 16 weeks and 25 weeks. But if you experience the flutters before 16 weeks, it is perfectly normal as well and there is nothing to worry about.
After 24 weeks of pregnancy, you will feel the kicks quite often. But if you stop feeling any movement or kicks after this, you must consult with a gynecologist.
Miscarriage symptoms in the second trimester
Dr Sharma also notes that that miscarriage can also occur in the advent of the following medical conditions:
- Lifestyle diseases. If a woman has poorly controlled diabetes, severe high blood pressure, kidney diseases and lupus, the chances of miscarriage rise.
- Infections. Some infections including rubella, cytomegalovirus, toxoplasmosis, syphilis, malaria during pregnancy or right before implantation can also lead to a miscarriage.
- Anatomy of the mother. Another reason for a miscarriage is distortion of the womb structure cavity, possibly due to fibroids (non-cancerous compact tumours made up of muscle cells) or an abnormally shaped womb.
- Weakened cervix. Typically, a woman's cervix begins to thin down and then open (efface and dilate) for the baby to come out. But if the cervix opens early, and without any contractions during the second trimester, it is called weakened cervix. This can also lead to a miscarriage.
Ideally, if you notice any of these, you should report back to your doctor, who can diagnosis the miscarriage with a pelvic examination and an ultrasound.
Unfortunately, a miscarriage is not treatable. Once you have lost the fetus, it cannot be revived. However, there are ways to prevent a miscarriage from happening in the first place.
How do you prevent a miscarriage?
If you are planning a baby, there are precautions that you can take in order to reduce the chances of a miscarriage. Here are a few things you must bear in mind:
- Do not smoke during pregnancy.
- Avoid drinking alcohol or using illegal drugs during pregnancy.
- Eat a healthy and balanced diet with at least five portions of fruit and vegetables each day.
- Try to keep your safe from infections during pregnancy, such as rubella. You can consult with your doctor on precautions you can employ for the same.
- Avoid certain foods during pregnancy, which could make you ill or harm your baby.
- Try to gain healthy weight before getting pregnant and exercise after consultation during the gestation period.
- Incorporate a daily prenatal vitamin or folic acid supplement and ideally begin a few months before conception. Again, consult with your doctor to better understand what you need during the pregnancy.
If unfortunately, a miscarriage could not be prevented, and you want to try again, make sure you speak with your doctor before doing so.
How long should you wait before trying again?
The World Health Organisation (WHO) recommends waiting at least six months before you try to conceive again. But other experts and studies have found no evidence to support delaying a conception.
The "Right from the Start" study published in The American Journal of Epidemiology reportedly proved that "women with intervals of less than three months had about a seven percent risk of repeat miscarriage, compared with a 22 percent risk for women who waited six to 18 months weeks after the miscarriage to get pregnant again."
So if a woman is healthy and feels ready, there might be no need to wait to conceive after one miscarriage.
As with any woman who has lost a baby, it is important to relax and de-stress. If the pregnancy loss happened because of hormonal imbalance, then it is important to correct it. "Make sure you have multivitamins, vitamin D, folic acid. The couple must also wait for at least three months before planning their next pregnancy," advises Dr Bhalla.
Role of your partner after a miscarriage
Any family that goes through a miscarriage needs to heal emotionally as well as physically. But the partner plays a very important role in coping with the loss.
Often times, the husband hides the pain and tries to be strong for the wife. It is imperative that they both talk about the situation and accept the loss. If needed, you must also consider counselling.
Just remember that a miscarriage is not the end of your pregnancy journey. You can try again and hopefully with better care, you can have your little bundle of joy in your arms sooner than you imagined.
Sources: WebMD, Healthline, NCBI, Reuters
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Republished with permission from: theAsianParent Singapore