What Are the Warning Signs of a Miscarriage?
Vaginal bleeding during pregnancy may be the first warning sign of a miscarriage. However, about 20% of women have vaginal bleeding during the first 12 weeks of pregnancy, and less than half of them miscarry. And, 75% of women who have had three or four miscarriages will go on to have a successful pregnancy.
If you are pregnant and bleeding vaginally, your health care provider will probably use an ultrasound to help assess whether your pregnancy is healthy. An ultrasound can help determine whether there is a fetal heartbeat and whether the amniotic sac that surrounds the fetus is normal. It can also tell whether the placenta is separating. An ultrasound will also help determine whether the pregnancy is ectopic (occurring outside the uterus, such as in one of the fallopian tubes) or whether you may have spontaneously aborted one fetus in a twins or triplets pregnancy.
A blood test can determine whether pregnancy hormones are being produced. A complete blood count (CBC) may be done to determine the degree of blood loss, and several other tests may be done to rule out potential infection. Your health care provider may also perform a pelvic exam, looking for signs of miscarriage, including changes to the cervix and ruptured membranes. Your blood type will also be checked. If you are Rh negative and have miscarried, an injection of rho (D) immune globulin will be given to help prevent problems associated with incompatible blood types in future pregnancies.
Because chromosomal abnormalities of the embryo are identified in more than half of miscarriages occurring in the first 13 weeks, doctors don't usually recommend special testing to look for a cause. The chances are excellent that the next pregnancy will be healthy. After three or more miscarriages, consider consulting an OB/GYN who specializes in or has extensive experience with miscarriage. Testing for clotting and bleeding disorders may be performed. Special hormone tests and exams looking for connective tissue disorders in the mother may also be given. You and your partner should also discuss undergoing genetic testing with your health care provider.
An X-ray or ultrasound of your reproductive organs may be recommended to look for structural differences that may have played a role in your miscarriages.
What Are the Treatments for Miscarriage?
If your health care provider determines that you are at risk for a miscarriage, he or she may recommend that you stay in bed, restrict activity, and abstain from sexual intercourse until the signs are gone. Some health care providers recommend this kind of bed rest, although there is no scientific evidence that it will prevent a miscarriage. It can also lead to increased risk for other health issues. More often than not, little can be done to stop a miscarriage.
Treatment of a miscarriage, once it has begun, depends on your symptoms. The primary goal of treatment during and after a miscarriage is to prevent hemorrhaging and infection.
If vaginal bleeding fills more than one super sanitary pad in an hour for 2 hours in a row, you should contact your health care provider. Heavier bleeding and cramping often indicate that a miscarriage is progressing. In most cases, a woman's body expels all of the pregnancy-related tissue. The earlier you are in the pregnancy, the more likely that your body will complete the miscarriage on its own.
If all pregnancy-related tissue wasn't expelled, a condition known as an incomplete miscarriage, you may need treatment to stop the bleeding and prevent infection. The most common procedure is a dilation and curettage (D&C), which involves the widening of the cervix and scraping of the uterine lining, called the endometrium. Sometimes suction is used along with scraping. This procedure can be uncomfortable, so it is most often done under general anesthesia. Another option is to take medication (misoprostol), which will help your body expel the tissue. Talk to your health care provider to determine the best treatment for you.
You may be given antibiotics or other medications afterward to minimize bleeding. Any additional vaginal bleeding should be monitored closely. You should also find out whether you are Rh negative. If you are, you probably will need a shot of Rh immune globulin vaccine to prevent problems in future pregnancies.
Call Your Doctor About Miscarriage If:
You have a fever or chills. Septic (infected) abortions are rare in cases of miscarriage, but a fever or chills may indicate infection. Any remaining pregnancy-related tissue must be removed, and you should take antibiotics to prevent serious illness.
Recovering Emotionally After Miscarriage
It's common to feel sad after losing a pregnancy. Many couples feel the grief of losing a child. This is normal, so allow yourself time to grieve. Consider joining a support group where you can talk about your experience and feelings with others who have had a miscarriage. Family and friends may want to be comforting, but they may feel like they don't know how best to respond. If you can, let them know that you need their support, tell them what they can do, and rely on their help.
Miscarriage can be a physical and emotional challenge for you and your partner. The stress in a relationship can be high. Some people may be tempted to blame themselves or their partner for the miscarriage -- even though it's highly unlikely that either of them did anything to cause the miscarriage or could have done anything to prevent it.
Keep in mind that there is a good chance that you will give birth to a healthy baby in the future. Only about 20% of women who have had a miscarriage have another miscarriage the next time they become pregnant.
Although it's possible to become pregnant right after a miscarriage, most experts recommend waiting until after you have had one or two normal menstrual cycles before trying to get pregnant again.