A miscarriage is the natural end of pregnancy when the developing embryo or fetus is less than 20 weeks old and incapable of surviving outside the womb. Miscarriages that occur less than six weeks after your last menstrual period are referred to as an 'early pregnancy loss', whereas miscarriages that occur after this point are termed 'clinical spontaneous abortion'. If you are less than six weeks pregnant, you may not even realize you have been so, and may mistake the miscarriage for a heavy menstrual bleed.
More than three-quarters of all miscarriages occur in the first twelve weeks (also known as the first trimester) of your pregnancy. The causes of miscarriage in this first trimester are mostly because of chromosomal abnormalities. As expectant parents, you need to understand that such abnormalities occur at random and are unlikely to occur in future pregnancies. Sometimes a miscarriage in the first trimester can be due to a deficiency of the hormone progesterone. In future pregnancies, your doctor will prescribe a progesterone supplement to ensure your pregnancy proceeds as normal.
Miscarriages in the second trimester are generally related to problems with your uterus, placenta or cervix. Malformations in the umbilical cord can also cause a clinical spontaneous abortion.
While the large proportion of miscarriages are beyond your control, there are several risk factors for miscarriage. Among them are:
- If you are pregnant with twins, there is a greater chance of early pregnancy loss.
- If you are a diabetic who does not control your diabetes, there is a considerably heightened risk of miscarriage.
- Cigarette smoking, whether by you or your partner, increases the chance that your baby may not make it to term.
- Physical trauma, such as falls or blows, especially to your abdomen may also result in a miscarriage.
- Excessive caffeine or alcohol intake, obesity and exposure to certain chemicals will also enhance the likelihood of miscarriage.
The most obvious sign of miscarriage is bleeding. If you notice unusual bleeding during your pregnancy, you will need to talk to your doctor, who may perform an ultrasound scan to visualize your developing baby. In many cases, when a miscarriage occurs, your doctor may wish to undertake a procedure known as a curette. A curette ensures that all the baby's tissue is removed from your uterus, thereby preventing infection and scarring. After a miscarriage, your doctor will want to investigate why the miscarriage occurred and may recommend that you wait several menstrual cycles before attempting to become pregnant again.
Although the physical effects are usually mild, the emotional pain that you and your partner may experience can be quite severe. There is a natural tendency to blame yourself for somehow causing the miscarriage, although in many cases you will have had no control over or effect upon the health of your developing baby.
Your feelings of grief and loss may be very strong, so do not be afraid to seek counseling to help you and your partner through this difficult time. In many instances, there will be no reason for you not to become pregnant in the future, and every likelihood that the pregnancy will proceed smoothly.
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