Causes, Tests and Treatments
There are different types of miscarriage with differing symptoms. The most common sign of miscarriage is vaginal bleeding. This can vary from light spotting or brownish discharge, to heavy bleeding and bright red blood. The bleeding may come and go over several days. Light vaginal bleeding, however, is relatively common during the first trimester of pregnancy (the first 12 weeks) and does not necessarily mean you are having a miscarriage.
Other symptoms of a miscarriage include:
- cramping and pain in your lower abdomen
- a discharge of fluid or clots from your vagina
- no longer experiencing the symptoms of pregnancy, such as morning sickness and breast tenderness
Please find below some information regarding miscarriages and investigations available.
This occurs when all the products of conception are passed from the womb. This usually occurs before 6-8 weeks of pregnancy.
In some cases a woman will experience the symptoms of miscarriage, such as pain or bleeding, without miscarrying and will carry the baby to full term. This is not usually associated with any problems later in the pregnancy or in the baby.
An incomplete miscarriage is when, following a miscarriage, not all the pregnancy tissue is passed from the womb and the womb may need to be cleaned medically or surgically.
In this situation the pregnancy fails, but instead of being passed out of the womb it is retained inside. Often the symptoms of pregnancy, such as nausea and breast tenderness, will disappear but there is no vaginal bleeding. It is diagnosed by an ultrasound scan.
This is a rare condition affecting one in every 2,000 pregnant women in which the placenta starts to grow very abnormally and the embryo dies. The placenta continues to grow, becoming distended with cysts. The first signs are usually vaginal bleeding, a larger than expected womb and severe symptoms of pregnancy, especially morning sickness. These symptoms are all due to the production of excessive amounts of the pregnancy hormone Human Chorionic Gonadotrophin (hCG).
Recurrent miscarriage is diagnosed when there have been 3 consecutive miscarriages. It is a very distressing situation and is poorly understood. Causes can include:
- Abnormalities of the uterine cavity, such as fibroids or intra-uterine adhesions.
- Cervical incompetence, where the cervix is weak and cannot retain the pregnancy.
- Infections in the mother account for 15% of recurrent miscarriages.
- Abnormal development of the foetus and hormonal problems account for approximately 3%.
Even though it can be a very depressing situation, the probability of achieving a successful outcome in subsequent pregnancies is still more than 50%.
It’s important to know that that your miscarriage is very unlikely to have happened because of anything you did or didn’t do, although sadly a cause is often not found.
Roughly 3 in every 4 miscarriages happen in the first trimester and are usually due to problems with the unborn baby (fetus). Miscarriages that occur during the second trimester of pregnancy (between 14-26 weeks) may be the result of an underlying health condition in the mother. The main causes of miscarriage are:
- Genetic: In almost half of all early miscarriages, the baby does not develop normally right from the start and doesn’t survive.
- Hormonal: Women with very irregular periods may find it harder to conceive and when they do are more likely to miscarry.
- Immunological/blood-clotting: Problems in the blood vessels which supply the placenta can lead to miscarriage, especially if the blood clots more than it should.
- Infection: Minor infections are not harmful but a very high temperature and some illnesses or infections, such as German measles, may cause miscarriage.
- There are three main structural causes of miscarriage:
- If the cervix (the neck of the womb) is weak it may start to open as the uterus becomes heavier in later pregnancy and this may lead to miscarriage.
- If the uterus has an irregular shape there may not be enough room for the baby to grow.
- Large fibroids (harmless growths in the uterus) may cause miscarriage in later pregnancy.
It is usually recommended you wait 7-14 days after a miscarriage for the tissue to pass out naturally, this is referred to as expectant management. If the pain and bleeding have lessened or stopped completely during this time, this may mean the miscarriage has finished.
This involves taking tablets that cause the cervix to open allowing the tissue to pass out. A medication called Mifepristone is used first followed 48 hours later by a medication called Misoprostol. The effects of Misoprostol tablets usually begin within a few hours. You will experience symptoms similar to a heavy period, such as cramping and heavy vaginal bleeding.
In some cases surgery is used to remove any remaining pregnancy tissue. This is known as a uterine evacuation. Surgery involves opening the cervix with a small tube known as a dilator and removing any remaining tissue with a suction device under general anaesthetic. The pregnancy tissue is then sent for laboratory examination and possibly a chromosomal check.
You may be advised to have immediate surgery if:
- you experience continuous heavy bleeding
- there is evidence the pregnancy tissue has become infected
- medication, or waiting for the tissue to pass out naturally, has been unsuccessful
If you think you are having a miscarriage, or are concerned and would like a check-up, we can offer you an immediate review involving:
Pelvic Ultrasound Scan
This is carried out using a small probe inserted into the vagina (transvaginal ultrasound). The scan will be used to check the development of your baby to confirm viability.
You may also be offered blood tests to measure hormones associated with pregnancy, such as Beta-Human Chorionic Gonadotropin (Beta hCG) and Progesterone. These may be repeated after 48 hours if the levels are borderline or if it is very early in your pregnancy.
Sometimes a miscarriage cannot be confirmed immediately using ultrasound or blood testing. For example, a heartbeat may not be noticeable if your baby is at a very early stage of development (less than 6 weeks). If this is the case you may be advised to have a further ultrasound and/or a pregnancy test in a week or two.
If a miscarriage is confirmed then we will arrange the necessary management, ideally as soon as possible.
If you would like to schedule an appointment to meet with Mr Downes, please call 020 7935 7341 and we will endeavour to book you an appointment the same day.