Miscarriage

Miscarriage is such a tragic and unfortunate event. I think it’s a bit of a taboo subject, but that women should feel more comfortable to talk about.
Approx. 25% off all pregnancies end in miscarriage. It is possible that it is as high as 50% due to the fact that some women will never know they were pregnant and think that their period was just late or heavier than usual.
Most miscarriages are likely to have happened due to a chromosomal abnormality like down’s syndrome or due to a structural problem like a heart defect or a neural tube defect like spina bifida and that the outcome of this pregnancy will not be a healthy baby.
A miscarriage is NEVER your fault!
There are some risk factors though that are worth mentioning. This is because if they are well managed before getting pregnant, that risk for miscarriage will hopefully decrease.
Some of these include: Type 1 and 2 diabetes, over and under active thyroid, obesity, lupus, smoking and inflammatory bowel disease. One that we can’t change unfortunately is our age. Our eggs are as old as we are, which means the quality is worse with time. The risk of miscarriage with each pregnancy is 50% at the age of 40.
So how do you know if your pregnancy is ok or not?
A pregnancy with a heart beat can be seen on ultrasound at approx. 6-7 weeks. Before that, an ultrasound can pick up a sac in thur uterus when the pregnancy level is about 1800. Before that, the pregnancy level, or hCG should double every 48 hours- or at least increase by about 60%.
Once we see something on ultrasound the blood tests become irrelevant because they can continue to rise even if you’ve miscarried. So we see a gestational sac first, then a yolk sac think it, then a fetal pole, then a heart beat.
There are some ultrasound places around that specialise in obstetric and gynaecology ultrasound only. While they can be more expensive, they are the best places to go if there are concerns.
A miscarriage occurs when:
1. There is no heart beat and the pregnancy measures more than 7mm.
2. The gestational sac is empty and measures more than 25mm.
3. The have been 2 ultrasounds about 10 days apart with very little changes.
Most public hospitals provide an Early Pregnancy Assessment Service. This is where the emergency department will often refer you to. The GP also can if you have pain and/or bleeding. They will do a blood test, possibly an ultrasound and be seen by a Dr.
If you have miscarried, the are several options for treatment:
1. Watch and wait. This is 60% successful and gives your body a chance to do it in it’s own.
2. Medication- it is 85% effective in the first 48hrs of taking it. I won’t go into details here as it is an off level use and best discussed in a consultation.
3. Surgery- this a D&C, curette or curettage- they are all the same. This is when you are put to sleep and the uterus is emptied.
It is your choice. Regardless of what you choose, there is no impact on future pregnancies or conception. You can get pregnant whenever you are ready after a miscarriage.
Most importantly, it is NOT your fault! Talk about it, be open. I bet if you asked your mum, aunties, sisters and cousins you would be surprised at the responses.
All the best. Feel free to ask anything you like and I’ll respond as soon as I can.