MISCARRIAGE
About Miscarriage
Miscarriage is the loss of a pregnancy prior to 20 weeks. Loss of a pregnancy at or after 20 weeks is known as still birth. Approximately 20% of all pregnancies result in miscarriage, with the majority of miscarriages happening in the first trimester. The risk of miscarriage reduces significantly after 12 weeks.
There has historically been a stigma, and a silence associated with miscarriage. The topic is is still not widely discussed, which can make miscarriage a very isolating experience. However, support groups exist to help break down the stigma and silence, supporting couples who have experienced a miscarriage.
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There are 5 types of miscarriage: Anembryonic pregnancy, Early fetal demise, Incomplete miscarriage, Complete miscarriage and Chemical Pregnancy.
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Around 50% of first trimester miscarriages are due to anembryonic pregnancy. An anembryonic pregnancy is also known as a blighted ovum. This is whereby the fertilised egg implants into the uterus, but the embryo never develops.
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Early Fetal Demise or 'missed' miscarriage - when a fetus implants in the uterus, but does not survive, and is not expelled from the uterus (remains inside the woman's uterus).
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Incomplete miscarriage - Demise of the fetus whereby some but not all of the pregnancy tissue is expelled from the uterus.
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Complete miscarriage - Demise of the fetus whereby all of the pregnancy tissue is expelled from the uterus.
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Chemical pregnancy - A pregnancy that is non viable shortly after implantation so never progresses, and is expelled from the uterus, often without the woman ever knowing she was pregnant.
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Certain risk factors increase the chance of having a miscarriage. The risk of chromosomal abnormalities and the risk of miscarriage increases with age. The risk of miscarriage is approx 40% by age 40, and approx 80% by age 45. Exposure to teratogens or toxic substances also increases the risk of miscarriage. A teratogen is 'any agent that can disturb the development of an embryo or fetus. Teratogens may cause a birth defect in the child. Or a teratogen may halt the pregnancy outright. The classes of teratogens include radiation, maternal infections, chemicals, and drugs.'
Source MedicineNet.
Treatment Options
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If miscarriage is suspected a doctor will usually request an ultrasound be performed to assist in diagnosis. The ultrasound will generally be an transvaginal ultrasound, whereby the wand is inserted into the vagina.
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In the case of an anembryonic pregnancy, an empty gestational sac (no yolk, no embryo) is likely to be seen on ultrasound. However, since an empty gestational sac is also a feature of an early viable pregnancy, an anembryonic pregnancy can sometimes be mistaken on ultrasound for a viable pregnancy in its early stages. A yolk sac would generally become visible on ultrasound around week 5, and a fetal pole (first evidence of a developing fetus), usually would be visible on transvaginal ultrasound by around week 6, but can be as late as week 8 or 9. The outcome of the ultrasound, the symptoms, the amount of bleeding (if any), the medical risks, and patient preferences, will all play a key part in defining what treatment is prescribed next in the case where a miscarriage is suspected.
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Treatment options for miscarriage are dependent on the level of intervention. Passing the products of a miscarriage can often occur naturally without intervention (expectant management), or you may be advised by your doctor to take medication (medical management), or have a surgical procedure known as a dilatation and curettage (D&C) to clear pregnancy tissue from the uterus (surgical management). Unless you are prescribed to undergo a D&C for medical reasons, consider waiting for the miscarriage to take its course naturally. If you undergo a D&C procedure, there is a risk of infection which is estimated to be approximately 1 in 10.
Further information on Treating Miscarriage can be found on The Royal Women's Hospital website.
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Support & Self care
Self care, and getting the emotional support you need, is especially important at this time. Speak to a trusted friend, or a professional. You may have access to counselling & psychologist services at no cost, either through your employer, or your partner's employer, as part of the Employee Assistance Program.
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Supporting partners are often overlooked in the case of miscarriages, however, they are not shielded from their own sense of loss and grief at the news of the pregnancy being lost. It is important to check in with your supporting partner to ensure they receive the support they need to process and come to terms with what has happened.
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Support group Pink Elephants supports couples through the experience of losing a baby through miscarriage. Pink Elephants successfully campaigned for bereavement leave for miscarriage to be made available to all employees, with the 'leave for loss' campaign. The bill passed the Senate in September 2021 resulting in changes to the Fair Work Act, to mandate 2 days bereavement leave when a miscarriage occurs.
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Miscarriage is a traumatic event. In order to stay healthy and cope with the sense of grief and loss that arises, it's important to reduce all stressors: build a routine which promotes stress relief and relaxation; includes regular exercise; and also includes creative outlets you enjoy, for example: painting, playing music, writing, designing.
Top 5
1. Miscarriages are traumatic and emotionally difficult to process. The subject of miscarriage is not frequently discussed which can cause further isolation for those experiencing it.
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2. Approximately 20% of all pregnancies result in miscarriage. The risk of miscarriage is approx 40% by age 40, and approx 80% by age 45.
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3. Seek support whether professionally via a counsellor, or privately from a friend or family member. Remember partners feel the trauma of miscarriage too.
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4. Whilst miscarriage will usually be as a result of natural causes or chromosomal abnormality, certain factors can increase the risk of miscarriage, including age, and exposure to teratogens & toxic substances.
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5. Remember you are not alone. You deserve to be heard and to receive compassion and love during this process. Do not be ashamed to speak of your experience and connect with others.