What You Should Know About Miscarriage
A recognized pregnancy is everything from a positive urine pregnancy, to seeing a heartbeat by ultrasound. Once a heartbeat is seen on an ultrasound, the chance of common or early miscarriage goes down to about Five percent (one in twenty), rather than fifteen percent.Miscarriage is common. Fifteen percent (one of every seven) recognized pregnancies end in miscarriage. This common miscarriage will happen within the first three months of pregnancy. Three months is approximately 13 weeks gestation, which is 13 weeks since the first day of the last period.
Miscarriage diagnosis is often straightforward. A fetus measuring greater than 7 weeks gestation by ultrasound without a heartbeat is a miscarriage. In other circumstances the diagnosis requires multiple blood tests and ultrasounds. There are two typical scenarios when ultrasound is used to diagnose miscarriage.
- FIRST: The ultrasound finds a fetus that measures greater than 7 weeks size without a heartbeat.
- SECOND: Two ultrasound measurements, at least one week apart, show no fetal growth, and no fetal heartbeat.
- UNCERTAINTY: Some normal healthy pregnancies will not show a fetal heartbeat before 7 weeks fetal size.
- BLOOD TESTS: The pregnancy blood test, known as “BETA HCG” is not as reliable as ultrasound for miscarriage.
Once we establish the sure diagnosis of miscarriage, or ectopic pregnancy, there are numerous treatment options. Sometimes the pregnancy will resolve naturally, other times we must help complete the process with medicine or surgery.
The miscarriage is not over or completed until the pregnancy tissue inside the uterus comes out. The tissue in the uterus is mostly placenta. Before 10 or 11 weeks fetal size, there is almost no baby tissue to see. The tissue will come out either on its own, like a really heavy and really crampy period, or with a surgical procedure called a D&C. Patients have some choice, regarding how the miscarriage is completed.
WAIT & SEE: One may elect to let nature complete the miscarriage. The time course is not predictable. Miscarriage, passing tissue, can happen any day at any time. It may occur soon, or it can take weeks. There is no test to predict when it will happen.
Risks: When miscarriage at home goes smoothly the bleeding and cramping last for only a short time and all the tissue passes on its own. Complete resolution is marked by light tapering bleeding and no more cramping. When miscarriage at home goes poorly, the bleeding and cramping just keep going. Some tissue comes out, but women have persistent cramping with off and on bleeding. In these cases surgery is often necessary.
Surgery: When miscarriage is managed surgically, we Dilate the cervix and gently empty the uterus with an instrument known as a Curette, known as a D&C. Surgery is done for a few reasons:
- Nature is taking too long to complete the miscarriage.
- Nature can not finish the miscarriage, marked by persistent cramping and bleeding which is sometimes heavy.
- Patient prefers to schedule the procedure rather than waiting for the miscarriage to happen at home, or at work, or anywhere. Even when the miscarriage is completed at home, the bleeding and pain can be more than you expect.
Complication of D&C: Sometimes surgery does not get all the tissue out, and the patient may need a second procedure to finish emptying the uterus. Also, there is an uncommon but serious problem of developing scar tissue inside the uterus after this surgery called Asherman’s Syndrome, and it can result in infertility.
Vaginal Pill: This pill is used to bring on a miscarriage. Once the miscarriage gets going, its just like a natural miscarriage, with all the bleeding and cramping. If the pill is going to do something it usually happens within six hours of taking the dose. A second dose can be taken the next day. Like wait and see, the pill can work, or not.
When to Decide: There is No Medical Urgency in deciding what to do. Any time a patient decides to have the surgical procedure, she need only call the office to get this arranged. Logistically, the procedure is scheduled at the hospital, during the week. Patients need to be fasting, which is nothing to eat or drink for 6 hours prior to the procedure.
A miscarriage is complete when the uterus is empty. The HCG (human chorionic gonadotropin, a hormone produced during pregnancy) will return to zero or negative.
Symptoms of Unfinished Miscarriage: Persistent cramping is highly suggestive of an incomplete miscarriage. Bleeding after a miscarriage can continue for 2-3 weeks, but it typically less than 10 days. The HCG blood test is not as reliable as cramping to determine if a miscarriage is finished and patients with persistent cramping need to make an appointment for evaluation. This may still happen, even after a D&C procedure.
Next Period: Women can expect the next period to come within 5-8 weeks of the miscarriage. Bleeding before 3 weeks after the miscarriage is not considered a period. If you have not gotten a period by 8 weeks you should make an appointment.
Ectopic pregnancy should be considered a type of miscarriage. An ectopic pregnancy develops outside the uterus, usually in the fallopian tube. Ectopic pregnancy is more likely in women who previously had pelvic infections like chlamydia and gonorrhea, pelvic inflammatory disease (PID), a burst appendix, and women who get pregnant after tubal ligation…[read more]
Recovering from miscarriage and D&C is relatively straight forward. There are not very many special things to do, or Not to do. Basically, the bleeding and the cramps should go away, and in a day or two, you should feel normal. If you are not getting better…[read more]
Women should wait for One Normal period after miscarriage before getting pregnant again. The normal period will clean out and reset the lining of the uterus, preparing for a healthy pregnancy. There may be a higher chance of another miscarriage if the next pregnancy follows too close to a miscarriage…[read more]
If you are suffering from consecutive miscarriages there may be alternative treatment options for you. There are a number of interventions we use to make it more likely you will have a become and stay pregnant. It will be important to discuss whether one of these treatment options is right for you, and why…[read more]