What is a miscarriage, why do they happen and what to do in case one happens?

Bleeding or abdominal pain during a pregnancy could indicate a miscarriage or a missed miscarriage, so it is recommended to seek medical attention immediately in case of these symptoms. A miscarriage or missed miscarriage is diagnosed on the basis of symptoms and ultrasound findings.

The rate of miscarriage depends on the age of the woman: it has been found that the chance of a miscarriage before the 20th week of pregnancy is 10% for 20-year-old women, 50% for women between the ages of 40 and 44 and more than 90% for women aged 45 or older. Most miscarriages happen when the woman doesn’t know that she is pregnant. The cause of a miscarriage or missed miscarriage in the first few months of a pregnancy is usually a random genetic deviation that would not have allowed the pregnancy to develop further. Because of this, it is impossible to prevent a miscarriage or missed miscarriage with medication. A miscarriage or missed miscarriage during the early stages of a pregnancy is a common occurrence and does not indicate any health problems on behalf of the woman or the man, does not require additional examination and does not raise the risk of miscarriage or missed miscarriage in the next pregnancy.

Miscarriage or spontaneous abortion – a non-viable pregnancy spontaneously leaves the uterus either partially or fully, accompanied by bleeding and abdominal pain. A very early miscarriage can also manifest itself as a menstruation that is bloodier than usual.

Missed miscarriage – the pregnancy is no longer viable and isn’t growing anymore, but hasn’t left the uterus yet. Sometimes it is not possible to conclusively diagnose a missed miscarriage with a single examination and repeated ultrasound scans may be needed after 1 or 2 weeks. A missed miscarriage may be accompanied by bleeding and abdominal pains, but it can also occur without any symptoms.

The following factors may contribute to a miscarriage or a missed miscarriage:

  • the woman’s age – the risk of a miscarriage and a missed miscarriage increases with age
  • sperm quality (quantity, motility)
  • smoking
  • consumption of alcohol
  • drug use
  • a very low or very high body weight
  • fibroids and congenital peculiarities

If a doctor or midwife has diagnosed a miscarriage or a missed miscarriage, different treatment techniques may be used depending on the woman’s condition and the severity of the symptoms:

Observation – if there is no major bleeding or signs of inflammation, the pregnancy tissue can be expected to exit the uterine cavity on its own. In cases like this, the woman is usually called back to a repeated appointment.

Medication-based tactics – in the case of more serious bleeding or if the pregnancy tissue still hasn’t started exiting the uterus during the observation period, when, if the woman wishes, medications that encourage uterine contractions are administered in order to speed up the exit of the pregnancy tissue from the uterus.

Surgical tactics – If there is heavy bleeding or if medication-based tactics haven’t achieved the complete emptying of the uterus, it may be necessary to remove the pregnancy tissue through surgical means, i.e. by performing surgical abrasion or “cleansing”. It is performed under general anaesthesia administered by intravenous injection.

Treatment methods are decided individually, taking into account the woman’s condition, wishes and the size of the pregnancy.

If a miscarriage or missed miscarriage has happened two or more times already, additional examinations at your gynaecologist are recommended. These are usually performed when at least two months have passed since the miscarriage or missed miscarriage.

After a miscarriage, ovulation can occur as early as a couple of weeks after it. If you have no plans to get pregnant again at the moment, you should start using strong contraceptives immediately after a miscarriage. If you wish to get pregnant again, then you can do it as soon as you want. Menstruation can take 4-6 weeks to arrive after a miscarriage.

A miscarriage or a missed miscarriage can be an unexpected and emotionally difficult event for a couple. Sadness and grief are normal feelings after a miscarriage or a missed miscarriage. If necessary, you need to take your time to cope with your feelings and, if you wish, you should consult with a psychologist or a pregnancy crisis counsellor.

The article is based on the Estonian Sexual Health Association’s Sexual Health www.seksuaaltervis.ee website.

The Estonian Sexual Health Association is an advocacy organisation for sexual and reproductive health and rights.

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