Unfortunately 20% of all pregnancies will end in a miscarriage. This is very distressing for the couple who will have invested emotionally in the pregnancy from the time of the positive pregnancy test. However, it should be remembered that miscarriage is very common, that it is ‘nature’s way’ of making sure that only healthy pregnancies continue further and, most importantly, that getting pregnant is the biggest obstacle to having a baby – couples who experience miscarriage(s) are fertile and will almost always have a successful pregnancy later on.
Miscarriages can be diagnosed following vaginal bleeding and period-like cramps but commonly they are diagnosed by ultrasound scan before the woman is symptomatic. This is because the baby can stop growing and the heart can stop beating many days or weeks before the body recognises that there is a problem.
Management of miscarriage
- Some couples prefer to wait for some time following the diagnosis of a miscarriage. This is safe and allows the couple some time to accept the news and prepare for the miscarriage.
- Medical management – In order to make the miscarriage start, an oral tablet is taken and then 48h later a vaginal examination is performed to place 4 small tablets of Prostaglandin near the cervix. The miscarriage usually starts a few hours later but if not then a further 2 tablets are taken at 4h and 6h later by placing in the inside of the mouth and letting them dissolve. Usually the pain and bleeding lasts 4-6h and the women can feel light headed and dizzy when the cervix finally opens. This lasts less than an hour. Afterwards, the pain subsides rapidly and bleeding should settle quickly and finish within a week. During the process, once the pain has started, ibuprofen 400mg can be taken every 6h.
- Surgical treatment by curettage or ‘D and C’. If the medical management fails, if the woman prefers or if it is medically necessary (for example with heavy bleeding) the pregnancy can be removed with a special suction device under general anaesthesia. This procedure takes a few minutes and the woman is able to go home a few hours later. There are small risks associated with the general anaesthetic and the procedure itself but it remains a safe intervention.
Around 1% of couples will experience 3 or more miscarriages in a row. Amongst these couples a small proportion will have an underlying reason to account for these miscarriages. Investigations include an ultrasound scan of the uterus and pelvis, a blood test for hormones, to analyse chromosomes of the couple and to check for a thrombophilia (a medical condition that makes the blood clot easily). These tests are easily arranged. Most couples will have normal results and therefore unexplained recurrent miscarriage. In this case it has been shown that careful frequent care in the first trimester of subsequent pregnancies can increase the chance of a successful outcome.