Miscarriage

A miscarriage can bring about a myriad of feelings in partners, from sadness and regret to jealously and anger.

Although most miscarriages occur during the first trimester – or 13 weeks – of pregnancy, the term refers to any pregnancy that ends by itself within the first 20 weeks of gestation. When a baby dies in utero after 20 weeks of pregnancy, it is referred to as a stillbirth.

However, in the majority of cases, a miscarriage has no relationship to what a woman did or didn't do. Consequently, many aspiring parents never find out exactly what causes the miscarriage.

This guide will help women understand miscarriage better as well as how to prevent miscarriages or recuperate for a healthy, full-term pregnancy after a miscarriage. It will also address tips for couple interaction to improve communication during this difficult stage.

Miscarriage

About

Quick Facts about Miscarriage

  • According to the American Pregnancy Association, 10 - 25% of recognized pregnancies will result in miscarriage.
  • Women who have previously miscarried have a 25% chance of having another miscarriage.
  • According to the American College of Obstetricians and Gynecologists (ACOG), miscarriage is the most common type of pregnancy loss.

About 50 - 75% of all miscarriages occur when the pregnancy is lost shortly after implantation. This results in bleeding that occurs around the time of one's expected period. The woman may not even realize she experienced a miscarriage.

Most of the time, all types of miscarriages are just simply referred to as a miscarriage. However, there are a variety of names doctors use to refer to what the woman experiences. Some specific types of miscarriages include threatened miscarriages, complete miscarriages, or missed miscarriages. Types of pregnancies that result in miscarriages include ectopic pregnancy, molar pregnancy, and blighted ovum.

Identifying Miscarriages

Sometimes it is difficult to accurately establish the exact time a woman is going through a miscarriage in the first trimester, as they often happen without a woman even noticing. However, there are three criteria to help identify signs of an early miscarriage: frequency, duration, and intensity.

About Miscarriage

Causes

A healthy pregnancy generally begins with the absence of structural problems as well as a healthy hormonal balance. A pregnancy brought to full-term also indicates the absence of chromosomal and genetic abnormalities from the beginning.

Hormonal Causes of Miscarriage

The female reproductive cycle is regulated by the complex rise and fluctuations of various reproductive hormones, mainly estrogen and progesterone, which work together to prepare a woman's body for pregnancy.

After fertilization and implantation of the egg, progesterone levels should be higher than estrogen levels to maintain the uterine lining. Insufficient levels of progesterone can cause initial implantation failure and a subsequent first trimester miscarriage through incidental shedding of the uterus lining.

Progesterone production is under the responsibility of the corpus luteum, which is what is left of the follicle after initial ovulation. After the first trimester, the placenta takes over further production of progesterone.

When the corpus luteum is inadequately developed or breaks down early, it fails to produce enough progesterone. Luteal phase insufficiency - also known as the corpus luteum deficiency or corpus luteum defect - causes the uterus lining to shed itself with a miscarriage.

There are a couple stages within a woman's reproductive life in which it will be more or most likely for her to miscarry, including perimenopause and postmenopause.

Chromosomal Causes of Miscarriage

One study reports that 50 - 60% of all first trimester miscarriages are due to chromosomal abnormalities. Chromosomal abnormalities can be the cause of a damaged egg or sperm cell, when an egg or sperm has too many or too few chromosomes, or are due to a problem at the time that the zygote went through the division process. Sometimes the abnormality is spontaneous while other times it is inherited.

Anatomical Causes of Miscarriage

Anatomical problems with the uterus may also be a cause of miscarriages. For example, an unprepared cervix may start to open as the uterus becomes heavier in later pregnancy, leading to a miscarriage by not remaining closed as the developing fetus reaches a certain weight and puts pressure on the opening. Also, babies will not be able to properly grow in malformed uteruses. Fibroids - harmless growths in the uterus - may cause miscarriages later on in pregnancy.

Other Causes of Miscarriage

While hormonal imbalance can be a major underlying cause of miscarriages, experts also point out other factors. Some of them include infections, insulin resistance, and environmental factors.

Causes of Miscarriage

Risk Factors and Triggers

Risk Factors for Miscarriage

Some women are more likely than others to have a miscarriage because of health reasons, such as weight, age, and sexual history, as well as behavioral reasons, from alcohol consumption to excessive caffeine consumption. These predisposing factors can affect a woman's chances of having a full, healthy pregnancy after conception.

Miscarriage - Risk Factors and Triggers

Signs and Symptoms

Women experience miscarriage symptoms of varying degrees, with some not displaying symptoms at all. These few may discover that their pregnancy ended only when they have a routine ultrasound scan. It is important to note that bleeding or spotting in the pregnancy, especially during the first trimester, does not always signify a miscarriage.

Common Symptoms of Miscarriage

  • Vaginal bleeding or spotting
  • Unusual or brown vaginal discharge
  • Intense cramping that feels like a period
  • Pain in lower abdomen (dull ache to severe pain)

Signs of Miscarriage

As opposed to more noticeable symptoms, medical signs are measurable criteria that are usually assessed by a physician. The following medical signs will most likely be taken into account by a physician when diagnosing miscarriages.

  • Womb abnormalities
  • No heartbeat in a transvaginal ultrasound (if after 6 weeks)
  • Presence of extra or missing chromosomes
  • High blood levels of antiphospholipid (aPL) antibody and lupus anticoagulant

Diagnosis of Miscarriages

Diagnosing and identifying the causes of miscarriage is generally done by a doctor if the woman has fertility problems and miscarries twice; miscarries more than twice in the first trimester; or miscarries in the second trimester. Women who miscarry once or twice in the first trimester often times go on to have a successful pregnancy as their miscarriage was due to chance rather than an underlying cause. It is important to note that going through with a test does not mean the cause will be found. Tests taken to diagnose causes of miscarriage vary, from chromosome tests to hormone tests and blood tests.

Complications of Miscarriages

In rare cases, when miscarriages are left untreated, they can lead to certain complications, which are more risky for a woman's emotional and physical health. However, it is important to remember that in the majority of cases, miscarriages will not require serious medical intervention. These possible, but uncommon, complications of untreated miscarriages can include anemia, infections, and depression.

Women experiencing miscarriages may wish to treat or learn how to prevent future ones. Luckily, there are healthful tips and habits that will lessen a woman's chance of having a miscarriage if caused by an avoidable issue or allow her to learn how to manage it.

Miscarriage - Signs and Symptoms

Prevention and Management

Preventing a Miscarriage

The majority of miscarriages cannot be prevented, especially if caused by anatomical problems or chromosomal abnormalities. However, there are a few steps women can take to reduce the risk of having a miscarriage due to hormonal imbalance by getting as healthy as possible before trying to conceive either for the first time or again after a previous miscarriage.

Lifestyle Changes for Prevention

  • Nutrition. Diet is key in reducing the risk of having a miscarriage caused by a hormonal imbalance. By eating a balanced diet rich in foods that boost essential vitamin levels, of iron, vitamin C, and calcium, one's body will promote early pregnancy the best.
  • Regular exercise. It is important to maintain a healthy body weight with regular exercise to promote a healthy first, second, or third conception. Women who are over or underweight have a heightened chance of miscarrying. Moderate exercise during pregnancy is believed to help reduce stress, aches, and pains as well as increase stamina for labor. Exercises such as walking, swimming, or yoga can all help. It is important to keep the abdomen safe by avoiding contact sports or activities with high risk of injury.
  • Healthy habits. Some habits can be particularly harmful on women in early pregnancy and for those who are trying to have a successful pregnancy. Studies suggest that women who smoke or are exposed to secondhand smoke have a heightened risk of miscarriage. The same can be said for those who consume excessive amounts of alcohol. Moreover, it is important to learn how to properly manage stress levels through healthy coping techniques.
  • Supplements. It is believed that vitamin supplementation before or in early pregnancy may be beneficial to prevent birth defects and stillbirths, but the connection between them and miscarriages is still uncertain. In any case, if possible, it is recommended for women to take at least 400 mg of folic acid (vitamin B9) daily for up to two months before conception for proper cell growth and embryonic development.

Managing Miscarriages after a Miscarriage Happens

Miscarriage can be a troubling time as women are often left with unanswered questions regarding their emotional and physical recovery and how to try conceiving again. Some general management tips for all women going through a miscarriage are to attend support groups, use web-based resources, and strengthen relationships.

Furthermore, there are also specific miscarriage management tips that can be followed by women who are below the age of 35 and above the age of 35.
Specific tips for managing miscarriages below age 35 include recognizing that miscarriage is not rare and knowing when to seek help.

Specific tips for managing miscarriages after a previous miscarriage when above age 35 include continuing practicing good habits and seeking other options.

Alternative Management Tips for after a Miscarriage Happens

Alternative treatments are also a great way to manage miscarriages by reducing stress and improving emotional and physical health. Alternative treatments include massage, acupuncture, and Emotional Freedom Technique.

While these measures often help prevent the initial possibility of miscarrying and help women learn how to manage afterwards, they are unable to treat the root cause. There are several natural miscarriage treatments that can help treat the hormonal causes of the problem.

Miscarriage - Prevention and Management

Treatments

When trying to start a family, having a miscarriage can present a wall to long-term plans; however, miscarriage treatment is possible most times.

Three Stages of Miscarriage Treatment

Women who have symptoms and risk factors for having a miscarriage can still treat themselves and prevent hormonal imbalances. However, once a woman has a complete miscarriage without complications, it is possible to pursue further treatment in preparation to have a full-term pregnancy.

Three stages can be considered when a woman is going through miscarriage treatment. These are categorized as: (1) Preventing a Miscarriage Before It Happens, (2) Treating a Miscarriage as it is Happening, and (3) Treating the After Effects of a Miscarriage.

If possible, women are encouraged to begin with the least risky approach to prevent or treat miscarriages and then proceed to the next level of care based on their specific situation. Depending on the condition, medical intervention may be necessary. 

1

Preventing a Miscarriage Before It Happens

Lifestyle Changes

Often, simple changes in lifestyle can reap huge benefits in preventing an initial miscarriage. To achieve a higher overall level of health, women should start with an improved diet, regular exercise, and healthy habits.

When considering nutrition, it is important to choose fresh and whole grain foods to supplement the body with proper vitamins and nutrients, such as calcium, which can plummet during pregnancy. Reduce caffeine and alcohol intake along with excess sugars.

Alternative Medicine

Some natural supplements promote a woman's health for healthy conception, including prenatal supplements. These vitamin supplements are often started before conception to help nourish early pregnancy.

Pharmaceutical Medicine

Progesterone is a reproductive hormone made in the body that can also be manufactured in a laboratory. Women trying to prevent having miscarriages may have the option of using progesterone medications that cause some or all of the hormone's biological effects.

2

Treating a Miscarriage as it is Happening

For women who are in the midst of having a miscarriage, there is nothing that can be done to deter it. Anything done during this period will be aimed at choosing lifestyle changes to avoid heavy bleeding and infection.

Lifestyle Changes

When women are waiting for a miscarriage to pass, they should try to rest and relax at home while avoiding strenuous activity. If there is bleeding, use sanitary pads in place of tampons, and change them regularly according to how heavy the blood flow is.

Moreover, choosing to wait out the miscarriage may take longer than conventional medication or surgery, causing women to become worried or possibly frightened of further complications.  Therefore, during this time, it is important to try and minimize outside stressors as the waiting time for the miscarriage to end may be emotionally draining.

For incomplete miscarriages, pharmaceutical medicines and surgeries are optional to speed up the complete passing of the pregnancy tissue.

3

Treating the After Effects of a Miscarriage

Lifestyle Changes

Just like those who are preventing a first pregnancy miscarriage, women recovering from a miscarriage should also choose fresh and whole grain foods rich in iron and vitamin C. Women who had miscarriages need iron to help replenish what was lost during the bleeding, while vitamin C enhances iron absorption.

If anticipating re-conception, these women should also reduce caffeine and alcohol intake and try to manage stress levels. Also, regular exercise should be performed with the ideal goal to maintain a healthy weight.

Alternative Medicine

Alternative medicines and supplements generally involve little to no risk and can be an extremely effective for treating hormonal imbalances and regulating menstrual cycles again after a previous miscarriage. In the case of herbal supplements, there are two main types to take into consideration: phytoestrogenic and hormone-regulating herbal supplements.

Phytoestrogenic herbal supplements

These supplements, such as dong quai, contain plant estrogens that regulate hormones. By consuming plant-based estrogens following a miscarriage, these herbs help normalize menstrual cycles again. Women with irregular cycles may find it harder to initially conceive, and when they do, they are more likely to miscarry.

However, after conception, consumption of excess estrogen is unnecessary as progesterone takes over as the dominant hormone to build up the uterine lining. Moreover, some of these phytoestrogenic herbs can expel the products of conception, causing a miscarriage.

Hormone-regulating herbal supplements

Hormone-regulating supplements like Macafem stimulate the body's natural hormone production by nourishing and regulating actions of the whole reproductive system. This process ultimately results in balancing hormones before and throughout the early stages of pregnancy.

These supplements can be considered the safest and most natural way to treat an underlying hormonal imbalance behind miscarriages. Moreover, because they support the body's natural hormone production, they can be taken throughout a woman's life, including into postmenopausal years.

Additionally, there are other types of supplements that help treat a miscarriage in its entirety. Some herbal supplements - such as black cohosh and ginger - help dispel the pregnancy remnants to hasten the miscarriage treatment process.

Pharmaceutical Medicines

For women who have had an incomplete miscarriage with no complications, they may have the option of using uterus-contracting medication that causes tissue to pass out of the womb. On the other hand, progesterone medications can also be used to treat miscarriages for a successful full-term pregnancy the next time around.

Advanced Options

The earlier a miscarriage happens, the more likely it will be for the body to expel all of the fetal tissue by itself without further medical intervention. One of the main goals of miscarriage treatment is to prevent hemorrhaging and/or infection. If this happens, there are advanced options to consider for miscarriage treatment, including dilation and curettage.

Overall, these approaches are not mutually exclusive. A woman may use different approaches at different times or any combination of them, depending on her specific condition. Recently, more and more women find that preventing and dealing with miscarriages can be accomplished via a combination of healthy lifestyle and alternative treatments.

Miscarriage Treatments

Bibliography

  • American Journal of Epidemiology. (2014). Systematic Review and Meta-Analysis of Miscarriage and Maternal Exposure to Tobacco Smoke During Pregnancy. Retrieved May 15, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969532/
  • American Pregnancy Association.(n.d.). Infertility and Acupuncture. Retrieved May 15, 2017, from http://americanpregnancy.org/infertility/acupuncture/
  • American Pregnancy Association. (n.d.). Miscarriage. Retrieved May 15, 2017, from http://americanpregnancy.org/pregnancy-complications/miscarriage/
  • American Pregnancy Association.(n.d.). Sexually Transmitted Diseases (STDs) and Pregnancy. Retrieved May 15, 2017, from http://americanpregnancy.org/pregnancy-complications/stds-and-pregnancy/
  • American Psychological Association. (2012). Miscarriage and loss. Retrieved May 16, 2017, from http://www.apa.org/monitor/2012/06/miscarriage.aspx
  • Oxford Academic. (2004). Obesity is associated with increased risk of first trimester and recurrent miscarriage: matched case – control study.  Retrieved May 15, 2017, from https://academic.oup.com/humrep/article/19/7/1644/2356447/Obesity-is-associated-with-increased-risk-of-first
  • Miscarriage Association. (n.d.). Signs & symptoms. Retrieved May 17, 2017, from http://www.miscarriageassociation.org.uk/information/signs-and-symptoms/pain-bleeding-or-spotting/
  • National Center of Biotechnological Information. (2016). Vitamin supplementation for preventing miscarriage. Retrieved May 16, 2017, from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0012521/
  • National Health Service UK. (2015). Miscarriage. Retrieved May 15, 2017, from http://www.nhs.uk/Conditions/Miscarriage/Pages/Introduction.aspx
  • Pregnancy, Birth & Baby. (n.d.). Miscarriage. Retrieved May 17, 2017, from http://www.pregnancybirthbaby.org.au/miscarriage
  • Shah. D., & Naragajan. N. (2013). Luteal insufficiency in first trimester. Retrieved May 12, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659905/
  • The National Infertility Association. (n.d.). Common Causes of Miscarriage. Retrieved May 12, 2017, from http://www.resolve.org/about-infertility/medical-conditions/common-causes-of-miscarriage.html
  • The Royal Women's Hospital. (n.d.). Treating miscarriage. Retrieved May 23, 2017, from https://www.thewomens.org.au/health-information/pregnancy-and-birth/pregnancy-problems/early-pregnancy-problems/treating-miscarriage/
  • TIME Health. (2017). Miscarriages May Be Prevented with Progesterone. Retrieved May 18, 2017, from http://time.com/4629589/miscarriage-progesterone-pregnancy/
  • University of California San Francisco Medical Center. (n.d.). Substance Use During Pregnancy. Retrieved May 15, 2017, from https://www.ucsfhealth.org/education/substance_use_during_pregnancy/