Miscarriage

What is a miscarriage?

miscarriage
A miscarriage describes the loss of a pregnancy before 6months (24 weeks). Most miscarriages happen in the first 12 weeks of pregnancy, sometimes within days of a positive test. One in four women will experience a miscarriage at some stage. We are able to recognise miscarriage more often these days because pregnancy tests are so accurate in the early stages. Previously many women would simply have had a delayed period. An early miscarriage (before 8 weeks counting from the first day of your last period) causes a heavy, sometimes prolonged bleed but usually no other treatment is required. Surgery to remove remaining tissue is sometimes required when the pregnancy is more advanced. You should always see a Doctor if you think you are having a miscarriage.
Why they happen
Unfortunately we never know why most miscarriages happen, but often the pregnancy is abnormal, and nature is making sure that it should not continue. One miscarriage rarely means that a normal pregnancy cannot happen next time. The risk of miscarriage is significantly higher in older women, especially when pregnancy happens in your 40s. The risk is also higher in families who carry abnormal genes. Couples in this situation are usually aware of the risk before pregnancy, but rarely a re-arrangement of chromosomes in either you or your partner can predispose you to having repeated miscarriages. Vaginal infection, especially bacterial vaginosis, hormone imbalance, abnormalities in the shape of your womb, and alterations in your immune system or the way your blood clots may also predispose you to having repeated miscarriages. All of these may be treated to reduce the risk in future pregnancies.
When to investigate further
Specific screening tests for infection, immune or clotting disturbances, genetic tests and assessment of your womb can be arranged at any stage, but not whilst you are actually pregnant. It makes good sense to see a gynaecologist before contemplating pregnancy. The more detailed tests are often not performed until repeated miscarriages have occurred. A full screen for all potential treatable causes can be arranged by Miss Matthews at any time. Surgical removal of the pregnancy from the womb in cases when miscarriage is inevitable permits genetic assessment of the pregnancy, and may be useful when repeated loss occurs.
What investigations I might recommend
• An ultrasound scan of your womb
• A hysteroscopy
• A hysterosalpingogram (HSG) or Saline Sonogram
• Vaginal swab tests for infection
• Blood tests to check:
  • thyroid function
  • the immune system
  • the clotting system
  • your chromosomes
• your hormone levels
• Genetic tests on the pregnancy tissue at the time of miscarriage
• A sperm test
What treatment I might recommend
• Surgery to correct womb abnormalities
• Medicine to adjust hormone imbalance
• Formal fertility treatment (rarely)
• Genetic counselling
• Medicine to re-balance disturbances in the way blood clots, or the way your immune system works
• Treatment of thyroid disease
• Antibiotics for infection
Grief counselling
Miscarriages are always traumatic, and often quite frightening, as they can be associated with heavy bleeding. It takes time to recover both physically and emotionally. Sometimes the prospect of another pregnancy is daunting, and often self confidence is knocked. Women often blame themselves when they have done nothing wrong. An appointment with a qualified counseller can be extremely helpful. Miss Matthews works closely with Miss Jacqui Feld, who is an expert in the field.