When it comes to taking care of our health, asking questions never hurts. But is it always worth a visit to your doctor? We’re asking experts to weigh in on your burning questions—from feminine to general health and everything in between—so you can get advice from a pro before you go. The doctor will see you now.
Whether you’re pregnant, thinking about trying to conceive, or hoping to have children some time in the future, it can be scary to consider the possibility of enduring a miscarriage. More and more people—even Facebook CEO Mark Zuckerberg—are talking about pregnancy loss these days, making the stat that 15 to 20 percent of known pregnancies end in miscarriage feel all the more real.
There is no denying the emotional, mental, and physical pain of a pregnancy loss. But understanding more about what happens during miscarriage can alleviate some of the fears that surround it. Knowledge, as they say, is power.
We asked Dr. A. Nicky Hjort, M.D., OB-GYN, to help us understand the typical causes of miscarriage and how to know if it’s happening to you.
Q. What technically is a miscarriage?
A miscarriage is any time a pregnancy is lost before full gestation. Dr. Hjort says most miscarriages “occur in the first twelve weeks,” but they can present in a variety of ways. A course of treatment should always be specific to the patient, but there are probable recommendations for each situation.
What most people refer to as a miscarriage, is technically called an “abortion” in medical terms—but it's not meant in the way the general population uses it. To those in the fields of obstetrics and gynecology, the word “abortion” (sometimes “spontaneous abortion”) describes pregnancy loss before 20 weeks’ gestation that is not a result of an intended interruption. It is not a word most women who have suffered such a loss prefer to use, and it can be challenging for a grieving mother to see or hear that term, but it's helpful to be aware of what the doctor or medical records actually mean by it.
Q. How would I know if I were having a miscarriage?
“Most women who come in for a miscarriage are having one of two presentations,” says Dr. Hjort. “Either they come in with symptoms of bleeding and/or pain or fever and seem to be actively passing the pregnancy, or patients who come into the office for their routine first prenatal visit, and we do the ultrasound and the unthinkable happens: We don’t see the development that we expect, there are no heart tones, or there’s a fetus that is obviously already in the process of miscarrying.”
To diagnose a miscarriage, your healthcare provider will consider this information, as well as a physical examination and an ultrasound to see the embryo (implantation through week eight), fetus (week nine through birth), or absence thereof. Dr. Hjort says you can typically see the fetal heartbeat at six weeks and hear it externally with a Doppler ultrasound at eight weeks.
Q. Are there different miscarriages?
A variety of situations fall under the general definition of miscarriage given above.
A “threatened miscarriage” occurs in a pregnancy in which there is “any amount of bleeding.” Dr. Hjort says in these cases that “there is still a decent chance that the pregnancy will carry, and so we observe.”
An “inevitable miscarriage” is less optimistic. Dr. Hjort says, “There is no way around it. The cervix is open, the water bag has ruptured, the fetus is starting to expulse, and that is a miscarriage that must be completed in order to minimize risks to the mother.” Dr Hjort confirms that the baby, membranes and fluids must be cleared from the uterus, and pregnancy hormone levels (HCG) need to be back to pre-pregnancy levels in order for a miscarriage to be considered complete.
A complete miscarriage is self-explanatory: “when everything has passed on its own,” per Dr. Hjort. An incomplete miscarriage is when “part of the tissue or process has occurred, but not all of it. These are often patients who present to the emergency room actively bleeding in true medical risk and require immediate intervention to avoid the long-term sequela of hemorrhage, which can result in death,” Dr. Hjort says.
The direst possibility is “septic miscarriage,” which Dr. Hjort describes as a “very dangerous scenario.” This occurs in a woman “who has an active infection either in the fetal tissues or in the miscarriage process.” For the mother’s safety, the miscarriage “must be completed either with medications or surgical intervention,” Dr. Hjort says.
Q. What causes miscarriage?
Dr. Hjort groups miscarriages into two categories. The first is an “unexplained, most likely not to recur again” loss of pregnancy, and could be a woman’s first or even second loss. In layman’s terms, Dr. Hjort says, these are losses in which “things didn’t go well, and it was bad luck.”
The second is recurrent miscarriage—that is, three or more “clinically recognized pregnancies with subsequent loss." Patients who experience habitual or recurrent miscarriage are “at higher risk to be found to have something of consequence causing the miscarriage,” Dr. Hjort says. It could be an “endocrinological problem, such as a thyroid issue” or they may have “certain blood factors which make them more likely to have tiny blood clots, which can cause the loss of the pregnancy.” Other possibilities include an “abnormality to the shape, size, or nature of their uterus,” or a “true genetic problem” in the woman or her partner.
“Even in those patients,” Dr. Hjort says, “we sometimes find no specific cause.” In those cases, a doctor may recommend daily doses of low-dose aspirin, blood thinners, or supplementing the strength of the lining of the uterus with progesterone. Dr. Hjort says such a patient may also be referred to a reproductive endocrinologist (REI), who specializes in helping women who are having issues getting and/or staying pregnant.
Q. How can I prevent miscarriage?
There is no scientifically proven way to absolutely prevent miscarriage, but you can help lower the risks. Dr. Hjort explains there are some known risk factors:
- Age, especially at extremes of gestation, i.e., being very young or being over 35 and even more so being over 40.
- Prior miscarriage. Dr. Hjort says if you’ve had two or three miscarriages, you have to consider your risk elevated.
- Alcohol. Because we don’t know how much is dangerous, Dr. Hjort recommends pregnant woman avoid alcohol. Because no amount has been proven to be safe for consumption, the CDC, the U.S. Surgeon General, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics advise pregnant women not to drink alcohol at all. At this time, more research needs to be conducted.
- Fever, especially in the first trimester.
- Trauma, especially to the uterus, e.g., a car accident.
- Environment, meaning medication, chemotherapy, radiation.
- Caffeine. As with alcohol, the amounts that are dangerous are unclear. One or two cups a day is probably safe, but beyond that, Dr. Hjort says the medical community doesn’t know how much is damaging.
Q. What is the emotional impact?
Dr. Hjort says with any miscarriage, the “biggest piece is emotional or psychological aspect of this.” Most women she sees experience the same level of suffering “regardless of the length of the pregnancy.” She typically sees “two weeks or so of deep grief,” whether or not the pregnancy was planned. Thereafter, women tend to go through the stages of loss of losing a family member, a friend, or in receiving a medical diagnosis of significance, Dr. Hjort shares.
Miscarriage is something we can’t always prevent. As someone who’s suffered one, I’d argue we can’t really prepare ourselves for it, either. What we can do is keep talking about it, so the lines of communication in our circles are open when we need them, and know where to access dependable resources so we can support the women we love if it happens to them.
Photo Credit: Tina Sosna