Monday, May 25, 2015

miscarriageCARE: 10 Miscarriage Facts

As stated in the previous miscarriageCARE post, misconceptions about miscarriage abound. A recent study found this to be true, and a thoughtful article from NPR unpacked these findings. Some of these misconceptions include:
  1. Miscarriage is rare, occurring in less than 5% of pregnancies. 
  2. Stress or physical exertion can cause miscarriage. 
  3. Lifestyle choices are the main reason miscarriages occur. 
When interacting with someone who has experienced miscarriage it is important to let go of these misconceptions and understand the facts. This post will explore 10 important facts about miscarriage, its causes, symptoms, treatment, and aftermath. 

1. It is estimated that 25% or more pregnancies end in miscarriage. 

This may seem like an unusually high number, but many doctors estimate a good portion of miscarriages go unnoticed because a woman doesn't even know she's pregnant yet and simply thinks she's having a late (and unusually heavy) period. Around 15-20% of clinically recognized pregnancies (indicated by a positive pregnancy test done at home or by a healthcare provider) end in miscarriage. Miscarriage is defined as a pregnancy loss before 20 weeks, after which it is called a stillbirth

2. Miscarriage is, by far, the most common pregnancy complication.

This is the main reason women are encouraged to wait until their second trimester to reveal their pregnancy to others. When a woman reaches her second trimester, her chances of miscarrying are drastically reduced--around 80% of all pregnancy losses occur in the first trimester. 

3. Chromosomal abnormalities are the most common cause of miscarriage.

Chromosomal abnormalities account for 50-75% of miscarriages. These losses are completely unavoidable and inevitable. The reason can often be detected if the products of conception (the deceased embryo or fetus) are retrieved and brought in for testing, although that is not always possible. This is why a woman's age is often a factor when determining her risk for miscarriage. A woman is born with all the eggs she will ever have, so by her late thirties, not only has her egg quantity diminished, her egg quality has also decreased, making it more likely that implanted embryos will have chromosomal abnormalities. 

4. Miscarriages not caused by chromosomal abnormalities can be caused by a number of other factors.

A woman could have a health condition which prevents her from carrying a pregnancy to term, such as infection, hormonal problems, immune system disorders, diseases, cancer, or physical abnormalities such as a misshapen uterus or a cervix that opens too early. Certain medications a woman takes to treat health conditions can also contribute to miscarriage. Extreme environmental conditions like high levels of radiation or toxic agents can be a factor. Lifestyle factors like malnutrition, smoking, drug and/or alcohol abuse can also contribute.* Many of these issues can be treated or corrected to increase the chance of full-term pregnancy and live birth. 

*Regular and repeated use of these substances is a contributing factor. A woman who had a glass of wine while pregnant and then miscarries should by no means assume that was the cause. 

5. Miscarriage is often physically painful

Symptoms of miscarriage include heavy bleeding, intense cramps, true contractions, abdominal and/or back pain, fever, chills, and passing of tissue. Women who are farther along will occasionally experience true labor pains during a miscarriage. Those who do describe them as no different than the labor pains that accompany a live birth. 

6. Miscarriage is a process rather than a single event

The different stages of miscarriage can happen simultaneously, but are often spread out over a number of weeks. Miscarriage, or the inevitable loss of a pregnancy, can be discovered weeks before a woman's body is finished dealing with it. After a woman's body has expelled the products of conception, it can take up to six weeks for her pregnancy hormone levels to return to 0, and she is usually required to come in for testing on a weekly basis until her healthcare provider feels confident she is close enough to 0. If her hormone levels do not drop far enough, she could require additional procedures to remove any remaining tissue. This is important to prevent infection. Women who have more than three miscarriages can be subject to any number of tests and procedures to determine potential problems or issues. 

7. Miscarriage is not a one-size-fits-all experience

There are many different kinds of miscarriage, different treatments for each, and different risk factors for each as well. Some of the different kinds of miscarriage include: 

Inevitable or Incomplete Miscarriage
This occurs when there is a problem with the cervix or a rupture of the membranes (her water breaks) occurs. 

Missed Miscarriage
This occurs when the embryo or fetus has died but no expulsion has occurred. This is most often discovered when fetal heart tones cannot be found on an ultrasound. A healthcare practitioner may wait for the woman's body to begin the expulsion process naturally or may schedule a D & C, a procedure performed to remove the products of conception manually. 

Blighted Ovum
This is also called an embryonic pregnancy. A fertilized egg implants, but no development occurs in the embryo. Everything else develops and progresses for a time, but miscarriage must occur to expel the undeveloped embryo. 

Ectopic Pregnancy
This occurs when a fertilized egg implants somewhere other than the uterus, usually in the fallopian tube. The requires medical intervention to stop the development of the embryo because it could result in serious complications for the woman. 

Molar Pregnancy
This occurs when there is a genetic error during fertilization. No embryo exists, and, instead, a growth begins in the uterus. A woman's body still displays the symptoms of pregnancy, including a positive pregnancy test, a missed period, and nausea. 

8. Miscarriage cannot be prevented. 

By the time a woman is aware of the symptoms of miscarriage it is already too late, for these indicate the body's expulsion of a deceased embryo or fetus. The most a woman can do to prevent miscarriage is take care of herself physically, remove herself from extreme environmental factors, address any current health concerns, and follow the advice of her healthcare provider. She can have herself tested for different conditions if she so chooses and employ any number of interventions, but the rest is out of her hands.

9. Miscarriage does not indicate a woman cannot carry a healthy baby to term.

A woman's miscarriage experience in no way means that she is unable to carry a baby to term. Many women who experience miscarriage, even multiple miscarriages, are able to (and do) have a healthy pregnancy afterward--sometimes immediately afterward. Some healthcare providers recommend waiting a number of months before a woman tries to get pregnant again, but many women have had successful pregnancies immediately after miscarriage--some so quickly they never even have a period.

10. Miscarriage often changes a woman's or couple's approach to subsequent pregnancies. 

Pregnancies after any miscarriage are often much different for a woman or expectant couple. They may be more cautious or proactive during a subsequent pregnancy. They may deal with unwanted or insensitive advice from others on how to make the next pregnancy work. They may still feel attached to their lost pregnancy and wish to acknowledge unmet milestones and/or dates (especially due dates). They may feel confused about whether or not to call their current pregnancy their ___th pregnancy based on how many times they've been pregnant or how many babies they've carried to term. They may seem unenthusiastic or reserved, often due to a desire not to get too carried away or forget their miscarried pregnancy. 


Knowing and understanding these facts can significantly change the way you approach someone who has experienced miscarriage. As this series goes on, we will use these facts to shape ways to approach others with care, understanding, and knowledge.

We'll continue next week. Keep it real, y'all.


Advanced Fertility Center of Chicago; "Female Age, Fertility, and Infertility."
American Pregnancy Association; "After a Miscarriage: Getting Pregnant Again." 
American Pregnancy Association; "After a Miscarriage: Surviving Emotionally."

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