Miscarriage is one of the unfortunate and sad aspects of the care that I provide to women. It is, however, a persistent reality and is both upsetting and unnerving, not just at the tragedy of the loss, but also because it often makes you question your ability to achieve a healthy baby down the track.
I would like to take this opportunity to explain miscarriage to you in more detail.
From the moment you conceive, when the egg and the sperm meet and fertilize, approximately 50 per cent of all pregnancies will fail, yes that is 50 per cent! Due to the very precise processes required to allow this fertilization to occur, notwithstanding potential problems with egg quality, sperm quality and the uterine environment, it is not surprising that there is a very high attrition rate.
Once the embryo begins to develop, approximately 15 per cent per cent of all those progressive pregnancies will then fail. What this means is that 1 in 7 women, after they have had a positive home pregnancy test or even see an early baby develop on an ultrasound scan, will end up miscarrying. As a pregnancy progresses through the first 14 weeks (known as the first trimester) the percentage rate for miscarriage diminishes and certainly by the end of the first trimester there is only a very small percentage rate of loss.
When a woman miscarries, it can occur in a variety of ways. Sometimes there will be bleeding or pain and there can be a varied magnitude of both. Some women will have a sudden absence of symptoms and others may present feeling that they are unremarkably and normally pregnant only to be told by an ultrasound scan that the pregnancy has failed. On that note, sometimes a pregnancy can have failed weeks before, with the size of the foetus being much smaller than was expected by the gestation that the woman presented at. There can even be situations where all that you see is a sac but no actual foetus growing and we call this a blighted miscarriage. Either way the pregnancy is no longer viable.
The first thing to determine in this situation is whether you need some medical assistance to help to remove the non-viable tissue from your womb. Options will vary from the conservative approach of waiting to have this happen spontaneously through to the use of medication which can be taken orally to induce passage of the tissue. Then of course there is the option of having it managed surgically where you have a mild anaesthetic and have what is called a suction curette to remove the tissue for you. Your doctor would be able to go through these options with you and explain the pros and cons.
One of the most pressing questions that all couples have in this situation is why?
There are obvious risk factors for miscarriage which can include conceiving as a mature age mother, having a significant pre-existing medical condition such as diabetes which is perhaps poorly controlled and of course smoking, but for the vast majority of women, particularly younger mothers, the cause is not apparent. What we know from statistical studies is that the vast majority of miscarriages occur because there is a problem with the baby's genetic make-up, which usually happens as a random event and which has a relatively low risk of recurrence. Whilst testing is available to assess the tissue's genetic status, we would normally not do this if you presented for your first miscarriage. Also, this can only happen if you were to have an operative curette. For a very small percentage of the population there is a subset of women who are at risk of having recurring and repeat miscarriages. This is extremely distressing and can also occur for a wide variety of reasons, which can include underlying issues in relation to your reproductive hormones, your immune system, your clotting system and even abnormalities within the uterine environment.
For a lot of these conditions you may not have even known that you had the issue in the first place but thankfully there are a number of tests which can be arranged and thankfully potential treatment depending on the abnormality that is found.
As a Doctor with training in High Risk Obstetrics and having worked in one of the first recurrent miscarriage clinics of its kind in Australia, I have extensive expertise in this area and have been able to help a large number of women over the years go on to ultimately have a healthy baby.