Miscarriage



Having a miscarriage can be very distressing and traumatizing for many women and their partner. Sometimes guilt, sadness and anxiety can be overwhelming. 10-15% of women may experience depressive symptoms, which commonly persist up to 4 months. Thus, having a better understand about this common complication may help them in coping with grief.


What is Miscarriage?


Miscarriage is the loss of pregnancy before the fetus is able to survive independently. World Health Organization defines miscarriage as loss of a fetus before 24 weeks of gestational age or before the fetus weight reaches 500 gram. Sadly, miscarriage is a very common complication of early pregnancy. Studies suggest that 10-20% of recognized pregnancy ended with a miscarriage. In fact, miscarriage can happen in up to 50% of pregnancies before a woman misses her period or even knows she is pregnant. 80% of all miscarriage occurs in the first 3 months of pregnancy.


What causes Miscarriage?


There are many reasons why miscarriages happen but it is usually impossible to identify it. However, mothers need to understand that majority of the cases are not caused by anything the mother has done. Up to 70% of miscarriages are thought to be random events chromosomal abnormalities in the fertilized eggs. Chromosomes are the building blocks that guide the development of a fetus. Development would not happen if fetus has too many, not little or imbalanced building blocks. For most women, a miscarriage is a one-off event and they can have a successful pregnancy in the future without any problem.



Which group of women has higher risk for Miscarriage?

  • Women in older age group

  • Women with 3 miscarriages or more

  • Women with chronic diseases such as diabetes, autoimmune disorder, blood clotting disorder or hormonal disorder

  • Women with reproductive system disorder such as uterine fibroids, short cervix or uterine scarring.

  • Women who smoke or consume alcohol

  • Women who are exposed to environment toxins and drugs

  • Women with obesity

What are the common symptoms of miscarriage?

  • Vaginal bleeding (light vaginal spotting is common during early pregnancy and it does not necessary means miscarriage)

  • Lower abdomen pain or cramping

  • Discharge of fluid or tissue from vagina

  • Loss of pregnancy symptoms

What should you do if you think you have a miscarriage?


Women should contact their doctor immediately if they experience symptoms mentioned above. They can also go to the nearest clinic or hospital to have a medical check. If women notice something comes out from vagina, save the tissue in a container or takes a photo of it and shows it to the doctor.


In the clinic, the doctor will examine to see if the bleeding is coming from the cervix. Doctor will also check the abdomen for any tenderness or bloating.


Normally an ultrasound scan will be performed to see the fetal condition and health. If the fetus is viable, women will be given medication and advised to rest. A repeat ultrasound will be done a week later to determine the fetal health.


What happen if women have a miscarriage?


If there is no pregnancy tissue left in the womb, no further treatment is required.

If there is still pregnancy tissue in the womb, the option could be:-

  • Expectant management - waits for the tissue to pass out naturally.

  • Medical treatment – takes medication that cause tissue to be expelled out from the womb

  • Surgical treatment – tissues are surgically removed by D&C

All these options have their pros and cons. Women need to discuss with their doctor to get the best option.


What happen after miscarriage?


It is commonly to emotional impact immediate after a miscarriage. Many people affected by a miscarriage go through a bereavement period. Family support is very important.


Miscarriage symptoms such as bleeding would last for 1-2 weeks. It is advisable to avoid sex until symptoms fully resolved to prevent infection.


Period will come after 4 weeks to 6 weeks. But regular period sometimes could take up to 6 months to establish.


There is no best answer for the best time to get pregnant again. Women might want to wait longer because of the bereavement and fear. However, the soonest time can be after the first normal period.



Written by:


Dr. Wai Kok Yau is a consultant Obstetrician, Gynaecologist and Fertility Specialist in TMC Fertility and Women’s Specialist Centre, Kota Damansara and Kepong, Malaysia.

Dr. Wai completed his medical training and obtained his MBBS in University of Malaya. He started his specialization in Obstetrics and Gynaecology in 2004. Since then, he has served in various tertiary and district hospitals, providing services in Women’s Health to the communities in need.

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