What is a miscarriage?
Expulsion or extraction of a fetus, weighing less than 500g or less, from the mother’s womb when it is not capable of surviving independently is called abortion. An abortion occurring spontaneously is termed as miscarriage.
What are the first signs for detection?
Miscarriage can alert you with a few signs like spontaneous heavy bleeding after you have got a positive pregnancy test. Sudden bleeding at any time throughout entire gestation is always a signal for something gone wrong with your pregnancy. As the growing embryo detaches, uterine vessels also get damaged for which heavy bleeding occurs. The amount of bleeding depends on how long you have been pregnant.
Antenatal hemorrhage can also occur if there is abnormality in placenta, the tissue connecting the fetus with uterus. In the initial two months of pregnancy there can be light bleeding or spotting, called implantation bleeding. One should not confuse it with bleeding due to miscarriage as the former is a symptom of normal course of pregnancy.
Lower abdominal cramps and back pain also accompanies a miscarriage. Severe pain may occur along with bleeding as the uterine muscles contract vigorously to expel the dead fetus outside. This can continue for up to 2 days.
Breast changes like tenderness, heaviness or leaking milk can also occur in a few women.
What are the possible measures to be taken?
When a miscarriage is suspected, it’s always preferable to seek medical attention as early as possible.
Blood level of Human Chorionic Gonadotropin (hCG), the hormone which helps in detection of pregnancy, decreases drastically after an abortion. It may still be present in blood for as long as 2 months after this event.
The process of miscarriage can be complete by the time you reach a clinic, or the expulsion may be ongoing. In the latter case, the person is said to be having an incomplete miscarriage and needs medical help for the expulsion of the fetus.
Drugs like Misoprostol along with Mifepristone or Methotrexate may be administered as a vaginal pessary to hasten the process. Misoprostol dilates the cervix while the other two help in detaching the fetus and fetal tissues. It may take a couple of days for the process to complete after which normal menstrual cycle can resume.
One can also opt for surgery where dilatation and curettage (D&C) is done to take out the remaining products of conception from the uterus. The woman is put under anesthesia and the procedure is carried out. The cervix is first dilated and the inside of uterus is cleaned by scraping and scooping.
Women with Rh negative blood group should be extra cautious as they have a chance of developing complications in the following pregnancy. They usually receive Anti-Rh antibodies to counteract the antigen produced inside them after coming in contact with fetal blood during miscarriage.
It is advisable to go for a psychiatric counseling which will help the mother to cope better with the unfortunate turn of events.
What complications can you develop?
Though rare, a miscarriage is at times associated with infection. Infection presents with bleeding for a long duration along with vaginal discharge, lower abdominal cramps and often fever. This can be treated with a course of antibiotics easily. Abstinence from sexual intercourse and use of tampons for a couple of weeks lessen the chances of infection.
Bleeding can also occur if there is any part of fetus or placenta retained inside the body. In such a case surgical removal is recommended as the retained tissue may prompt formation of malignant cells (cancerous cells) in the uterus.
Following D&C, there can be another complication in a few women, known as Asherman’s syndrome or Fritsch’s syndrome. Often, these women experience menstrual irregularities which may lead to infertility in severe cases.
Your doctor may recommend a follow up to check whether you have developed any complication.
Can you become pregnant after miscarriage?
A woman can attempt for pregnancy after almost 6 months following miscarriage. The chances of another mishap are less as miscarriage is usually a one-time occurrence. But if there has been a history of more than two miscarriages, it’s better to consult your obstetrician before planning another pregnancy.
A series of blood tests are done to eliminate chances of hormonal and immunological problems. Chromosomal tests of both the parents should be conducted if possible, since genetic anomalies in the fetus are a predisposition for early miscarriage in about 50% of the cases.
A thorough examination of uterus and rest of the female reproductive tract is also conducted using techniques like sonography, hysteroscopy, etc. to check for any structural abnormalities like fibroids, adhesions, obstruction in tube, etc.