07 Apr Miscarriage
About one in five pregnant women had some vaginal bleeding or staining in the first 3 months (trimester). Of these women, about 30% ended in miscarriage (spontaneous abortion). Most women miscarry in the first trimester, occasionally this may occur in the mid-pregnancy.
The most common cause (more than 50%) is death of the developing baby (fetus), either a result of chromosomal (gene) or developmental abnormalities. In other words, the fetus that is miscarried probably would not have lived anyway. Infections such as German measles, uncontrolled diabetes, kidney problems, heart diseases, big fibroid(s) (see web page on fibroid) or womb defects can also cause miscarriage. Induced abortion causing laxity of the neck of womb (cervical incompetence) (see web page on abortion ) can cause miscarriage in the mid-pregnancy.
Miscarriage and D&C
When miscarriage occurs, there may be some vaginal bleeding, which may be light or heavy, constant or irregular with red or brown stains. Low backache or abdominal cramps may be present and some fleshy tissue or blood clots may pass out from the vagina. Some miscarriages may not have symptoms for a while after the fetus has died. This is called a missed miscarriage (missed abortion). Over time, symptoms and signs of pregnancy, such as nausea and breast tenderness disappear. An ultrasound examination and blood hormone test of B-HCG may be performed to determine whether the baby is dead.
Once the baby is dead, there is no way of reversing a miscarriage. Usually a minor procedure called Dilatation and Curettage (D&C) is performed to remove the remaining products of conception (placenta and the dead fetus) as there is an increased risk of infection and bleeding.
Recently, there are some studies that show that it is safe to treat miscarriage conservatively. In other words, under doctor’s supervision, it is possible to wait for the placenta and fetus to be expelled spontaneously. D&C is only performed when ultrasound examination shows that the womb is not completely empty.
Some doctors also recommend a D&C as soon as possible to examine fresh placental and fetal tissue to check the chromosomes and find possible causes of the miscarriage.
In general, the further along in pregnancy a woman is, the more likely a D&C may be necessary.