Miscarriage

About one in four women will experience at least one miscarriage during their lifetime. It is always a shock and associated with grief and a sense of loss. The bleeding and cramps can be heavy and frightening.

You should always consult a Doctor if you have bleeding at any stage of pregnancy. We can normally see you within 24 hours and advise you if you feel you might be having a miscarriage.

We also specialise in women who have repeated miscarriages. We will try to find the reason and treat it and hopefully help you to have a healthy baby.

A miscarriage is the loss of a pregnancy before the baby is viable, before 24 weeks. Over 90% happen in the first 12 weeks (first trimester).

The most common cause of early miscarriage is a fetal genetic problem. These become more common as a woman gets older such that at 30 years the risk of a miscarriage is about 10%, but at 40 the risk is trebled to over 30%. The risk of losing a pregnancy in the early stages at 45 years is almost 70%.

Other causes of miscarriage include:

• Infection
• An incompetent cervix (not strong enough to hold the pregnancy)
• An abnormally shaped womb
• Fibroids
• Immune issues and problems with the way blood clots
• Ovulation issues such as PCOS
• Inadequate hormone levels to ensure proper implantation

A miscarriage is usually marked by pain and bleeding, but sometimes the pregnancy can stop growing and no bleeding occurs. This is a missed miscarriage and is diagnosed with an ultrasound scan.

A routine early pregnancy ultrasound from 6 weeks onwards (2 weeks after your positive test) can provide great reassurance that all is well. The scan does no harm to the pregnancy whatsoever. It can provide clues if a pregnancy is destined to fail, allowing the woman to prepare for a possible miscarriage. I routinely send a vaginal swab test at the time of this first scan, to exclude any potentially harmful infections.

If there is bleeding then everything might still be fine with the pregnancy, and an ultrasound will confirm that. The bleeding might also be a sign that a miscarriage is happening.

Most early miscarriages are just like a heavy, more painful period. The bleeding is usually finished in a week. You should use pads only for the bleeding but go to hospital if the bleeding is uncontrollable or you feel faint.

Later miscarriages or missed miscarriages can also be dealt with by taking some medication to induce the bleed, or by a quick operation to empty the womb called an ERPOC (before 14 weeks). The tissue that is removed can be sent for genetic tests. We can offer rapid 6 day access to the Portland Hospital for an ERPOC as required.

I always see my ladies a few weeks after a miscarriage for an ultrasound scan, maybe discuss results, and to make a plan. It is important to offer support, and usually also to reassure that no one is to blame for the miscarriage.

Recurrent miscarriage