A miscarriage is the loss of a non-viable fetus in the first 16 weeks of pregnancy. Approximately 10% of pregnancies end in a miscarriage. Most of the miscarriages take place in the first weeks. When a beating heart is seen as a beating heart (from the 6th week), the chance of a miscarriage is only 1-3%!
Vaginal blood loss and / or abdominal pain are usually the first signs of miscarriage. In case of blood loss in the beginning of pregnancy, 50% of the cases also ends in a miscarriage.
Cause of miscarriage
Often a miscarriage is caused by an error that occurs during the fertilization of the egg cell with the sperm cell. This causes a serious chromosomal aberration in the fetus, so that the fetus is not viable. Chromosomes are indispensable in the development of a fetus to a child. With a serious chromosome deviation, a good development is therefore impossible. The fetus is not well laid out and nature finds a logical solution, as it were; it does not grow any further and the body repels it. As a rule, these are not hereditary defects, so there are no consequences for a subsequent pregnancy. Such a mistake that can occur during fertilization occurs regularly. One in ten pregnancies end in a miscarriage.
There is nothing you can do about it!
Because the cause of miscarriage is usually a predisposition to the fetus, treatment is not possible. Medication or measures such as bed rest and stopping work are useless. A miscarriage can also not come through for example sex or sports.
Blood loss in the beginning of pregnancy can be a sign of miscarriage, but can also be innocent. Yet you will always be startled if you lose blood in pregnancy. In blood loss for the 16 weeks of pregnancy we are talking about a threatening miscarriage. If you have little vaginal bleeding, chances are that the pregnancy will continue and that a healthy child will eventually be born. If the blood loss increases and if you also get cramps it is likely that you get a miscarriage. One in ten pregnancies ends in a miscarriage.
It is possible that you have had an ultrasound and have seen that the fetus has no heart action anymore, while this should have been the case. We call this a missed abortion. The fetus is then no longer alive, but your body has not started a miscarriage yet. Sometimes the fetus has stopped growing for several weeks and sometimes some ueran for the ultrasound.
If a missed abortion has been established, you have a choice between three ways in which a miscarriage can take place:
- Wait until the miscarriage occurs spontaneously.
- Cytotec is a pill that you have to inject vaginally. In 80% of cases, this medicine causes the miscarriage to start.
- Curettage, an operation where under general anesthesia or local anesthesia the pregnancy tissue is removed via the sheath (vagina) and the cervix.
Usually a miscarriage spontaneously proceeds without complications and without intervention really necessary. Waiting is safe and by waiting for the natural course in the first week, up to 40% of the procedures (medicines or curettages) can be prevented.
Waiting for the natural course is preferable and our policy is based on this. You decide for yourself what suits you best. The choice is a matter of personal preference. Discuss the policy with us; weigh the pros and cons against each other and take a few days to think. An interim solution is also always possible, such as waiting for some time, and then medication or curettage. Make your own wishes and desires known to us, so that it is done for you in an appropriate way.
Vaginal blood loss or abdominal pain are the first signs of miscarriage. Often it starts with light blood loss that quickly increases in quantity. Generally, the blood loss is fierce the first days; about two sanitary napkins per day soaked with blood. The blood loss is often accompanied by blood clots; dark red color and smooth shape. After that, most women also get abdominal pain. The abdominal pain is comparable to very severe menstrual cramps. This is usually the most intense on the third day of the blood loss. The pain can radiate into the back or thighs and can look like contractions. If the miscarriage has taken place, the blood loss and cramps often decrease rapidly.
How long does it take?
In half to three-quarters of the women, the expulsion of the fetus takes place within one week. Sometimes this period takes longer. When the whole fetus is emitted, blood loss and abdominal pain gradually decrease in about a week. When the fetus is not completely emitted, the blood loss and abdominal pain will stop temporarily, but then come back again. Signs of complete expulsion of the fetus are decrease in abdominal pain and blood loss.
How does it look?
In most cases the fetus is not present or recognizable as a small person, but blood clots are seen with a amniotic sac. The amniotic sac is recognizable as a fluid filled vesicle with a filmy cover that is covered with pink flakes. At 6 weeks gestation the fetus is 6mm, at 8 weeks over 1cm, at 12 weeks 7cm and at 16 weeks 15cm. If the fetus is emitted, it is usually smaller than fits with the duration of the pregnancy because it has stopped growing before.
Which research is possible?
If you have blood loss and call us we will ask a lot of questions. In this way we form a picture of the situation and to assess whether investigations have to be done. Sometimes we do this by telephone, sometimes we cancel so that we can investigate you. In case of blood loss, everyone wants to know as soon as possible whether it is a sign of miscarriage or not. Unfortunately that is not possible. There are no tests that can provide clarity with certainty. Nothing will change the course. A miscarriage can not be stopped in any way.
- A pregnancy test does not make sense to find out whether the fetus is still alive, because the pregnancy hormone can still be detected in the urine for a long time, even during a miscarriage.
- Making an ultrasound immediately after the occurrence of blood loss usually does not provide any clarity. Often there is nothing abnormal to see on an ultrasound immediately after the occurrence of blood loss. Only a few hours to days after the occurrence of blood loss can echo clarity. If, on an ultrasound, a vital pregnancy is seen a few days after the blood loss, that is a good sign. But unfortunately that does not give any guarantees. because even after the echo a miscarriage can still occur.
- An investigation with a speculum can sometimes give clarity. When we see that the cervix is open, it is a sign that it is a miscarriage.
Based on your answers and any research, we assess whether waiting (of the natural course) is justified. We will refer you for an ultrasound if the blood loss or cramps will not decrease after a few days, your extreme loss of blood (more than two sanitary napkins per day soaked with blood) or there are signs of an ectopic pregnancy.
When to call?
It is wise to call us if you have a miscarriage and:
- you are worried.
- you have an increase in blood loss; more than two sanitary napkins per day soaked with blood.
- you get more and more pain or constant pain.
- you have a fever> 38 ºC.
The physical recovery after a miscarriage (spontaneously and after medication / curettage) is usually smooth. During one or two weeks there is still some blood loss and brown discharge. After the blood loss has stopped, the body has recovered sufficiently to become pregnant again. Getting pregnant is not complicated by a miscarriage. The menstruation automatically got going again. Sometimes after 2 weeks, sometimes after 8 weeks. Research shows that half of the women were pregnant again within 4 months after a miscarriage.
If you want to become pregnant again after a miscarriage, do not forget to swallow folic acid again!
For many women, bleeding is difficult at the beginning of the pregnancy because it brings a lot of uncertainty about the pregnancy. When a miscarriage occurs, the sadness can be profound. The miscarriage means a line through the future as you intended it. It abruptly ends all plans and fantasies about the expected child. A miscarriage usually comes very unexpectedly, so that many women initially react rather shocked and full of disbelief. A small proportion of the women had a premonition, that it was not right. Sad feelings are most intense within the first 4-6 weeks after the miscarriage and usually disappear after 3-4 months. In some women, these feelings exist for more than 3-4 months. In addition to feelings of sadness, other feelings may exist such as guilt, disbelief, anger, a feeling of emptiness, failure of one's own body, or jealousy towards other pregnant women. These feelings are certainly common in the beginning and are very understandable. Time is needed to process these feelings and there is no reason to deny or stop them. Nor is there reason for feelings of shame. The question why this happened to you and why misgiving may keep you busy. The cause of miscarriage is usually a predisposition to the fetus.
To say goodbye there are various possibilities, which could help you in the processing of the loss. You can view the fetus, bury it in a special place, or keep a keepsake in the form of an echo image or giving a name. You could write your story in a diary, make a drawing or write a poem or letter to your unborn child. If the feelings of acute mourning are over, it may be good to slowly pick up certain activities that give distraction. You feel yourself when this is nice for you and you are ready for it.
Realize that the loss for the outside world is usually invisible. This sometimes makes it difficult to share your feelings with others. Both reactions from the environment that give support, and reactions that will prevent hurt. The processing of a miscarriage differs from person to person; everyone does that in his or her own way. This difference in processing can also give a pressure on the relationship. Try to talk about this together and give each other space and time to process this loss. Support can also be sought from other parents who have experienced the same thing. For this you can go to Women Health Center Isis, Foundation for contact with fellow miscarriages. Phone: 020 - 6934358.
Do you have questions after the miscarriage, or questions about and next pregnancy? Then come to our pregnancy planning consultation. During this consultation of 45 minutes we take a medical history. This means that we ask a lot of questions about your health, the health of both families and your lifestyle. On the basis of your answers, if necessary we will do blood tests and give you personal advice.
If you want to, we also provide information about the possibilities of research into congenital or hereditary disorders. Some of these studies can be done better before the pregnancy. We will also discuss your menstrual cycle to assess when you are most fertile.
At the end of the appointment you have a clear picture of what you can do and have to do to become as healthy and fast as possible. You will receive a booklet with all the tips and advice explained once again so that you can read everything quietly at home.
A pregnancy planning consultation is free of charge. Everyone who lives in Amsterdam Center, West, East, South, De Pijp, Westerdok, Jordaan and Prinseneiland is welcome.
We will guide and support you during a miscarriage. We will also provide you with all information. If investigations in the hospital are necessary, we will arrange these for you in the hospital that you prefer. We can quickly arrange these appointments because we work closely with all hospitals. It is good to know that during a miscarriage you can always call us on the emergency number (06-5478 8178), also at night.
If you like it, we can schedule a follow-up discussion a few weeks after the miscarriage if you need it. In this conversation you can come back to a number of topics, such as the cause of the miscarriage, the physical recovery or the start of menstruation. In this conversation the processing of the loss can also be discussed. There may be questions, feelings and fears that play with regard to a next pregnancy, or, if no new pregnancy is desired at that time, a good method of contraception can be discussed. If you have had two or more consecutive miscarriages, it is possible to have further research done. We will provide you with more information during a follow-up discussion.