Five important questions about miscarriage

Miscarriage is the saddest complication of pregnancy. Unfortunately, more than one tenth of pregnancies end in miscarriage, but usually before the 13th week of pregnancy. Miscarriage is something that should be talked about, says Professor Oskari Heikinheimo, specialist in obstetrics and gynaecology.

What is a miscarriage?

Sometimes there is a clear cause behind miscarriages, which can be treated.

Miscarriage means an early loss of pregnancy. This means that the pregnancy ends before the 22nd week of pregnancy or the fetus weighs less than 500 grams and is born without signs of life. If the pregnancy ends after the 22nd week of pregnancy, it is referred to as premature birth or stillbirth.

If the parents are experiencing recurring and consecutive miscarriages, their chromosomes and potential structural abnormalities are examined. Sometimes there is a clear cause behind miscarriages, which can be treated.

What causes miscarriages?

Over half of miscarriages are caused by fetal chromosomal abnormalities. Chromosomal abnormalities have been observed in miscarried fetuses that aren’t seen in healthy full-term babies.

“No one can influence the development of gametes right before fertilisation”, Heikinheimo says.

The risk of chromosomal abnormalities increases with the age of the mother, so the number of miscarriages among women who give birth later in life also increases.

The majority of miscarriages occur in the first trimester of pregnancy. During middle pregnancy, that is, the third trimester, miscarriages rarely occur.

Less common causes of miscarriage are uterine malformations or intrauterine infections. Uterine malformations mean, for example, a uterine septum or benign tumors. The mother’s cervix may also be weak. Uterine malformations are not uncommon.

“Women who have normal pregnancies may display surprising uterine septa. However, there still isn’t an automatic cause-effect relationship between miscarriages and the uterine structure”, Oskari Heikinheimo says.

The majority of intrauterine infections cannot be affected. The mother can still prevent infections of the uterus by protecting herself from sexually transmitted diseases. For example, a chlamydia infection doubles the risk of premature birth. If you suspect you have been exposed to a sexually transmitted disease, you should get tested.

The health of the mother and fetus is closely monitored during pregnancy. Samples are taken if there is even the smallest sign of infection.

“People rarely receive as much attention as they do during pregnancy”, Heikinheimo says.

The most common chronic illnesses in women do not pose a particular risk for pregnancy when treated. Instead, a badly treated primary disease, such as diabetes, may cause complications. It is important for women with illnesses that require specialised medical care or continuous medical treatment to discuss the planning of pregnancy at their treatment unit in good time.

How do I know if it’s a miscarriage?

Miscarriages aren’t easy to identify because their symptoms vary greatly. Sometimes everything seems fine, but ultrasound screening reveals that the pregnancy has ended.

The most common symptoms of miscarriage are bleeding and cramp-like lower abdominal pain. However, light bleeding or spotting is also common in normal early pregnancy. Cervical blood flow increases during pregnancy and bleeding may easily occur from just touching the area. There is no need to visit the emergency department in this case, unless the symptoms get worse.

“The symptoms depend on what stage the miscarriage is in. Even a symptomless miscarriage will cause bleeding sooner or later and possible lower abdominal pain as the uterus empties”, Heikinheimo says.

If unclear symptoms appear, you should seek help from a healthcare professional.

Exercise, too much hard work, stress or diet don’t end pregnancy. A normal pregnancy can withstand normal life.

Should you worry about miscarriage?

Worrying about the risks of miscarriage won’t improve the matter in one way or the other. Of course, being a parent still often causes people anxiety.

“It continues for at least the next twenty years after the child is born”, says Heikinheimo, laughing.

Exercise, too much hard work, stress or diet don’t end pregnancy. Heikinheimo often tells his patients that there was nothing that could’ve been done to prevent the miscarriage.

“Normal pregnancy can withstand normal life. Some of the parents who have experienced miscarriage blame themselves. That isn’t necessary.”

The vast majority of those who experience miscarriage experience full-term pregnancy later on.

What happens after a miscarriage?

Heikinheimo emphasises that miscarriages aren’t so rare. Many have experiences with it: when you talk about the issue, you realise that you’re not alone with it.

“When it happens to you, it still feels crushing. The child can be very real in the mind of the parents, even if so far they’re just a positive pregnancy test.”

Treatment options exist, from dilation and curettage to medical evacuation of the uterus, but a large part of miscarriages can be treated without any procedures. There is no rush on treatment. Usually, the mother is given sick leave as necessary and advised to avoid strenuous activity.

Healthcare units have psychiatric nurses and hospital pastors present who provide parents with mental support for their loss. The support is organised in different ways depending on the municipality.

For many, the best help is the support of a loved one. The crucial thing is to not be left alone with the experience.

The vast majority of those who experience miscarriage experience full-term pregnancy later on.

“The probable cause of miscarriage is in the embryo. The beginning of pregnancy indicates that the uterus, fallopian tubes and ovaries function normally. At the beginning of the next pregnancy, there are new gametes and a new embryo in the uterus, but all the functioning organs are already there.”

Sources: Interview with Oskari Heikinheimo, Terveyskirjasto, http://www.webmd.com/baby/tc/miscarriage-symptoms