Miscarriage

What is a miscarriage?

The first period of pregnancy is an exciting time. The foetus is developing and nestling in the uterine wall. Unfortunately, this does not always go well. This is when a miscarriage occurs. A miscarriage (= spontaneous abortion) is the loss of a non-viable fetus in the first period of pregnancy. The fetus can die and be expelled for a variety of reasons. If there is a non-viable fetus that has not yet been spontaneously expelled, we call this a “missed abortion. In one in ten women, the pregnancy ends in miscarriage.

Symptoms

The first thing you may notice is the disappearance of the features that let you know you are pregnant. Nausea subsides and your breasts hurt less. You may feel like something is wrong. Some miscarriages are almost symptomless or are accompanied by little (brown) blood loss or mild abdominal pain. Sometimes, however, more blood loss and substantial menstrual-like cramps occur. The intensity of the pain is often related to the duration of the pregnancy. An ultrasound can rule out whether or not the pregnancy is intact, because blood loss and/or abdominal pain does not necessarily mean that the pregnancy will end in miscarriage.

Causes

In 95% of all cases, miscarriage involves a disposition disorder of the fetus. There is often a chromosomal abnormality that occurred at or even before fertilization. Nature seeks a “solution” and the pregnancy ends in miscarriage. This is usually not a hereditary factor, so there is no increased risk for a subsequent pregnancy. If you have had multiple miscarriages, you can be examined to see if a cause can be found. In 5% of the cases, it is due to an implantation that did not go well, an infection, an abnormal uterine shape, a fibroid or an unknown cause. You cannot cause a miscarriage yourself by e.g. physical exertion, having sex, cycling or falling. However, it can be the trigger for an already existing miscarriage to start.

What if the miscarriage is established?

There is no treatment for miscarriage; however, there is a choice between three ways in which miscarriage can occur:

• Waiting for miscarriage to occur spontaneously
• The use of medications that trigger spontaneous miscarriage
• Curettage: a procedure in which pregnancy tissue is removed through the vagina and cervix

You can decide what you feel most comfortable with. For medication or a curettage we refer you to the gynecologist. An in-between solution is always possible, such as waiting a while and if it takes too long still a curettage.

The course of a spontaneous miscarriage

The course of a miscarriage can vary greatly from woman to woman. Usually there is little blood loss initially that can last from a few days to as long as 2 weeks. As the miscarriage “progresses,” you gradually experience cramping pain in the uterus and increased blood loss, similar to a heavy period. You may also lose clots (lumps of blood), sometimes the size of a fist. Over the course of several hours, the amniotic sac detaches from the uterus and comes out through the vagina. Once the uterus is empty, the pain becomes much less, the blood loss diminishes and continues for several days as in the last days of a period.

When should you call us?

• If you continue to lose many large clots or if you need more than 2 large pads within an hour to accommodate the blood loss. Briefly this may be the case, mainly at the time the fetus is expelled.
• If there is dizziness, fainting or starry vision.
• If you develop a fever during or after the miscarriage or curettage. A temperature of 38 C or higher may indicate an infection.
• If prolonged and severe blood loss or abdominal pain persists after a spontaneous miscarriage or curettage, this may indicate an incomplete miscarriage. Treatment by curettage may be necessary.
• If you are unsure, have questions or want to chat.

Midwifery practice ‘De Lekbrug’, midwife on duty: 088-4300400 (24h a day)

Physical recovery

Physical recovery after a spontaneous miscarriage or curettage is usually smooth. For 1 or 2 weeks there may be some blood loss, first bright red, later brown. During this bleeding it is advisable to wait with sex, use tampons, take a bath and go swimming. You can expect your next period after about 4-6 weeks, but it may happen earlier or later. It is not more difficult to get pregnant after a miscarriage, and there is no medical need to wait to get pregnant again.

Emotional recovery

Some people are able to put aside a miscarriage they have gone through quite well; others need more time to do so. A miscarriage can be a very drastic event after which there can be a grieving process. Each person deals with a miscarriage in his or her own way. How long this process takes is different for everyone. It is important to give it a place and to talk about it together. Because the loss is often invisible to those around you, it can be comforting to talk with others who have gone through the same thing. Do not hesitate to share your grief with others, there is always someone who can give you support.

The next pregnancy

Over time (different for everyone), the desire for another pregnancy usually arises anyway. In most cases the next pregnancy proceeds without any problems. Because the first months are extra exciting, you may contact us early in the pregnancy. We may make an early ultrasound (from 8 weeks).

Relief organizations

Miscarriage Counseling Mirjam van Kreij

Online

A miscarriage. Now what?

Books

M. Cuisinier, H. Janssen: “With empty hands” Van Holkema and Warendorf, 3rd edition 2000. ISBN 9026966997 M. van Buren, W. Braam: “If your pregnancy goes wrong”. De Kern, Baarn, 6th edition 1999. ISBN 9032506749 Spitz, M. Keirse and A. Vandermeulen: “Between something and nothing, dealing with the loss of an early pregnancy” Lannoo Tielt, 1998 ISBN 9020934449