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When a woman bleeds during her pregnancy it is natural to fear that
she is going to lose the baby. Although miscarriage is a common
occurrence, for the majority of women, bleeding is harmless and
go on to have a full term, healthy pregnancy. This article explores
the implications of vaginal bleeding in pregnancy and the facts
about miscarriage.
One of the most disconcerting occurrences for pregnant women is
vaginal bleeding, which naturally raises the fear of losing the
baby. However, blood loss in pregnancy is in fact quite common and,
in the majority of cases there is nothing to worry about. Most often
it can be put down to 'breakthrough' bleeding, normally seen at
the time when a regular period is due. Up to a quarter of women
experience some bleeding in the first twelve weeks of pregnancy
and a good three quarters of these go to full term, with a healthy
baby as a result.
The loss of a baby before the 28th week of pregnancy is referred
to as a miscarriage and most often occurs within the first three
months. A miscarriage is almost always due to an unexpected problem
arising in the process of fertilisation and in the early development
of the embryo, although it can be caused by illness in the mother.
It is totally natural to be very upset if you miscarry and to imagine
that you have done something yourself to have caused it to happen.
Although not necessarily comforting, it is important to realise
that a miscarriage is almost always nature's way of ending a pregnancy
that has gone wrong and was therefore likely to be lost.
It is also normal to go through a period of grieving and it may
take some time before you come to terms with the loss. It is important
during this time to try to talk it over with your doctor and friends,
but most importantly your partner, as he will be suffering the loss
too. Also, because you have had a miscarriage does not necessarily
mean that you are at greater risk of a repeat the next time you
become pregnant. However, it is only natural to feel quite anxious
for the first few months, until the pregnancy is well established
and you and the baby are both confirmed healthy.
A miscarriage most often starts with continued vaginal bleeding,
combined with a low abdominal pain. You should contact your doctor
if you experience either or both of these symptoms. You may also
pass blood clots rather like lumps of liver. In this event, these
should be saved and shown to your doctor so that he can ascertain
whether they are part of the placenta. If you do suffer a miscarriage
it is usual that you be taken into hospital for a D&C (dilation
and curettage), which will be performed under general anaesthetic.
This ensures that the entire placenta is removed to avoid any further
bleeding or infection.
The medical world tend to use different terms for the type of miscarriage
a woman has suffered and it is worth understanding what each term
means as medical jargon can leave you confused and unclear as to
what has actually occurred.
Some women can experience a threatened miscarriage but then continue
without any further problems until the pregnancy has reached full
term. The main warning sign is vaginal bleeding that varies from
a pale brown discharge to heavy bleeding with blood clots. You may
also experience mild pains, rather like period pains. However, the
bleeding eases off and a normal healthy pregnancy results, although
there is a very slight risk of going into early labour.
An inevitable miscarriage occurs when the uterus contracts enough
to dilate the cervix, which is sealed by a plug of mucus during
pregnancy. If this happens then it is inevitable that the baby will
be lost. The symptoms are not unlike that of a threatened miscarriage,
but the bleeding often becomes heavier, combined with strong, painful
and regular contractions of the uterus.
This expression is used when both the baby and placenta are expelled
from the uterus. This can sometimes happen suddenly, without any
obvious symptoms. The bleeding will gradually slow down and stop,
and the uterus will return to its normal size.
This is when some of the products of conception have been lost but
some remain inside the uterus. Bleeding continues over several days.
This happens when the baby has died but is not expelled from the
uterus. There may be no symptoms, but the 'feeling' of being pregnant,
such as morning sickness and tender breasts, disappears. Bleeding
may have occurred but eases off.
The treatment for a miscarriage tends to depend on the policy or
your hospital or GP, but in general there are three approaches:
- The miscarriage can be allowed to complete itself naturally.
- Drugs can be given, which will help the uterus to expel its contents.
- Surgery, similar to a D and C can be performed to remove the entire
contents of the uterus.
Most of the time the exact reason why a woman suffers a miscarriage
is not known and why they are so common is a mystery. The following
are the more common causes:
Figures from the Miscarriage Association show that about one pregnant
woman in 100 suffers an ectopic pregnancy. This occurs when the
fertilised egg becomes implanted in one of the fallopian tubes and
causes severe bleeding. Although surgery can usually save the tube,
unfortunately it is inevitable that the baby will be lost. The first
symptoms of an ectopic pregnancy usually appear around week six
and include the following:
- Continued bleed over several days, which can be very dark red
or brown.
- Severe abdominal pain, often on one side only.
- Shoulder pain on the same side as the abdominal pain.
- Fainting or lightheadedness.
- Pain when you either pass urine or open your bowels.
- Pain when you are making love.
If you are suffering from such symptoms it is essential that you
see your doctor at the earliest opportunity, as early diagnosis
of an ectopic pregnancy is imperative. The biggest problem is that
as it occurs so early on in a pregnancy the symptoms can be mistaken
for a normal, if late period.
If an ectopic pregnancy is left untreated the growing embryo can
rupture to fallopian tube, which can be fatal for the mother. The
symptoms of a ruptured tube are severe pain, excessive paleness
and a fast, weak pulse. In this event an ambulance should be called
immediately. However, despite these alarming implications it should
be noted that only about 20% of women with an ectopic pregnancy
reach this point.
This is probably the most frequent cause of miscarriages. The most
common defects are:
Trisomy: this is when there are three chromosomes of one type rather
than the normal pair. This occurs usually as the result of an imperfect
egg and seems to be more common in older women. The condition is
detected with a scan, which will show the characteristic indication
of an empty sac or a baby, which is overly small for dates.
It has also been found that a woman who has had a miscarriage as
a result of trisomy is slightly more likely to suffer a second.
One X-chromosome missing: All normal girls have two X-chromosomes,
however, occasionally one of the chromosomes may by missing. This
is the cause of about 10-15% of all miscarriages. Only about 1%
of pregnancies with one sex chromosome survive to birth. The few
children who are born with only one X-chromosome are afflicted with
a condition known as Turner's syndrome, which results in poor growth,
lack of periods and infertility.
Polyploidy: this means multiple or extra chromosomes. The most common
situation is where there is an entire extra set of chromosomes,
possibly as a consequence of an egg being fertilised by more than
one sperm at once. An ultrasound scan will not necessarily pick
up the defects in the baby but abnormalities in the placenta may
be. Other babies may have such severe defects that they could not
possibly survive.
Changes in individual chromosomes: This is a less common cause of
miscarriage. Some of these anatomical changes are inherited from
one of the parents, who may be a carrier of a chromosomal defect,
even though they are perfectly 'normal' themselves.
Rarely, a miscarriage may be caused by a defect in the genes. Some
of these defects may cause a miscarriage, however, most result in
the serious problem of a severely handicapped baby.
A woman's age has an important bearing on the chances of miscarrying.
This is the older a woman is, the greater the percentage of abnormal
eggs she will have in her ovaries. It is possible that if such an
egg became fertilised it could result in an abnormal embryo forming,
that is not capable of resulting in a proper pregnancy.
Occasionally a woman does not produce the right female hormones
in the correct quantities or produces too much of the male hormone,
testosterone. Some women experience recurring miscarriages as the
result of not making enough progesterone.
Another hormonal problem that can cause miscarriage is high levels
of LH (luteinising hormone) in the blood. Abnormalities of LH hormone
are often found in women with polycystic ovaries and this condition
is now accepted as a very common cause of miscarriage.
Abnormalities of the uterus is a fairly common cause of miscarriage.
Occasionally swellings in the uterus, such as fibroids, may make
the cavity irregular, which may prevent an egg implanting properly.
Inborn defects, such as a double uterus, are much more likely to
cause miscarriage, often after the twelfth week.
In normal circumstances the cervix is tightly closed but loosens
up in labour to open and allow the baby to pass through. However,
some women have an open cervix (cervical incompetence), which means
that the muscles may be weak, opening the cervical canal to let
bacteria in. Infection may then occur in the membranes surrounding
the baby and a miscarriage most often results.
It is generally accepted that some chemicals can be the cause of
miscarriage as are some insecticides and poisons. Certain drugs
are also dangerous, particularly illegal ones as is smoking and
the use of marijuana. Abuse of these and heavy drinking can all
be contributory factors in miscarriage.
Very rarely a serious illness may result in miscarriage, most often
because the pregnancy has been harmed by a high fever. The most
common is probably acute influenza.
A Hydatidiform mole is a type of tumour that develops when the embryo
fails to grow and is a very rare condition. The main symptoms are
bleeding around six to twelve weeks after your last period, severe
morning sickness and breast tenderness caused by the high levels
of hormones produced by the tumour.
The condition is confirmed by a scan and urine and blood tests
and it treated by having a D and C operation. There is also a small
risk that the mole can develop into something more serious, so women
who have had one will need regular blood tests to check their hormone
levels.
Once a woman has suffered a miscarriage she is naturally afraid
about the chances of it happening again. However, the encouraging
news is that if you have had one miscarriage it does not increase
the odds of it happening again. In fact doctors tend not to become
concerned unless there have been three or more concurrent miscarriages.
If this happens to you, you will need to be screened to eliminate
the possibility of infection as well as any anatomical abnormality.
It is considered that the most common cause of recurrent miscarriage
is immunological.
When a woman suffers a miscarriage she is subject to many negative
emotions and fears, most commonly shock, guilt and a deep sense
of grief. Furthermore, there is often a loss of focus for the future.
Even if the baby is lost at a very early stage, much planning and
decisions will have taken place, even if just subconsciously. This
is taken away, often with little warning, leaving both parents feeling
lost and disorientated. It particularly helps to talk to others
who have also suffered a miscarriage, but most important, to share
your feelings with your partner. Telling your friends and family
can sometimes be difficult as well meaning advice, such as 'at least
you are young and can try again', can sometimes sound quite tactless.
It is generally recommended that you allow a few months for your
hormonal balance and emotional state to settle before trying to
get pregnant again. However, it is thought that following a miscarriage
women are more fertile, and some do fall pregnant straight away.
Your doctor can advise you what he considers best for you depending
on the cause, if it is known.
Clayton Hospital
Northgate
Wakefield
WF1 3JS
Tel: 01924 200799
www.miscarriageassociation.org.uk
Information, advice and support.
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