EARLY PREGNANCY LOSS
What is early pregnancy loss?
Early pregnancy loss is also called miscarriage or spontaneous abortion. It is the loss of a pregnancy in the rst 13 weeks of pregnancy. Early pregnancy loss is very common and happens in about 20 to 25% of all pregnancies.
What are the different types of miscarriage?
A complete miscarriage means that you have passed all of the pregnancy tissue. The uterus or womb is empty and you do not need any treatment. An incomplete miscarriage means that you have passed some of the pregnancy tissue but there is still some left in the uterus or womb. A missed abortion means that the pregnancy has stopped developing but your body has not started to pass the tissue yet.
If you have an incomplete miscarriage or a missed abortion, you might need medical or surgical treatment.
Why did this happen?
Most miscarriages happen because of genetic problems in the pregnancy. When there is a genetic problem, a baby cannot develop and the pregnancy stops growing. This usually happens by chance.
Did I do something wrong?
It’s important to know that normal daily activities do not cause miscarriages to happen. Having sex, exercising, falling down or working do not cause miscarriage. Drinking 3 cups of coffee or less per day does not increase the risk of miscarriage. It is not clear if drinking alcohol increases the chance of miscarriage. Some research shows that smoking may increase the chance of miscarriage.
What happens now?
Your doctor will want to make sure that all of the pregnancy tissue is cleared out of your uterus. If tissue is left behind, this can cause heavy bleeding or an infection. You might need an ultrasound to see how much pregnancy tissue is still inside your uterus. You may also need a blood test to check your pregnancy hormone: beta-HCG level. If it is high, then it is likely that there is still pregnancy tissue left in your uterus.
Why do you need to check my blood type?
It is very important to check your blood type to determine if you are Rh-positive or Rh-negative. Most people have Rh-positive blood. Rh is a protein that can be found on red blood cells. If you are Rh-positive, your blood cells have this protein. If you are Rh-negative, you do not have this protein. The blood type you have is determined by your genetics. Because babies have genes from their mother and father, the baby might have a different blood type than their mother.
If you have Rh-positive blood you do not need any treatment.
If you have Rh-negative blood it is important for you to get a shot called “RhoGam” or “WinRho” as soon as possible. This is because your baby might have Rh-positive blood and your body can develop antibodies to your baby’s blood. If you have antibodies to the Rh protein, this can lead to very serious complications for any new pregnancies. This shot will prevent your body from possibly making Rh antibodies.
What are my treatment options?
You will only need treatment if there is still pregnancy tissue in your uterus. If you have an incomplete miscarriage or missed abortion, there are 3 options for treatment:
1. Expectant management (“wait and see”)
2. Medication
3. Surgery
I don’t want surgery or medications. What should I expect if I decide to “wait and see”?
It can take up to 4 weeks for the pregnancy tissue to pass on its own. When it does you will have cramping and bleeding like a heavy period. It is hard to know when this will start. You may pass tissue that looks like ‘liver’ or you may pass blood clots.
If you are bleeding heavily enough to soak more than a pad an hour or you have a fever, severe pain or feel unwell, you need to go to the emergency department right away. These might be signs that you are losing too much blood or have an infection.
It can take up to 2 weeks for all of the tissue to pass and you may have bleeding for this entire time. Sometimes, a small amount of tissue is left behind and you may need surgery or medication to completely clean out the uterus. If your bleeding lasts longer than 2 weeks, see your doctor.
I decided to treat with medication. What should I expect?
You will be given a prescription for a medication called misoprostol. Push these tablets with your nger into the vagina as far as you can. This medication will cause your uterus to contract and push out the pregnancy tissue. Cramping and bleeding usually start within 6-8 hours after taking the medication.
The side effects of the medication include:
• Diarrhea
• Low-grade fever (temperature less than 38.2oC)
• Nausea, or feeling sick to your stomach
If you are bleeding heavily enough to soak more than a pad an hour or you have a fever greater than 38.2oC, severe pain or feel unwell, you need to go to the emergency department right away.
It can take up to 2 weeks for all of the tissue to pass and you may have bleeding for this entire time. Sometimes, a small amount of tissue is left behind and you may need surgery or more medication to completely clean out the uterus. If your bleeding lasts longer than 2 weeks, see your doctor.
I want surgery. What should I expect?
The procedure to clean out the uterus is called dilatation and curettage or “D&C”. A D&C is a surgery that can be done in an operating room while you are completely asleep but can also be done awake in an outpatient clinic. Once you are comfortable, your doctor will use instruments to dilate your cervix and remove the pregnancy tissue.
The major risks of surgery are:
• Excessive bleeding
• Infections
• Injury to the cervix caused by instruments
• Injury to the uterus caused by instruments and possibly the need to do another surgery to check other organs in the abdomen
• Scarring of the lining of the uterus or Asherman’s syndrome, which can make getting pregnant in future more di cult
Your chance of a normal pregnancy next time is the same with all 3 treatment options.
Can I get pregnant again?
Yes! Early pregnancy loss is usually a chance, one-time event. Most women go on to have successful, healthy pregnancies next time. A single miscarriage does not increase your chances of having another miscarriage in the future. However, if you have had more than three miscarriages, your doctor may choose to do some testing to look for a cause.
How long do I have to wait before trying to get pregnant again?
It usually takes between 4 to 6 weeks to get your period after a miscarriage. If you want to get pregnant again as soon as possible, you can start as soon as you get your period. This helps make sure that the miscarriage is complete and helps your doctor to date your next pregnancy. If you don’t want to get pregnant, talk to your doctor about a birth control method that is right for you.
I am very sad and upset. Is this normal?
The loss of any pregnancy, at any time, can be very upsetting. A range of emotions are normal after miscarriage. These can include sadness, grief, self-doubt or guilt, shock and denial. People react differently to this news. For some people this can last a very long time and can be very upsetting.
Where can I get more help or information?
If you are having difficulty coping or feel that you would like some support, contact your family doctor.
There are many organizations that you can contact to get more help or more information:
Pregnancy & Infant Loss Network
pailnetwork@sunnybrook.ca
T. 416.480.5330 or 1.844.772.9388
Bereaved Families of Ontario
Toronto, ON
bfotoronto.ca
T. 416.440.0290 or 1.800.236.6364
Miscarriage Association UK
miscarriageassociation.org.uk
Sunnybrook Health Sciences Centre
2075 Bayview Avenue Toronto, ON M4N 3M5
Telephone: 416.480.6100
PR xxxxx (Feb 2017)
