EARLY PREGNANCY LOSS / MISCARRIAGE

What is early pregnancy loss?

Early pregnancy loss, also known as miscarriage or spontaneous abortion, is the loss of a pregnancy in the first 13 weeks of pregnancy. Early pregnancy loss is very common, and happens to 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. There is no tissue left in the uterus or womb. No further treatment is needed.
An incomplete miscarriage means that you have passed some of the pregnancy tissue but there is 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.

Why did this happen?

Most miscarriages are because of genetic problems in the baby. When there is a genetic problem, the baby cannot develop properly. This usually happens by chance and is random.

Did I do anything wrong?

It’s important to know that having sex, exercising, falling down or working do not cause miscarriages. Drinking less than 3 cups of coffee per day does not affect the risk of miscarriage.

There is some research showing that smoking does increase the chance of miscarriage. It is unclear if alcohol increases the risk of miscarriage.

What happens now?

Your doctor will want to make sure that there is no tissue left in your uterus, or womb, because this can cause heavy bleeding or an infection.

You might need a blood test to check your pregnancy hormone beta-HCG. If this is high, then you probably still have pregnancy tissue in your uterus.
You might need an ultrasound to see how big the tissue is inside your uterus.

Why do you need to check my blood type?

You will need a blood test to see what your blood type is. This is very important.

If you have Rh-negative blood type, it is important for you to get a shot called “RhoGam” or “WinRho”. This is because your baby might have a different blood type called Rh-positive. If baby is Rh-positive, you could develop antibodies to that type of blood and this could affect your next pregnancy. If your next baby is Rh-positive and you have those antibodies, your antibodies will destroy that baby’s red blood cells. This can cause very serious problems for the baby.
If you have Rh-positive blood type, you do not need any further treatment.

What are my treatment options?

You only need treatment if you have an incomplete miscarriage or missed abortion.

There are 3 options:

Expectant (or “wait and see”)
Medications
Surgery

I don’t want surgery or medications. What should I expect if I “wait and see”?

It can take up to 4 weeks for the tissue to pass through the vagina. You will get cramping and bleeding when the tissue is passing. Sometimes a small bit of tissue is left behind and you might need surgery or medications.

If you have bleeding that is heavier than a period or you have a fever, you need to go to the emergency department right away.

I was told that I should take medications. What should I expect?

You will be given a prescription for a medication called misoprostol. Insert these tablets into the vagina as high as you can. This will cause you uterus to push out the tissue. It is normal to have some cramping and bleeding. If nothing happens in 24 hours, repeat the medication.

It can take up to 2 weeks for the pregnancy tissue to pass through the vagina. Sometimes a small bit of tissue is left behind and you need more medication or surgery to remove the rest of the tissue.

The side effects of the medication include:

Bleeding
Cramping and pain
Diarrhea
Low-grade fever (temperature less than 38.2oC)
Nausea, or feeling sick to your stomach

If you have bleeding that is heavier than a period or you have a high fever (temperature higher than 38.2oC), you need to go to the emergency department right away.

I want surgery. What should I expect?

This procedure is called dilatation and curettage or “D and C”. This surgery is done in the operating room. You will be asleep so you will not feel pain. Once you asleep, your doctor will dilate your cervix and use a suction to remove the pregnancy tissue.

The risks of surgery are:

Bleeding
Infection
Injury to the cervix (this might increase your chance of preterm delivery in your next pregnancy)
Uterine perforation (this means that a hole is made in your uterus. You might need an extra surgery to make sure there is no damage to your other organs).
Uterine scarring or Asherman's syndrome (this means that there is scarring inside the uterus. This might make it more difficult to get pregnant in the future).

You will have an equal chance of a normal pregnancy next time with all 3 options.

Can I get pregnant again?

Early pregnancy loss is usually a random, and one-time occurrence. Most women will go on to have successful, healthy pregnancies.

Although it is very rare, sometimes women can have repeated miscarriages. If you have 3 in a row, your doctor might do some tests to look for a cause.

How long do I have to wait before trying again?

It takes most women 4 to 6 weeks to have a period after a miscarriage.

If you want to get pregnant as soon as possible, you should wait until your period returns before trying. This will help ensure that the miscarriage is complete and to accurately date the next pregnancy.

If you don’t want to get pregnant right away, it is important that you talk to your doctor about a birth control 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 traumatic. 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, including how intensely they feel and for how long.

Where can I get more help or information?

If you are having difficulty coping or feel that you would like to have some support, you can contact your family doctor.

There are also many organizations that you can contact to get more help or more information:

Pregnancy & Infant Loss (PAIL) Network

Pickering, ON T 905.472.1807 or 1.888.301.7276

Bereaved Families of Ontario

Toronto, ON T 416.440.0290 or 1.800.236.6364

Ended Beginnings

Barrie, ON T 705.734.2125