Medical FAQ's - a Medical Perspective on Miscarriage

Miscarriage medical FAQ’s by Carri Warshak, Perintologist.

1. Why did I have a miscarriage?

Having a miscarriage is an emotionally devastating occurrence for prospective parents-to-be. Of course, the first question most women ask is “Why did this happen to my baby?” This is a tough question to answer, both medically and emotionally. The truth is, creating a baby really is quite a miracle, if you think about it. It takes one cell from the father-to-be and one cell from the mother-to-be to make another human being. It may happen thousands of times a day across the world, but to me it is pretty miraculous. Sometimes things just don’t come together right and a miscarriage is one of nature’s ways to ensure healthy babies. Usually, with an early pregnancy loss in the first trimester, this is what has happened to the chromosomes of the fetus and therefore it cannot develop properly.

2. Did I do something to cause miscarriage?

The answer to this question for 99% of pregnancies is a resounding “NO”! Yet most women feel a need to place blame on their loss as a reaction to their grief, and usually that blame becomes self-directed. Working, stress, sexual intercourse, caring for other children, lifting heavy things, possible regret about the pregnancy, even mild alcohol intake in the initial weeks of pregnancy, have not been shown to cause miscarriages.

However, when you are trying to conceive again, there are a few factors they may play a role that can be controlled. Smoking has been shown to increase miscarriage rate and if you have diabetes, optimizing your sugars can decrease the risk.

There is heated controversy and conflicting studies about caffeine intake and miscarriage rates. Recently a study of over 1000 women showed maternal consumption of over 200 mg/day was related to miscarriage. However, these women also were more likely to have other risk factors for miscarriage such as smoking and age greater than 35 years. Other studies of over 5000 and 2000 women have shown no relationship, even in women with high caffeine intakes of over 300 mg/day. Therefore, even though an exact relationship is controversial, most experts agree it cannot hurt to cut/ decrease caffeine intake in the first trimester.

3. I am having/had a miscarriage. Do I need a Dilation and Curettage (D & C)?

A miscarriage is a natural physiological event, and many women will undergo a miscarriage without complication. However, given the associated blood loss which can be severe in some cases, medical intervention may be necessary to optimize the safety of the mother. A six week medical check up would be helpful also for a healthy following pregnancy.

There are variances in medical and surgical management of miscarriage. The following are the options that should be available to you;

A Dilation and Curettage (surgical evacuation). Medically D& C’s are quite safe; however there are uncommon risks in 1-2% of procedures. These include uterine perforation that can injure the uterus, bladder and even the bowel, requiring further surgery, possibly a hysterectomy (although very uncommonly) and perhaps a transfusion for blood loss.
If your preference is to have the chance to allow the uterus to pass your pregnancy more naturally, you may choose “expectant management” which involves a variety of medicines to induce miscarriage. The risks are; increased blood loss, possible infection and even severe blood clotting disorders if the pregnancy remains in the uterus for many weeks or months.

There are certain circumstances when surgical management, not “expectant management”, should be more strongly considered. If a woman has had a previous ectopic (a pregnancy in their Fallopian tube) or is in pain, a D & C should be considered to help make sure the failed pregnancy is in the uterus and not the tube. When tubes rupture, because of a growing pregnancy, severe bleeding can occur and women today still die from ectopic pregnancies.

Finally, if a woman is severely anaemic or if an episode of blood loss is more medically dangerous for other than medical reasons, then a more controlled evacuation of the uterus is preferred. For most women, however, the choice can be theirs to make in concert with their care-provider’s recommendations.

4. How do I know if I have an infection?

An infection can occur prior to, during or after a miscarriage and can quickly become very dangerous. If you believe you may have an infection in your uterus (this can affect future pregnancies) seek help as a D&C should be carried out immediately. Symptoms of a miscarriage complicated by infection can include severe abdominal pain, a foul-smelling discharge and fevers. If a D&C is not performed it can greatly increase the potential need for a hysterectomy after becoming septic and cause extreme illness. Women have died from the overwhelming infection.

5. I have had a miscarriage, how long should I expect to continue to have bleeding after my loss?

This depends upon whether a D&C has been performed or if your miscarriage is being passed naturally. Passing a failed pregnancy naturally, bleeding may last for one or two weeks.It should be somewhat heavier than a normal period. With a D&C, the period of bleeding is shorter and most bleeding or spotting will stop within a week of the procedure. However, if large clots begin to pass or there is bleeding over one large pad per hour, you should be evaluated by a medical professional. In addition, if there are symptoms from the blood loss such as lightheadedness, dizziness, severe fatigue or chest pain then you should also seek medical care immediately. After the initial heavier blood loss, spotting and brownish discharge may continue for a week or two.

Returning to normal cycles varies extensively woman to woman, just like after a normal delivery. Some women will resume periods readily, others will have irregular cycles for a while. I usually recommend a woman wait at least 3 or 4 cycles before attempting to conceive again.

6. What are my chances for having another miscarriage?

If this is your first miscarriage or if you have had other normal pregnancies, then you are very likely to have a normal subsequent pregnancy. However, because miscarriages in general are so common, statistically there is a significant chance it could happen again. We do not become medically concerned there is a biological reason for repetitive miscarriage until a woman has more than 2 (or 3) in a row, especially with no prior normal pregnancies.
Women in this situation require extensive work-ups to evaluate potential reasons for recurrent miscarriage.