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What is early pregnancy loss?
Early Pregnancy Loss
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What is early pregnancy loss?
Early miscarriage is when a woman loses her pregnancy in the first three months. This may be accompanied by vaginal bleeding and pain.
Bleeding and pain in early pregnancy
Many early miscarriages occur before a woman has missed her first period or before her pregnancy has been confirmed. Once you have had a positive pregnancy test, there is around a one in five (20%) risk of having a miscarriage in the first three months. Most miscarriages occur as a 'one-off' (sporadic) event and there is a good chance of having a successful pregnancy in the future.
Why does early pregnancy loss occur?
Much is still unknown about why early miscarriages occur. The most common cause is chromosome problems. Chromosomes are tiny thread-like structures found in all the cells of the body. In order to grow and develop normally a baby needs a precise number of chromosomes. If there are too few or too many chromosomes, the pregnancy may end in a miscarriage.
What is the risk of having a miscarriage?
The risk of miscarriage is increased by:
- a woman's age - the risk of early miscarriage increases with age. At the age of 30, the risk of miscarriage is one in five (20%). At the age of 42, the risk of miscarriage is one in two (50%).
- health problems – as an example, poorly controlled diabetes can increase the risk of an early miscarriage.
- lifestyle factors – smoking and heavy drinking are linked with miscarriage. There is no scientific evidence to show that stress causes a miscarriage.
Early miscarriage:
Sex during pregnancy is not harmful and is not associated with early miscarriage. There is no treatment to prevent a miscarriage.
What happens if it is a miscarriage?
If the miscarriage has completed, you will not need any further treatment. If the miscarriage has not completed, there is a range of options available.
Options for your pregnancy remains following miscarriage
Useful Organisations
www.miscarriageassociation.org.uk
What happens if I have been diagnosed with a pregnancy loss?
There are 3 main options for a women if a pregnancy fails
- Wait for nature to resolve the situation
- Accelerate the natural process with a vaginal pessary
- Have an operation to end the bleeding
Natural (Expectant) Management
A significant proportion of miscarriages will resolve naturally, with success rates around 50%. This is a safe option for many patients, and the early pregnancy team will advise you if they think this is a suitable option for you. The main disadvantage is that it can take some time to resolve, and some women need additional treatment (such as medication or a short procedure) to remove remaining pregnancy tissue.
The main risk of opting for natural management is infection (2-3%). This is rare but can be very serious if not treated early. The main signs would be increasing abdominal pain or bleeding, feeling unwell, or a temperature. If you choose this option, we would advise you monitoring for these symptoms, and contacting your GP if you have any concerns.
The other risk with this option is heavy bleeding requiring you to come into hospital urgently, for further treatment, however this is also rare. If you choose this option, and you have not had any bleeding within 2 weeks, then please contact the early pregnancy clinic for advice.
Medical Management
Some women choose to have medication (given orally or inserted vaginally) to encourage the neck of the womb to open and the remaining pregnancy tissue to come away. This is successful in around 85% of patients.
The main risk associated with this option is adverse effects to the medication, which can result in nausea, vomiting or diarrhoea. Also, some patients, for example those with severe asthma, are not suited to have this medication. As with natural management, this option carries the risk of heavy bleeding needing a hospital admission, and a small risk of developing an infection.
If you choose this option, and bleeding has not started 24-48 hours after the treatment, then please contact the early pregnancy clinic for advice.
Surgical Management
Some women choose to have a short surgical procedure to empty their womb. This may also be an option which is recommended in some instances for pregnancy loss. The procedure is usually undertaken during planned appointment 1-2 weeks after attendance at the early pregnancy clinic. Success rates for this procedure are in the region of 95%.
The procedure involves passing a small canula through the vagina and the neck of the womb (cervix) into the womb to remove the pregnancy tissue. This can be completed under local anaesthesia with additional inhaled analgesia, or under general anaesthesia.
Patients who choose to have this procedure can usually go home the same day, regardless of what method of anaesthetic they choose.
The main risk associated with this procedure are damage to the cervix or womb (1 in 1000), or internal organs, which is rare. Another rare risk is scarring to the inside of the womb, called Asherman's syndrome.
The early pregnancy team will discuss all available options for management of pregnancy loss with you, and answer any questions you may have. Some management options are not suited to certain people or situations, and they will advise you if this is the case.
You can find more information on all options for the management of early pregnancy loss by using this link to the Royal College of Obstetricians and Gynaecologists Patient Advice Leaflet.
Early miscarriage - Patient advice leaflet
If I choose surgical management, what can I expect after the procedure?
Following The Procedure
During the first 24 hours after the procedure, you may feel drowsy or tired, and you should rest as much as you need.
If you have had a general anaesthetic, you should:
- Go home escorted by a responsible adult in a private care or taxi.
- Arrangements should be made for a responsible adult to be with you for the first 24 hours.
For 24 hours following a general anaesthetic, you must NOT:
- Drive a car or motorcycle or ride a bike.
- Operate heavy machinery.
- Drink alcohol or take sedative drugs – eg. sleeping tablets.
You may get some cramp like abdominal pains following the procedure. Simple pain relief, such as paracetamol or ibuprofen should help with this. If you have pain that is worrying you, or pain not responsive to basic painkillers, then contact your GP, or out of hours phone 111 or go to the Emergency Department.
Some bleeding is normal after the procedure, similar to a period, although the amount will vary from patient to patient. This could last up to 2-3 weeks. To reduce the risk of infection we would advise you to avoid using tampons for 3 weeks after the procedure. If you have heavy vaginal bleeding (changing more than 1 large sanitary towel per hour) or are feeling faint or dizzy, then seek medical advice.
Ongoing vaginal bleeding, associated with abdominal pain, feeling cold or shivery, or unusual smelling vaginal discharge could be a sign of infection, and if you develop these symptoms we would advise you seeing your GP for advice. You may have baths and showers as usual, and resume exercise when you feel able.
You can start having intercourse when you feel ready, although it is important that you feel well, and any pain and bleeding is minimal.
Please complete a pregnancy test 3 weeks after the procedure. If the pregnancy test is positive, or if you are still bleeding, then contact the Early Pregnancy Assessment Clinic at the Royal United Hospital.
Pregnancy tissue that was removed during surgery will be handled sensitively in accordance with our hospital policy. Some patients choose to make their own arrangements for their pregnancy tissue. If this is something you would like to discuss, then please talk to the nursing staff about this.
Some women, depending on their individual circumstance, may wish to discuss contraceptive options. If you would like to know more about this, then please feel free to bring this up with the nursing staff or doctors before you go home. Alternatively, you can contact your GP or local sexual health service if you prefer.