Pregnancy loss

The unexpected loss of a pregnancy is a devastating blow to any couple. The impact worsened if the pregnancy was conceived as a result of fertility treatment or if there have been previous pregnancy losses. Until recently, the emotional consequences of miscarriage have not been fully appreciated by either the medical community or society at large.

This leaflet aims to clearly explain about causes, possible treatments and support available to couples who have suffered pregnancy loss. 

It is now known that 25% of women will have at least one miscarriage, 15% of clinically recognized pregnancies end in miscarriage and recurrent miscarriage ( defined as 3 consecutive miscarriages) affects approximately 1% of women.


Causes of Early Pregnancy Loss
We know that early pregnancy loss is associated with a chromosomal abnormality of the fetus in 50-60% of pregnancies. A miscarriage can therefore be nature’s way of selecting healthy pregnancies. This helps to explain why miscarriage becomes commoner in women as they get older. At 35-39 years of age a woman has a 21% chance of miscarriage compared to 42% if she is over 42 years of age.

In women who have recurrent miscarriages, the following causes need to be investigated:-

• Minor chromosomal problems in the man or woman

• Hormonal problems eg diabetes or polycystic ovarian syndrome

• Abnormalities of the cavity of the uterus eg fibroids or uterine polyps

• Cervical incompetence, where the cervix opens up without contractions of the uterus (usually causes late miscarriages)

• Immunological causes

• Minor blood clotting problems

In women who have had 3 or more miscarriages it is usually sensible to investigate these causes. However, even after investigations, no identifiable cause is found in 50-75% of couples (unexplained recurrent miscarriages).  Even if a cause is found treatment to improve chances of a successful pregnancy is not always available.


Treatment of Early Miscarriage
A threatened miscarriage is “bleeding in early pregnancy”. It is important to inform your doctor or midwife if this occurs in order to assess whether the pregnancy is continuing or not.  If your blood group is rhesus negative you may require an injection of anti-D to prevent problems in a future pregnancy. No treatment has been shown to influence the outcome of a threatened miscarriage. In 75% of women the bleeding will stop with rest and as long as it does, the pregnancy should continue normally. You may need to be seen in Hospital for a scan and pregnancy test. Depending on the results, the pregnancy may or may not be continuing. It can be particularly devastating to find out at a routine scan that no fetal heartbeat is present, even when you felt all was well.

Treatment is not always necessary if the pregnancy has failed. The uterus may be empty already (complete miscarriage). If there is only a small amount of tissue remaining, then time alone will allow the tissue to be reabsorbed naturally avoiding the need for medical intervention. However, it is sometimes necessary to use drugs to expel the remaining tissue, or it may need to be removed by a small operation (evacuation of uterus).


Feelings Following Pregnancy Loss
Following pregnancy loss you will require:

• Time

• Support

The loss of a pregnancy can affect you with deep and unexpected feelings. Emotionally you are experiencing the loss of your baby and you can expect to go through a grieving process, as you would do if a love one died. Common feelings include emptiness, anger and disappointment. Sadness and a sense of isolation often linger. The range of intensity of emotions varies from person to person, from day to day and may last briefly or for many months.


Potential Providers of Support Following Pregnancy Loss.
In order to help you get through this difficult time there are many individuals or groups who can help. The important thing is to recognize you are not alone. Talking things over with your partner, a relative, friend or religious adviser can be very helpful. Your midwife will be happy to call and see you. Other groups that can offer support include:

Family Doctor or Health Clinic

• Counselors

• Hospital Bereavement Centers

• Miscarriage Association/SANDS

• Samaritans

• Internet Support Groups

Future Pregnancies
You should be positive about any future pregnancies as there is a very good chance that they will be successful. Overall, if you miscarried in your last pregnancy there is an 81% chance of a successful outcome for your next pregnancy and even if you have had 3 consecutive miscarriages there is still a 60% chance that your next pregnancy will be successful.