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June 23, 2009

Coping with miscarriage

By Gerald F. Joseph Jr, MD,

Early pregnancy loss— or miscarriage —is the loss of a pregnancy before 20 weeks. Estimates suggest that up to 50% to 75% of fertilized eggs are lost, many before a woman even misses her menstrual period. Among confirmed pregnancies in the US, between 15% and 20% are miscarried.

Most miscarriages occur between seven and 12 weeks of pregnancy, and the cause can be hard to pinpoint. A large number of fetal deaths are due to genetic problems that would have made it impossible for the fetus to survive outside the womb. On rare occasions, infection, hormonal factors, immune responses, and serious health issues of the woman can also cause early pregnancy loss.

The risk of miscarriage is higher in women with a chronic disease such as uncon-trolled diabetes and in those with a history of repeated pregnancy loss. It is more likely in women older than 35. It is estimated that more than one-third of pregnancies among women over age 40 are miscarried.

Some women worry that daily tasks, such as going to work, exercising, or having sex, will increase the risk of or cause a miscarriage. But these safe activities will not harm healthy pregnancies.

Signs of a miscarriage may include vaginal bleeding, lower back or abdominal pain, cramps, or tissue that passes from the vagina. Contact your doctor if you are or think you might be pregnant and notice any of these symptoms.

When a doctor suspects that a woman has miscarried, he or she will examine the cervix to see whether it has dilated (opened). If the pregnancy has been lost, the doctor will perform a procedure called a dilation and curettage or will provide medication to remove any remaining tissue (from the fetus or the placenta) from the woman’s uterus to help avoid heavy bleeding and infection.

Miscarriage can be devastating for women and families and often involves more than the physical loss of a fetus. Fortunately, previous miscarriage does not usually have long-term effects on a woman’s fertility, and the majority of women who have had them go on to successfully carry a pregnancy to full term.

Making healthy lifestyle changes such as maintaining weight, staying active, quitting smoking, and stopping the use of alcohol and illegal drugs may improve the odds of a healthy next pregnancy. Counseling may help women and their partners cope with the grief, anger, isolation, fear, and helplessness that some individuals experience after pregnancy loss.

For more information, the ACOG Patient Education Pamphlet “Early Pregnancy Loss” is available in English and Spanish at www.acog.org/publications/

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