Unfortunately, it can happen that things go wrong during pregnancy. This section contains information about what a miscarriage is, its process, what can happen if a miscarriage is identified and what feelings can come into play. This leaflet is also intended to support the consultation given by our midwives.
Blood loss in the first 16 weeks of pregnancy
If you lose blood during pregnancy, it’s normal to be worried. Blood loss in the first 16 weeks of pregnancy occurs in 1 in 5 women. In half of these women, blood loss stops after a few days and pregnancy continues normally. In the other half, blood loss remains and there may be a miscarriage. This means that the embryo is rejected. In women who have blood loss at the start of pregnancy, fifty per cent of these pregnancies end in a miscarriage. In general, 1 in 10 pregnancies ends in a miscarriage. The risk of miscarriage increases with age. You cannot predict with certainty if you will get a miscarriage. Usually it will be obvious within a few days.
What are the causes of a miscarriage?
A pregnancy consists of a gestational sac and an embryo. The embryo develops into a baby during normal pregnancy. A miscarriage is usually caused by an abnormality in the embryo. The embryo can no longer grow due to this abnormality and is rejected by the body. The cause is usually a chromosomal aberration that occurred during the fertilization. This chromosome aberration is rarely hereditary and usually there are no consequences for any subsequent pregnancies. A miscarriage can’t be caused by physical exertion. For example, making love, falling, cycling, horse riding or riding a motor bike cannot cause a miscarriage.
What are the indicators of a miscarriage?
Just before miscarriage, pregnancy symptoms such as tense breasts and morning sickness may decrease. Usually a miscarriage begins with blood loss. The bleeding can increase within hours or days and can be severe. The embryo will exit your body as clots and pieces of tissue (uterine mucosa). This can be accompanied by menstrual or contractions-like pain. The blood loss then decreases rapidly and stops after a few days. Sometimes a little (brown) blood loss will remain for a few weeks. It’s also possible that it’s discovered that the embryo is no longer alive during an ultrasound, even though no blood loss has been experienced. You can expect bleeding within a few days (sometimes weeks), as the embryo is being rejected.
What exams are possible?
With blood loss in the first 16 weeks of pregnancy it is not immediately clear whether the embryo is still alive or if it’s been rejected. A pregnancy test won’t be useful. The result of the test may, after rejection of the embryo, indicate that you are still pregnant for some time (up to two months). Our midwives will first ask a few questions about blood loss, possible stomach aches or other symptoms. We can discuss this by phone. Then our midwives can do a physical exam at the office or during a home visit. During this exam your belly is examined and the amount of blood loss assessed. You may receive an internal (vaginal) examination to exclude other causes of blood loss. The exam does not always offer certainty about the end of pregnancy. Sometimes the cervix is examined using a speculum.
Exams with use of an ultrasound
An ultrasound can clarify whether the embryo is still alive. Usually, we can see whether the heart is still beating. In that case, the chance of a miscarriage is very small, but not ruled out. An empty gestational sac or embryo the heart of which is no longer beating can be detected reliably with an ultrasound. An ultrasound shows the uterus's contents on a screen. During early pregnancy, an ultrasound can best be performed through the vagina. Later on, an ultrasound can also be made through the abdominal wall. Using an ultrasound, you can only determine whether the heart of the embryo is beating after six weeks of pregnancy.
The Jeroen Bosch Hospital offers the use of Misoprostol before a curettage is performed. This vaginal tablet may incite a miscarriage and may be introduced by the client at any time. A disadvantage to Misoprostol is that you do not rule out a curettage. It may cause a miscarriage, but you may not lose the full embryo or fetus, and still have to undergo a curettage.
It’s difficult for some women to wait for the miscarriage to start and for the bleeding to end again. Emotionally and practically, it may be unpleasant to have to wait for a spontaneous miscarriage. Physically it can be hard when blood loss persists. These are reasons for some women to intervene by having a curettage. In a curettage, the uterus is emptied through the vagina using a small tube, or cleaned with a scraper. This procedure takes 5 to 10 minutes. You’ll receive general but short-lasting anesthesia, so you won’t experience the procedure, and you can usually go home the same day. There’s a small change of complications with a curettage.
You cannot prevent or stop a miscarriage. Not by resting, or by taking medication. If blood loss increases or you get menstrual-like pain, make sure someone who you feel safe with is close by. If the blood loss or cramps is severe (temporarily), support from a trusted person is important. If you want to use painkillers, the best choices are Paracetamol or Naproxen. Do not use tampons during blood loss. The rejected tissue does not have to be saved or stored.
When should you contact?
If you have any questions or concerns, you can call our practice at: 073-6124569 or 06-53202915. Contact us immediately:
- If blood loss is very severe and it’s no longer possible to manage it with a sanitary napkin, especially in the case seeing flashes or fainting;
- If stomach ache increases and is constantly present;
- If you get a fever (higher than 38 ° C).
After a miscarriage, many midwives and doctors administer anti-D immunoglobulin (also called anti-D) in women with the blood group rhesus negative. It prevents the appearance of rhesus antibodies and the associated problems in a subsequent pregnancy. Medically, it is not required to administer anti-D if the ultrasound has shown that there is no embryo, or if it was rejected at a very early stage. If you have any questions, please contact our midwives.
Physical recovery after a miscarriage
The physical recovery after a spontaneous miscarriage or curettage is usually quick and smooth. During one to two weeks there may be some blood loss and brown secretion. After the blood loss has stopped, the body is restored sufficiently to get pregnant again. It’s not harder to get pregnant after a miscarriage. Our midwives advise you to wait one cycle before getting pregnant again.
Emotional recovery after a miscarriage
A miscarriage is often very profound. The miscarriage brings an abrupt end to your plans and the fantasies about having a child. Many women are initially quite shocked. Especially in the first few weeks, the grief can be very intense. In addition to sadness, there may be other feelings such as guilt, shame, disbelief, anger, feeling of emptiness, failure of the body or jealousy to other pregnant women. These feelings are very understandable. Take the time to process these feelings and try to talk to someone you trust. For the outside world, the loss is usually invisible. This makes it harder to share your feelings with others. Everyone processes a miscarriage in her or his own way. A difference in processing can put pressure on your relationship. Try to talk about this with each other and give each other space and time to process the loss. When other children in the family knew you were pregnant, it is usually good to talk about the miscarriage openly and simply. You can also find support from other people who have experienced the same. Of course, our midwives are there for you in a talk after miscarriage.
Talk after miscarriage
Feel free to make an appointment with our midwives to discuss the miscarriage, for example after a few weeks or when you need it. Perhaps you would like to talk again about the cause of the miscarriage, your physical recovery, the onset of menstruation or the processing of the loss. Do you have questions, feelings or fears in your mind for a next pregnancy? Feel free to ask them. If you do not want a new pregnancy (yet), you can inform about a good contraceptive method. Women who become pregnant after a miscarriage often feel insecure and afraid for a while. They are happy, but are also scared that a miscarriage might happen again. These feelings are very normal. Usually a subsequent pregnancy goes well, and it can even help with processing the grief. If you have experienced two or more consecutive miscarriages, it is possible to conduct further examinations. Our midwives can give you more information.
The above describes the process of an average miscarriage, what happens when a miscarriage is identified and what feelings can come into play. There are always exceptions, which may make the process different. If you have any further questions after reading this leaflet or if you have any concerns, please contact our midwives.