Menstrual Cycles


Early pregnancy loss (EPL) or biochemical pregnancy



Suffering a miscarriage or stillbirth can be very upsetting and traumatic. Many women feel the need to grieve after a pregnancy loss, regardless of whether it happened early in pregnancy or later on. Although it can be difficult, it is important to deal with your loss rather than ignore the emotions you may be feeling.

The loss of a baby through early miscarriage is much more common than people believe, and may account for many cases of what is thought to be delayed conception. It could be that as many as half of all early pregnancies end in miscarriage.

The warning signs for an impending miscarriage include vaginal bleeding, abdominal cramps and backache similar to those of a period. Excessive vomiting can also be a symptom. Once a misscarriage starts, there is little that can be done to halt it. However, it is important that you seek medical advise immediately because there is a risk of infection and complications.


Investigating Miscarriage

Having a misscarriage can be a very traumatic experience. For some women it is just as distressing as bereavement, even when it occurs in the early stages of pregnancy. It may be of some comfort to know that misscarriage, particularly in the early months, is very common. It does not mean that there is anything inherently wrong with you, or that you are likely to miscarry next time you become pregnant. For this reason, having one or even two early miscarriages is not usually seen as a reason for medical investigation.

Tests are usually done if a woman experiences repeated miscarriages: this is defined as three or more successive miscarriages with no successful pregnancy occurring in between. After suffering three miscarriages, you should seek medical help and advise. A late miscarriage - one that occurs after 14 weeks - should also be investigated.

Your family doctor will be able to refer you to a consultant gynaecologist if you have had recurrent miscarriages. In some cases, couples may be referred to a genetic counsellor. Genetic counselling may help determine the level of risk of future pregnancies, and discuss the best way forwards.


Why Miscarriage Happens

Doctors do not know why so many pregnancies end unsuccessfully, and determining the cause of a miscarriage can be very difficult or even impossible.

Some of the known causes of early miscarriage include:
  • A major abnormality in the baby. About three in every five early miscarriages are thought to be connected to fetal abnormality.
  • The mother contracting rubella, listeriosis or chlamydia during pregnancy.
  • The failure of the fertilized egg to implant successfully in the lining of the uterus.
  • The mother having a low level of progesterone, which is needed to sustain the pregnancy.
For the vast majority of miscarriages, there is nothing you can do to prevent it from happening.

Most miscarriages are caused by one time, non-repeating genetic defects in the embryo. The egg might be abnormal, the sperm might be abnormal or the combination might be abnormal. This does not mean that either you or your partner has a genetic defect. Every woman has some abnormal eggs and every man produces some abnormal sperm.

An embryo that has one of these defects is destined to miscarry from the moment of conception. That is why there is nothing that you can do to prevent the miscarriage. The embryo will stop growing and developing at some point, and will be expelled by your body.

There is a small group of miscarriages that can be prevented. These miscarriages are causes by a progesterone hormone deficiency (luteal phase defect). Progesterone is needed to support the growth of a pregnancy. In the early weeks of pregnancy, the mothers body produces the progesterone. By about 9 or 10 weeks of pregnancy, the placenta usually takes over the production of progesterone.

Women who do not produce enough progesterone hormone in the early weeks of pregnancy may have repeated miscarriages. These miscarriages can be prevented by progesterone supplements.

Later miscarriage (after 14 weeks) can be the result of:
  • An abnormality in the uterus, such as a large fibroid.
  • A weak (incompetent) cervix. This is a condition in which the cervix dilates instead of remaining tightly closed during pregnancy.
  • Certain antenatal tests: amniocentesis, for example, carries a 1 in 200 risk of miscarriage.
  • The mother having diabetes, epilepsy, asthma, kidney disease or high blood pressure.
Miscarriages are more common in very young women or women over 35. Many people think that minor injuries or distress can cause miscarriage, but there is no medical evidence to support this.


Blighted Ovum

Despite the fact that it is a fairly common complication, few people have heard of blighted ovum, also known as an anembryonic pregnancy. Simply put, a blighted ovum is when normal conception, implantation, and growth of the placenta happen but no fetus develops. A blighted ovum always ends in a miscarriage within the first trimester and is in fact the cause of 50% to 60% of all first trimester miscarriages. Unfortunately, there is nothing that can be done to prevent it.

What happens with Blighted Ovum?

Since the implanted egg is fertilized, it is natural to assume that everything should progress normally with the pregnancy. With a blighted ovum though, the body can detect that something is wrong with the fertilized egg and therefore stops developing it. It is your body's own way of ensuring you have a healthy pregnancy and baby.

While it is not known exactly what causes a blighted ovum, most experts believe that some sort of chromosomal abnormality with either the egg or the sperm prevents the normal development. However, this abnormality is not indicative of future problems. Although a blighted ovum is common, it usually happens no more than once. Therefore, your health care provider will not refer you for genetic testing. If you experience two or more consecutive miscarriages though, then you may be referred for genetic testing.

It is also possible to have a blighted ovum with a twin pregnancy. In this case, one of the fertilized eggs does not continue to develop while the other does. The blighted ovum does not affect the second fertilized egg. In a twin pregnancy, blighted ovum may also be referred to as blighted twin (disappearing twin).



Bleeding or Spotting in pregnancy


Light bleeding or Spotting

Spotting is light bleeding from the vagina similar to, but much lighter than, a period. It varies in colour from red to brown. While this is not exactly normal, light bleeding or spotting during pregnancy, particularly during the first three months is fairly common. Some spotting in early pregnancy can be quite normal and does not pose a threat. However, because bleeding is the most common warning sign of impending miscarriage, any sign of spotting or bleeding should be reported to your healthcare provider immediately.

The type of spotting or bleeding during the first trimester of most concern is fresh blood, or bright red especially if this is accompanied by cramping. While this type of spotting or bleeding can be serious, it is not always mean a miscarriage is occuring. Your caregiver will most likely give you an ultrasound to try to determine the cause and see if a miscarriage is likely.

The presence of an embryonic heartbeat is highly reassuring. When visualized by sonography, more than 90% of pregnancies continue. The rate of pregnancy loss with positive heartbeat varies with gestational age and the presence of vaginal bleeding:
  • Heartbeat at < 6 week., With bleeding 33% are lost, 16% are lost if no bleeding present
  • Heartbeat at 7-9 week., With bleeding 10% are lost, 5% are lost without bleeding present
  • Heartbeat at 9-11 week., With bleeding 4 % are lost, 1-2% are lost without bleeding present.
The prognosis for the living embryo improves as gestation proceeds.

Heavy bleeding or unusually long periods

Abnormal uterine bleeding - vaginal bleeding that is different from normal menstrual periods. It includes very heavy bleeding or unusually long periods (also called menorrhagia), periods too close together, and bleeding between periods. In adolescents and women approaching menopause, hormone imbalance problems often cause menorrhagia along with irregular cycles.

Sometimes this is called dysfunctional uterine bleeding (DUB). Other causes of abnormal bleeding include uterine fibroids and polyps. Treatment for abnormal bleeding depends on the cause.

The vast majority of women go on to conceive after a miscarriage with no problems.

  • It is recommended, though, that you wait anywhere from one to three months after miscarrying before you conceive again.

  • Even if you are physically ready to conceive, you may not be emotionally ready. Take your time and grieve if that's what feels right for you.



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