Early Pregnancy Loss

Early pregnancy loss, otherwise known as miscarriage or spontaneous abortion, happens when a baby stops developing during the first trimester (the first 12 weeks and 6 days of the pregnancy). Unfortunately, this is a subject women often struggle to talk openly about. This is partially due to remarks from others that minimize their grief, such as suggestions to “just try again." Women who experience early pregnancy loss might blame themselves for causing the loss or feel ashamed that they were unable to have a healthy baby. 

Incidence

Early pregnancy loss affects millions of women and partners worldwide and does not discriminate among culture, continent, or socioeconomic status. An estimated 10% of all pregnancies end in miscarriage and 80% of these losses occur in the first trimester (the first 13 weeks of pregnancy).

Risk Factors & Etiology

The primary risk factors for early pregnancy loss are late age of the mother (over 35 years old) and personal history of prior early pregnancy loss. By far, the most common cause, comprising about half of all miscarriages, is chromosomal abnormality. Humans have 23 pairs of chromosomes which are like special instructions for the development of our bodies. Each pair of chromosomes has a specific job, like what color a baby’s eyes will be. Sometimes there can be extra or missing blocks in these pairs or the blocks might not fit together correctly. This is called a chromosome abnormality akin to having a mistake in the blueprint of a project.  Such mistakes and abnormalities can cause the developing baby to stop growing. And although such abnormality is rare, it happens more commonly than we think, and is not due to any fault of the father’s or the mother’s.  

Diagnosis

Early pregnancy loss is usually suspected when a pregnant woman experiences vaginal bleeding or pelvic cramping.Sometimes, a woman does not have any indications (like bleeding or pain) and a routine ultrasound reveals that a baby’s heart is not beating.

Management

There are three categories of miscarriage management: expectant, medicated and surgical routes.  

Expectant management means waiting for the mother’s body to realize on its own that the baby is no longer growing. 80% of the time a woman’s body will expel the no-longer growing baby

Medication management involves using medicine to help.  The most common medication used is misoprostol (aka Cytotec). It is taken by inserting four tablets into the vaginal pathway. This usually causes pelvic cramping similar to strong period cramps which can last several hours. A second dose can be given if the first dose is not successful.

In both expectant and medicated management routes, women should be informed on what to expect while their pregnancy is being passed. Most women report pain which can be controlled with over the counter pain relievers and rarely require stronger prescription medicine. They should be educated that bleeding will likely be heavier than a period.

The medical team then orders blood work to monitor the human chorionic gonadotropin (HCG) level. This is a substance that normally increases in a woman’s body as the pregnancy progresses. After a miscarriage, it is expected that the HCG level decreases over the course of several weeks. Usually, an ultrasound is also done to make sure that the baby and its associated tissue have passed since any leftover pieces could cause an infection to develop. Expectant and medicated management are less risky than surgical options.

Surgical management involves a gynecologist removing the no-longer growing baby and the leftover tissue. This surgery takes about 30 minutes and the woman is given numbing medication as well as medicine to make her sleep safely. Usually the doctor uses a suction device to accomplish this goal. One strong benefit to this is that it completes the goal of removing all the tissue with the highest accuracy and requires no further follow up or blood tests. Some women prefer this surgery because it is convenient to schedule and they don’t have to worry about waiting for the baby to pass on its own. The biggest risk of having this surgery is that it can cause a scar inside the uterus.  This can make it difficult to become pregnant again in the future. 

Early pregnancy loss remains a sensitive topic but is fortunately gaining more coverage via social media as more women speak out about their experiences. The more women talk about their experiences, the less others suffer in silence thinking they are alone. 

Written By: Megan Sloan, PA-C

Edited by Hash Brown Taha

References

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5. Nanda K , Lopez LM , Grimes DA , Peloggia A , Nanda G . Expectant care versus surgical treatment for miscarriage . Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD003518.

6. Alijotas-Reig J , Garrido-Gimenez C . Current concepts and new trends in the diagnosis and management of recurrent miscarriage . Obstet Gynecol Surv 2013 ; 68 : 445 – 66.