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Understanding Miscarriage

As an Ob-Gyn, among the most devastating news I can share with my patient is that they are experiencing a miscarriage or stillbirth.

What is a miscarriage?

A miscarriage is any pregnancy loss that occurs during the first 20 weeks of the pregnancy, which is around the 5th month.  Even though there is some awareness on social media through celebrities sharing their experiences, what most couples don’t realize is how common miscarriages are.

About 20 percent, or 1 in 5, pregnancies will end up in a miscarriage.

The majority of these occur in the first trimester and fewer in the second trimester.  Stillbirth is a term used by many to describe a pregnancy loss during the last stages of pregnancy.

Symptoms of Miscarriage

Symptoms of a miscarriage can start with bleeding, cramping or passing large clots. Sadly, there is nothing that you or your doctor can do to prevent a miscarriage once symptoms have begun.

In some cases, a thorough examination and possible pelvic ultrasound will help determine if there has been a miscarriage or if the baby still has a heartbeat.  In other cases, a woman may need to be followed with blood work called HCG, also known as the “pregnancy hormone”, to help determine if the pregnancy has a chance of survival.

What causes a miscarriage?

There are numerous causes for a pregnancy to end up in a miscarriage.  Most commonly, the cause of a miscarriage can include:

  • Genetic problems
  • Anatomic problems with the uterus
  • Hormonal imbalances (such as thyroid disorders or diabetes)
  • Other autoimmune conditions

For cases in which a cause is identified, treatment could lead to successful future pregnancies. Other environmental causes that can increase risk for miscarriage include smoking and use of illegal drugs.

Another condition that can cause pregnancy loss, especially in the second trimester, is a condition known as “incompetent cervix” where the opening between the uterus and the vagina, called the cervix, is not strong enough to hold a pregnancy.  In this case, there are steps a doctor can take to increase the chance that a future pregnancy can be carried to term.

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Next Steps After a Miscarriage

If you are facing a miscarriage diagnosis, you will likely have the option of awaiting passage of all placental tissue, taking a medication to help expedite this process, or undergoing a surgical procedure known as D&C (dilation and curettage) of the uterus to remove the tissue via outpatient surgery.  This is an individual decision and should be made between you and your doctor.

For many couples, the entire process can be overwhelming and emotionally devastating.  This is a normal grieving time.  It is important to reach out to your family, your friends and your physician. Most importantly, do not blame yourself.

The good news is that after a miscarriage, most couples have a high chance of becoming pregnant again and having a normal term pregnancy.

There is no consensus as to when is a good time for a couple to try again after a miscarriage.

Most physicians recommend waiting at least three months after a miscarriage to reduce the chance of another miscarriage.  However, recent research suggests that trying even earlier can result in successful term pregnancies.

Speak with Your Physician

Pregnancy loss can be a difficult and devastating experience and even though the cause may not always be identified, the chance of a future successful pregnancy is high.  If you become pregnant again after a miscarriage, make sure you notify your physician early so that proper surveillance can begin early.


About Amantia Kennedy, MD

Dr. Amantia Kennedy is an obstetrician/gynecologist with WakeMed OB-GYN Brier Creek and WakeMed OB-GYN North Raleigh. Her clinical interests include infertility, high-risk obstetrics as well as minimally-invasive and robotic-assisted surgery.

Schedule an appointment with Dr. Kennedy today.

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