Miscarriage Symptoms, Types, Prevention, and Post-Miscarriage Care

Miscarriage happens when the fetus loses its opportunity to develop and grow fully. Most miscarriages happen during the first trimester. The reasons for it may lie with the mother or fetus. There are spontaneous abortion, missed abortion and threatened abortion, among others. 10-15% of expectant mothers may run the possibility of a miscarriage, so you must have some understanding of it.

Reasons for Miscarriage

Miscarriage in the first trimester is due to a problematic fetus

miscarriage

Reasons for miscarriage may lie with the fetus or its mother. As gestational ages vary for different mothers therefore, the reasons for miscarriage also vary. When this issue happens in the first trimester, it's generally because of the fetus. It's usually because the egg carrying defective chromosomes and sperm meet but cannot grow. Therefore, the fetus dies inside the stomach.

Conversely, if this issue happens the 13th week, the problem lies with the mother's body. Reasons for miscarriage include or placental anomalies, cervical incompetency (an incompetent cervix, a complication in which the cervix starts to open/dilate prematurely), cervical abnormalities, cervical cancer, diabetes or corpus luteum insufficiency (insufficient progesterone produced to allow a pregnancy to develop). The tendency to miscarriage during this period of time is significantly lower than the first trimester.When the placenta is fully formed after four months, the risk of a miscarriage is even slimmer.

Expectant mothers with a high risk for miscarriage

Women who have given birth many times before, expectant mothers of an advanced age, have hyperthyroidism (an overactive thyroid, a condition in which the thyroid gland produces too much of the hormone thyroxine) or have diabetes are more prone to miscarriages. The high-risk group also includes women with endocrine system anomalies which result in hormonal problems such as luteinizing hormone deficiency (insufficient luteinizing hormone which is associated with reproduction and stimulation of ovulation in women and testosterone production in men). Pregnant women with uterine weakness, heart problems or have suffered mental impact and body injuries are more susceptible to this issue as well. There are also many instances of miscarriages in which the expectant mother is careless or doesn't take care of herself. Therefore, stay vigilant and safe throughout your pregnancy.

Miscarriage Symptoms

2-3 Months of Pregnancy

Bleeding as if you’re having a menstrual period

The telling symptom is bleeding. There isn't peculiar pain, just a little discharge of dark brown colored blood. This is because the fetus' chorion (an extra-embryonic fetal membrane) has been detached from the uterus wall, resulting in bleeding. The bleeding will go on for five days like your menstrual flow. This type of bleeding is akin to the bleeding a woman will experience for 2-3 days in the beginning of her pregnancy when the fertilized egg attaches itself to the inner wall of the uterus.

During the first trimester, miscarriages happen most often during 2 to 3 months pregnancy, particularly the 7th and 8th weeks. After the fetus died inside the stomach, it'll be passed out of the body together with blood. As pregnancy confirmation also happens around this time, a pregnant mother may not know that a miscarriage has happened. There are also cases where pregnancy has been confirmed, but the mother only realizes she had a miscarriage when she goes to her pregnancy checkup.

After 4 months of Pregnancy

Serious bleeding coupled with lower abdominal pain

The symptoms of a miscarriage which happens after 4 months pregnancy are slightly different from the one which happens around 2 to 3 months of pregnancy. In the beginning, the mother will feel bloated in the lower abdomen as the already enlarged uterus is trying to contract while expelling the fetus and placenta. By the time the uterus contracts, the placenta is already dislodged and bleeding happens. It's then confirmed that there's a miscarriage.

Especially after 5 months pregnancy, symptoms of a miscarriage are identical to those of childbirth – there will be rhythmic spasms of pain. If there's bleeding but without rhythmic pain spasms, the risk of miscarriage happening is still low. If there isn't labor pain or bleeding but a leakage of amniotic fluid happens, there's now a high risk of miscarriage. When the amniotic fluid leaks, the mother will feel warm fluid trickling down from in between her legs. Wear a sanitary pad and consult the doctor immediately. If the lower abdomen is in pain, sit with both legs raised or lie down to rest. Get the mother to the hospital immediately after she feels better.

Types of Miscarriages

Spontaneous abortion

In this case, there may be bleeding and pain. However, there are also circumstances where there is no bleeding or pain, but the pregnant woman feels that something has been detached from her uterus. Go to the hospital at once. If it's confirmed to be a miscarriage, get a dilation and curettage procedure (D&C, a brief surgical procedure to remove tissue from inside the uterus) done immediately.

Threatened abortion

This is a condition when within 12 weeks of pregnancy, the mother feels bloated or pain in the stomach and there's bleeding, but the fetus is still alive. If she heeds these signs of miscarriage and seek help immediately, a miscarriage can be prevented as the fetus is still alive.

Nothing is more crucial than maintaining a stable pregnancy. Activities such as exercising, traveling, sex, riding a bicycle or motorcycle are best avoided. An expectant mother can also go to the hospital to stabilize her condition based on her needs. Directly injecting uterine contraction suppressant, anti-hemorrhagic agent (a substance that stops bleeding) and hormones that support pregnancy are all ways to maintain a stable environment for the fetus and mother during pregnancy. After the bleeding stops and she's feeling better, she may continue her normal daily routine. However, she must still avoid overburdening her body or stressing herself.

Missed abortion

Contrary to a threatened abortion, a missed abortion is when the fetus is already dead in the uterus. This is totally not observable from the outside. As there's almost no abdominal pain or bleeding, the expectant mother could be clueless about her condition and it's only discovered upon a pregnancy checkup at the hospital. During a pregnancy, if morning sickness suddenly disappears and the uterus feels slightly bigger than the gestational age, it's good to be aware that there could be a missed abortion.

If it's a missed abortion, remnants inside the uterus will start to deteriorate and become toxic, causing the blood of the expectant mother to coagulate and become abnormal. This will adversely affect the subsequent pregnancy. Therefore, a dilation and curettage procedure to remove the dead fetus and placenta is necessary. If she puts off the operation, there may be after effects of uterine anomalies. Regular checkups and not skipping any appointments is the true way to prevent various issues during pregnancy.

Inevitable abortion

This is characterized by abdominal pain and continual bleeding. Though the intensity of bleeding and pain vary for different individuals, these are signs that the fetus is in danger and the mother must go to the hospital immediately. If she feels excruciating pain in the lower abdomen, the amniotic membranes are ruptured, leading to the leakage of amniotic fluid. It'd be too late to stop the miscarriage.

Habitual abortion

If spontaneous abortion happens more than three times, it's considered habitual abortion. This is because the mother's uterus is malformed or there's abnormality in the hormone which sustains pregnancy. This type of abortion can be prevented via operations or hormonal therapy.

There are also instances where the immune system is abnormal and rejects the fertilized egg, thinking that it's a foreign object. There are also infections or environmental factors, cervical incompetence, frequent termination of pregnancies resulting in the uterus fusing together or abnormalities in the parents' chromosomes leading to chromosomal anomalies in the fertilized egg. Some causes of habitual abortion are unknown.

If there are abnormalities in the parents' chromosomes which result in chromosomal anomalies in the fertilized egg and subsequently causing frequent abortions, a chromosomal analysis is obligatory. This helps to identify the problem in the chromosomes and is useful in pregnancy management should a pregnancy would eventually lead to a malformed baby.

If an expectant mother doesn't deal with habitual abortion, it's very difficult for her to conceive again. Therefore, find out the real reason behind the condition. Through discovering the real reason behind habitual abortion and careful management of a pregnancy, the woman can still give birth to a healthy baby.

General Knowledge in a Box: Importance of Post-miscarriage Checkups

Should there be abnormal bleeding, abdominal pain or fever after miscarriage; a pregnant woman must consult the doctor immediately. It's highly possible that the uterine contraction isn't complete and is infected by bacteria, leading to inflammation. If the condition isn't very critical, she should recover after seven days of treatment.

A miscarriage not only puts tremendous pressure on the expectant mother's body, it also greatly impacts the emotional state. So an expectant mother should rest adequately and don't blame or pressurize herself too much. The people around her should be extra caring and supportive. Also, eat more protein-rich food.

Post-miscarriage Care

A first trimester miscarriage requires seven days for recovery

If a miscarriage happens in the first trimester because the uterus size hasn't changed, there's no need to observepuerperium (the period from childbirth to the return of normal uterine size). However, a doctor's examination and a body checkup are must-dos after miscarriage. When this issue causes bleeding, a woman should keep herself clean like what she does during menstruation. Boil some water and let it cool, pour in some feminine wash and wash the vulva gently. Don't wash the interior of the vagina.

It's better to start showering only after bleeding has completely stopped. After resting for two or three days, it's also all right to shower. If there isn't any special circumstance, a woman who just had a miscarriage can resume sex with her husband after two weeks. During the second and third week, avoid getting too tired, intense exercises and long distance traveling. It's best to remain stable.

Recuperate from a second trimester miscarriage in the same way as childbirth

The more advanced stage of pregnancy the miscarriage happens, the longer the recuperation time needed. Recuperation time refers to the time needed for the uterus to return to its normal size. The bleeding will gradually stop. If menstrual flow is heavy or menstrual period is very long, consult a doctor.

A miscarriage should be treated in the same way as childbirth. The woman should be treated in a hospital for three days or a week. Upon recovery, she may shower after two or three days. Should bleeding happens, use maternity washable pads and change them frequently. To wash and disinfect the maternity washable pads, pour feminine wash and Salvon antiseptic lotion into hot water which has been cooled. Disinfection should take place daily.

Rest for two or three days first before going to the office. The next menstrual cycle will start after one or two months. Sex with the husband should only resume after one menstrual cycle. Having menses again means that the body is ready and a woman may start planning for another pregnancy.

Rules for Miscarriage Prevention

First trimester (0-3 months)

Stay emotionally stable

During the first trimester when the placenta is taking shape, there's nothing more important than staying emotionally and physically stable. Avoid getting angry, flaring up and be stress-free as much as possible. Keeping the body warm is beneficial to blood circulation and staying emotionally stable. The pregnant woman should wear socks when she goes out and sitting on cushions will also help to keep warm.

Adequate sleep and a regular lifestyle

Sleep adequately during pregnancy and don't accumulate exhaustion. Get at least seven or eight hours of sleep daily, keep to regular hours and healthy lifestyle habits. Otherwise, insomnia may be triggered and throws the body out of sync.

Don't take medicine recklessly

If a woman already knows that she's pregnant, don't take any medicine rashly. The regular flu medicines, tranquilizers, sleeping pills, diarrheal medicines or diuretics are harmful to the fetus.

Avoid constipation

Even as the pregnant woman has constipation, she shouldn't be taking medicine carelessly. During pregnancy, if she feels the urge to go to the washroom, just go and don't hold the natural urges. She should also eat more food with fiber to prevent constipation. When defecating, remember not to overexert.

Second trimester (4-7 months)

Don't stay in the same position for too long

Spending too much time at the desk or staring at the computer will cause muscles to tighten – that's bad. Take a break every 40 minutes and breathe deeply frequently. Standing for too long will also cause discomfort to the waist and abdomen and will easily lead to uterine contraction, a condition which the expectant mother should also be wary of. Can't help it when it comes to standing for too long? Resting one foot gently on a low stool will help ease the burden on the waist. Keep working hours to between eight and 10 hours daily.

Don't ride for too long in a car or bus

As much as possible, avoid long distance traveling that requires more than an hour. Also stay away from high impact exercises such as cycling.

Relieve exhaustion immediately

Accumulating exhaustion not only throws the body off balance, it also gives rise to poor blood circulation. The expectant mother should rest immediately if she's tired. Place a cushion or pillow below the knees and legs to help promote good blood circulation. Treating herself to a lukewarm foot soak is also a good idea.

Avoid lifting heavy things

Don't lift heavy things or reach for things which are placed in high places. Should things accidentally drop, the impact could be harmful to the body and there will be tummy aches. A pregnant woman should ask people around her for help. If she's buying a lot of things, get the husband to carry them. For daily necessities, you can request that the husband buy them from the nearest supermarket.

Note that you should as much as possible stay happy during pregnancy. It will also help in order not to have a miscarriage.

Sandra Henderson
 

Editor-in-chief at Babiology and a proud mother of four passionate about sharing pregnancy and baby growth knowledges

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