Dr Ong Aihui Clara
Obstetrician & Gynaecologist
A miscarriage is a very painful and difficult time for couples. If you have recently suffered a miscarriage, you may be overwhelmed with emotions and questions on why it happened and how you can recover from the grief and loss. Although each of us deals with loss differently, this article will help provide answers to the common questions couples ask after a miscarriage.
There are many possible causes of a miscarriage.
Most miscarriages happen during the first trimester, the period most critical to a baby’s development in the womb. In first trimester miscarriages, the most common cause is chromosomal abnormalities of the foetus. Chromosomes are structures that carry the genetic material, and most chromosomal abnormalities happen by chance.
Other possible causes of miscarriage include:
There are different types of miscarriages, each present with different symptoms.
In a threatened miscarriage, a woman develops symptoms of miscarriage, such as abdominal pain and vaginal bleeding. However, the cervix remains closed. Some women can continue to have a healthy pregnancy, while others may progress to a complete miscarriage.
In an inevitable miscarriage, the woman also has abdominal pain and bleeding, but the cervix is already open. The foetus will eventually be expelled from the uterus along with bleeding.
A miscarriage is considered complete when all pregnancy tissue has left the uterus.
In an incomplete miscarriage, some pregnancy tissue remains in the uterus. This causes continued bleeding and abdominal pain. Sometimes, a procedure called dilatation and curettage (D&C) is needed to remove the remaining pregnancy tissue.
This type of miscarriage is less common. The woman does not experience any symptoms, but the foetus stops growing inside the uterus.
Women who experience pregnancy loss may try to get pregnant again as soon as they are medically recovered and psychologically ready. Studies do not report benefits for a delayed interval to conception.
Before trying again, it is best to avoid sexual intercourse while you still have bleeding, in order to avoid infection. It may also be helpful to wait until your regular menstrual period cycle has resumed so that you can better calculate the age of your baby in the next pregnancy.
It is also important for couples to be emotionally and mentally prepared for another pregnancy. Ultimately, the timing of when to try again for a baby is a very personal decision and should be carefully discussed.
After a miscarriage, it is important for a woman to take care of her physical and emotional needs.
Try to get as much rest as you can and eat well-balanced meals so that your body can recover. The duration of recovery varies depending on how far along you were in the pregnancy. You may experience bleeding for few days and spotting for a few weeks after. You may also have mild abdominal cramps for a few days. Your doctor may advise you to monitor your temperature for the first few days to see if you develop a fever.
Allow yourself to experience, and express your emotions. Miscarriage can cause a wide range of emotions, including sadness, anger, disappointment, guilt and grief. Give yourself time to process these emotions.
Couples often grieve and work through these difficult emotions in different ways. You can ask for help from family, friends, or other couples who have had a miscarriage. You may also find it helpful to join support groups for couples who experienced miscarriages. Other couples find it most helpful to lean on each other through these difficult times.
Accepting the loss is difficult, but it is an important step for you and your partner so that you can heal.
If you and your partner decide that you are ready to try again, it is recommended to take folic acid supplements to protect your future baby against neural tube defects, such as spina bifida.
Most women are able to have a healthy pregnancy after experiencing a miscarriage. However, approximately 1% can have recurrent miscarriages, defined as having at least 2 consecutive miscarriages.
If you experience recurrent miscarriages, your doctor may recommend some tests to find out the underlying cause. These may include one or more of the following:
A blood test can help to check for problems with your hormones and immune system.
Blood samples can also be used to check for chromosomal abnormalities.
Using high-frequency soundwaves, an ultrasound is used to create an image of your uterus to help identify problems such as fibroids in the uterine cavity.
In a hysteroscopy, a thin instrument with a light is inserted through the cervix into the uterus to check for problems.
In a hysterosalpingography (HSG), liquid contrast dye is inserted into the uterus and fallopian tubes before an X-ray is taken. This highlights the internal contours of the uterus and clearly reveals any obstructions in the fallopian tubes.
In a sonohysterography, saline is injected into the uterus, through the cervix. This is followed by an ultrasound to give doctors more information about the inside of the uterus.
Remember that a health pregnancy after a miscarriage is possible. When in doubt, consult your obstetrician for more information about how you can prepare yourself to try for a child again.