Reproductive Immunology Experts Answer Questions about Miscarriage

miscarriage questions 14445157466_0b2f32879d_z“Why did I lose my baby?”

That poignant question is asked by millions of women each year. Too often (about half the time) no answer can be found.

Once a woman suffers a miscarriage, the joy of future pregnancies will always be somewhat muted by chronic worry and the sudden fear that asserts itself with each twinge or unusual feeling: Is it happening again? Am I having another miscarriage?

No one can tell us why we lost our two babies,” Frances recalls. “That makes the burden even harder to bear.”

“It is very upsetting,” her husband Jim, agrees. “Our doctor conducted a whole bunch of tests and then shrugged her shoulders. We desperately want a child, but neither of us is ready to go through the trauma of having our hopes dashed again so cruelly.

Frances and Jim are not alone. Right now, as these words are written and read, their excruciating dilemma is faced by tens of thousands of other couples all across the country and indeed, throughout the world.

Many people affected directly or indirectly by miscarriages or worried about them have questions. Over the years we’ve answered many miscarriage questions. Here are answers to some of the most common. We hope they help you.

Dr. Matzner answers common miscarriage questions

What is a miscarriage?

Simply stated, miscarriage refers to the involuntary termination of a pregnancy before the fetus is viable, ·that is, before the unborn child is capable of life outside the mother’s womb. After viability, an unsuccessful pregnancy is known in medical terminology as “intrauterine fetal death,” more commonly known as still-birth.

Because of the many advances in medical technology, viability has been shortened drastically in recent years. Where once a baby could not be kept alive if born before the 26th week, viability is now seen as beginning in the 20th week of a 40-week (on average) gestation period. A small number of children born at this stage of gestation have lived and, with intensive medical intervention, some have gone on to live a normal life.

Since it is not easy to precisely know the actual length of fetal life (the precise moment of conception being difficult to determine) a better criteria is thought to be weight of the fetus. Thus, the World Health Organization decided that a lost fetus that weighs less than 500 grams (7.6 ounces) is a spontaneous abortion. Not coincidentally, the 20-22 week fetus weighs about 500 grams.

Of course, whether the failed pregnancy was technically a miscarriage, or whether it was actually a stillbirth, is not as important as the sad fact you have lost your baby. Determining what, if anything, can be done to prevent a recurrence should you again become pregnant, is paramount.

How often do women miscarry?

No one really knows how many miscarriages actually occur because many women who miscarry do not seek medical attention and may confuse an early miscarriage with the onset of a late menstrual period. Many fertilized eggs do not implant or the embryo does not remain vital, and the pregnancy quickly ends. These are technically failed. pregnancies, which if counted would raise the percentage of women who miscarry. That being said, up to 30% of all pregnancies end in miscarriage.

When do miscarriages occur?

Not surprisingly, most pregnancies fail during the first trimester of development when the fetus is most delicate and vulnerable. Of these, most end before the first 10 weeks of development. However, while later fetal deaths are not common, especially after the point of viability, they can occur up until the point of birth.

Is the age of the mother a factor in miscarriages?

Older women of child bearing age (late thirties and early for­ ties) are more likely to experience a miscarriage than are their younger counterparts. This is true for several reasons. With older women, there is a greater likelihood of chromosomal abnormalities in their offspring which sometimes cause miscarriage. Also, older women have a higher incidence of diabetes, high blood pressure or some other medical condition which might be a cause of miscarriage.

Of course, that does not mean that an older woman should not get pregnant. However, it is more important that she receives medical advice prior to pregnancy as well as quality prenatal care.

If i have had one miscarriage, how likely am i to have another?

That is hard to tell since the cause of failed pregnancies are not determined in about half the cases (often because they are not adequately investigated). Many miscarriages are isolated events caused by a problem unique to that particular pregnancy. In these cases, miscarriage is not likely to recur. Indeed, and here is a bit of good news, of women who have had a miscarriage, about 87% will carry successfully to term in their next pregnancy.

But what about the other 13%1 For a wide variety of reasons, some women have multiple miscarriages. Sometimes this is just a matter of coincidence, but often it is because there is a definite cause that may be correctable.

How many women experience multiple miscarriages?

Multiple miscarriages are not common, but they are not rare either, A woman who has had three miscarriages in a row is deemed to have experienced recurrent spontaneous abortion. These women are more likely to miscarry again. About 1 in 400 couples experience this problem.

Is there help for women who have had multiple miscarriages?

All hope is certainly not lost for women who have had multiple miscarriages. Many miscarriages, especially recurring miscarriages, have a determinable cause. If so, treatment is often available to correct the problem, allowing future pregnancies to succeed.

What are the signs that i am miscarrying?

The primary symptom of a pending miscarriage is bleeding and cramping. However, just because you experience some bleed­ing, that does not mean that you are going to miscarry. About 70% of all pregnant women experience some form of bleeding dur­ing pregnancy, generally in the form of “spotting,” that occurs at about the time you would have had your period. Also, occasional twinges are not uncommon even in early pregnancy.

If your bleeding is similar to your menstrual period, and/or if it is accompanied by cramping or backache, or if the discharge is brownish/reddish, bright red in color, or is experienced as a sudden flow of clear or pink fluid, special attention should be paid.

When these symptoms arise, it is known as a threatened abortion. Happily, not all threatened abortions result in miscarriage. In about half the cases, the pregnancy can be saved.

If i experience symptoms of a threatened abortion, what should i do?

If you are spotting, or your pain is light and you are early in your pregnancy, you are probably not experiencing a threatened abortion. Still, you should reduce your activities and call your doctor.

If you spot, bleed or cramp after the first three months of pregnancy, you should go to bed and immediately call your doc­ tor. If he or she is unavailable, tell the receptionist that you feel you may be miscarrying and ask for an immediate return call with instructions about what to do. If you are away from home, you may want to go to an emergency room.

Your doctor will want to examine and treat you if he or she detects a problem. This may be an internal examination to determine whether your cervix is closed. Your doctor may also order an ultrasound to visually determine the status of your pregnancy.

What is an “inevitable miscarriage?”

An inevitable miscarriage (also known as, inevitable abortion) occurs when the cervix prematurely dilates, causing the fetus to be expelled from the womb prior to viability. (After viability, this is known as premature birth.) Usually an inevitable abortion occurs because the fetus has died and the body is expelling what is now foreign tissue.

Much attention needs to be paid to your health at this time. An inevitable abortion may or may not expel all of the tissue that your body must release. If it does not expel all the fetal tissue or placenta, it is known as an incomplete miscarriage, which will require medical treatment. If all the tissue has been expelled (a complete miscarriage). further treatment may not be necessary.

However, it is important to be examined because you will not be able to tell whether your miscarriage expelled all of the fetal and placental tissue.

If i believe i have miscarried. What should i do?

As gruesome as this may sound, it is important to try and save the tissue expelled during a miscarriage so that it can be examined and hopefully, a cause for the failed pregnancy determined.

It is also very important that you see your doctor to deter­mine whether you have, in fact, miscarried and whether treatment is necessary. For example, if you have not actually miscarried and your symptoms are caused by a weakness in your cervix (sometimes called “incompetent cervix”), surgical treatment may be able to save your baby. If you have miscarried, you may need a “D & C.”

What is a D & C?

“D & C” is the common name for “dilation and curettage.” It is a surgical procedure, usually carried out under general anesthesia, in which the vagina is dilated with a speculum, the cervix is stretched open and a spoon-like instrument inserted into the uterus to scrape away the endometrial lining, with the purpose of removing unexpelled tissue after a miscarriage. (D & C is also a treatment sometimes applied for menstrual problems.) A D & C may also be required if a woman has experienced an “incomplete abortion,” in which the fetus has died but not been expelled by the body.

Is an ectopic pregnancy similar to a miscarriage?

Absolutely not! An ectopic pregnancy, which occurs in about 1 percent of all pregnancies, is a potentially life threatening condition. If the fertilized egg implants in the fallopian tube, a woman’s body will react as if a normal pregnancy had occurred. Menstruation will cease in about 80% of the cases and the woman will test “positive” for pregnancy.

The early symptoms of an ectopic pregnancy may be similar to that of a miscarriage, i.e. spotting and severe cramping. However, unless treated, the symptoms soon grow more worrisome, as the developing embryo ruptures the fallopian tube, causing internal bleeding. The woman will experience pallor, sweating, weakness and faintness. If untreated, the woman can go into shock and may die.

What is a blighted ovum?

Sometimes when a woman is impregnated, the fetus does not develop, but the placenta does. This will inevitably lead to a “miscarriage” when the empty placenta is expelled from the mother’s body. However, since it may take a long time to expel the placental tissue, a D and C will probably be recommended once the diagnosis is made.

Are there side effects of miscarriage?

Yes. Grief, of course, is the most common. It is natural to experience grief and depression at what has been a significant loss. Infection can also be a problem and may require treatment.

A few women may have difficulties getting pregnant again, or may have been bodily injured by the experience making a future miscarriage more likely. When a woman miscarries (regardless of cause), her own immune system may be triggered so as to rid of the body of fetal tissue, in much the same way that a body will seek to “reject” an implanted organ. This bit of bodily house­ cleaning creates a problem. Since the fetus is half maternal in origin, the immune reaction is autoimmune.

Is the autoimmune response worse in women who have had more than one miscarriage?

The autoimmune response is of special concern if a woman has had several miscarriages because it is an accumulative process that can create an insidious cycle. The more a woman miscarries, the higher the autoimmune response and hence, the greater likelihood of a miscarriage.

Worse, multiple miscarriages can adversely affect a woman’s overall long-term health. In rare cases, a woman’s hyper-stimulated autoimmune response resulting from multiple miscarriages, can result in expression of major systemic disease, such as Systemic Lupus Erythematosus or Antiphospholipid Antibody Syndrome.

Do you have questions about miscarriage or reproductive immunology? Call us at 1-805-578-7000 or email us today. We have been providing consultations, testing and diagnosis, and treatment for women who have experienced multiple miscarriages for more  than 15 years.

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