What Is a Miscarriage? Impact on Body and Mind

Miscarriage is defined as the loss of a pregnancy before the 20th week of gestation, with the majority occurring in the first trimester. Often referred to as "spontaneous abortion," this term is synonymous with miscarriage.

The most common cause of miscarriage is chromosomal abnormalities, though other factors such as hormonal imbalances, infections, or lifestyle choices can also contribute to early pregnancy loss.

In India, the Medical Termination of Pregnancy (MTP) Act, 1971 regulates induced abortions, ensuring that they are carried out under safe and sterile conditions by certified professionals.

Miscarriage is a profoundly distressing experience, affecting both the physical and emotional health of the woman, as well as her family.

Miscarriages affect approximately 10-20% of pregnant women, often without any apparent cause. They can occur at various stages, particularly in the first trimester.

While pregnancy brings joy, it can also come with complications that impact both the mother’s and the baby’s health, leading to natural concerns about fetal safety.

Below is an overview of the different types of miscarriages:

The symptoms of a miscarriage may vary from one pregnant woman to another. It may also depend on the stage of pregnancy. Sometimes, miscarriages can happen without any warning signs. However, recognising the common symptoms of miscarriage is crucial for diagnosis and treatment. The most common signs of a miscarriage are as follows:

• Sudden vaginal bleeding (ranging from light spotting to heavy bleeding)
• Abdominal cramps during early pregnancy
• Passage of tissue or fluid from your vagina
• Mild or severe back pain
• Lack of pregnancy symptoms such as tender breasts, or nausea
• Severe dizziness or fainting associated with heavy bleeding

While some women may experience mild spotting without it leading to miscarriage, it's important to consult a medical professional if you experience any of these symptoms to help prevent further complications.

Symptoms of miscarriage often overlap with early pregnancy signs. Early pregnancy symptoms include breast tenderness, nausea, mild cramping, occasional headaches or dizziness and light bleeding.

However, if bleeding becomes heavier than a period, accompanied by severe cramping or a decrease in pregnancy symptoms, it could indicate a miscarriage. Common miscarriage symptoms are:

• Heavy bleeding, heavier than a period
• Severe cramping or abdominal pain
• Lower backache
• Passing tissue or blood clots
• Sudden decrease in pregnancy symptoms (e.g., loss of breast tenderness or nausea)

Seek immediate medical attention if you experience these signs to ensure proper care.

Miscarriages can result from a variety of underlying factors, and in some cases, the exact cause may remain unknown. Understanding these factors is essential for preventing and managing future pregnancies.

Common causes typically include genetic or chromosomal abnormalities, maternal health conditions, environmental influences, and lifestyle choices. Here's an overview of potential causes of miscarriage:

• Incompetent cervix (your cervix begins to open too early in pregnancy)
• Exposure to TORCH diseases
• Severe kidney disease
• Congenital heart disease
• Diabetes that isn't managed - uncontrolled diabetes
• Thyroid disease
• Radiation
• Certain medicines, such as the acne drug isotretinoin (Accutane®)
• Severe malnutrition
• Lifestyle choices, including smoking, drinking alcohol, having excessive caffeine, and consuming narcotics, can increase the risk of miscarriage.

Around 50% of miscarriages that occur in the first trimester are due to chromosomal abnormalities. If there is an error in the structure and number of the chromosomes during conception, it leads to improper fetal development. These abnormalities occur randomly and cannot be predicted. However, these issues are more common in geriatric pregnancies, especially those over the age of 35.

Every developing fetus gets a pair of chromosomes from its father and mother. The chromosomal abnormalities are as follows.

1. Trisomy: It occurs when there is an extra chromosome in a set. The most common chromosomal abnormality is Trisomy21 which can cause Down syndrome.
2. Monosomy: It happens when a chromosome is missing from a set.
3. Triploidy: When an embryo has three complete sets of chromosomes instead of two, it results in 69 chromosomes instead of the normal 46 chromosomes.
4. Translocations: Translocations refer to broken chromosomes attached to other chromosomes. It leads to a structural abnormality that may cause a miscarriage.

Usually, these abnormalities occur during cell division, during the formation of an egg, or early fetal development.

Apart from these genetic issues, other risk factors of miscarriages also include chronic health conditions like uncontrolled diabetes, high blood pressure, autoimmune problems, and thyroid disorders.

Bad lifestyle choices like smoking, drinking, and drug use can also lead to pregnancy loss in the early stages. Additionally, exposure to environmental toxins can be a major cause of miscarriage.

Unchecked stress, hormonal imbalance, and physical trauma can impact the healthy growth of your fetus. So, managing these risk factors can also help you overcome unexpected miscarriages.

Treatment for miscarriage involves ensuring the complete expulsion of pregnancy tissue, along with physical and emotional recovery and infection prevention. It primarily depends on the individual's health and the type of miscarriage. Options include:

• Non-surgical treatment: Medications that allow the body to expel the tissue naturally.
• Surgical treatment: Procedures like dilation and curettage (D&C) or dilation and evacuation (D&E) to remove fetal tissue (up to 13 weeks) when necessary.

For some cases, like missed miscarriages and incomplete miscarriages, non-surgical management is enough to complete the process. Non-surgical treatment attempts to regulate the natural passing of the miscarried fetus through the vagina. This process will take typically a few days to a week. It involves taking oral medications such as Misoprostol, which helps in inducing uterine contractions and expelling the fetus.

Women undergoing this treatment may experience heavy vaginal bleeding, abdominal period cramps, and symptoms that occur during a heavy period. If the bleeding is excessive or prolonged, patients must consult their healthcare advisor.

If the removal of the fetal tissue cannot be completed naturally or if you are experiencing heavy bleeding, then you need to consider surgical interventions. The most common process in surgical management is D&C (Dilation and Curettage).

Generally, in a D&C, the cervix is dilated and the leftover fetal tissue is removed. After the completion of the surgical treatment, patients may experience light vaginal bleeding for several days.

Miscarriage is a traumatic event that requires both physical and mental recovery. Women who go through a miscarriage can experience guilt, sadness, grief, depression and PTSD.

A miscarriage, especially after a long-awaited pregnancy in the third trimester, is an incredibly devastating loss, making it challenging for a woman to regain a sense of normalcy. Even with early-stage miscarriages, the grief can be profound, though some may find it easier to recover emotionally.

Many women experience feelings of guilt, inadequacy, or the belief that they did something wrong. Healing from such a loss is deeply personal, and it takes time for each woman to find her way through it.

Emotional support is crucial for women who have experienced this traumatic loss. However, there are many options for support and healing available. This includes connecting with communities or support groups of others who have been through pregnancy loss. Focusing on internal health is also equally important.

Many women wonder how to support their bodies after a miscarriage, including how to help the uterus heal. Physical recovery involves eating nutritious foods and staying well-hydrated. It's common to have questions, such as "When will my period return after a miscarriage?" but the priority is to feel better emotionally.

For personalised guidance and clarity, it's always best to consult your healthcare provider.