Understand the distinct care and treatment approaches for miscarriages in early and late pregnancy stages.
Dr Veena H
Miscarriage is a difficult topic, but it's an important part of the pregnancy journey that every woman should be informed about. No one expects it, but with the right understanding and support, you don’t have to go through it alone.
Whether you're early in your pregnancy or further along, knowing about the different types of miscarriages and the care options available can help you navigate this challenging time with more clarity and compassion.
In the first few weeks of pregnancy, it’s important to be aware of the signs of a possible miscarriage so you can seek the right care. Symptoms of an early miscarriage can include:
If a missed miscarriage is diagnosed, your doctor will discuss management options with you. Similar to those for early pregnancy miscarriage, care/treatment for a missed miscarriage may include:
Your doctor will explain these options and help you make the best choice for your physical and emotional well-being.
A missed miscarriage is a type of early pregnancy loss where the embryo or foetus stops developing, but the body has not yet recognised or expelled the tissue. Unlike other types of miscarriage, there may be no obvious symptoms, such as vaginal bleeding or cramping. Instead, signs might include:
If a missed miscarriage is diagnosed, your doctor will discuss management options with you. Similar to those for early pregnancy misscarriages, care/treatment for a missed miscarriage may include:
A miscarriage that occurs during the first trimester (the first 12 weeks of pregnancy) is one of the most common types of pregnancy loss. It happens when the embryo or foetus stops developing and is no longer viable. The body may expel the pregnancy tissue naturally, or medical intervention may be necessary.
Medical intervention includes administering medicines to induce tissue expulsion or performing a surgical procedure like the D&C procedure. Treatment choice is generally based on your pregnancy status, preferences, and health condition.
Given the two most common treatment options for early-pregnancy miscarriages are medical management and surgical treatment it's important to know what to expect of each.
Medical management is a popular option for many women experiencing an early miscarriage, particularly within the first 10 weeks of pregnancy. This approach involves two medications: mifepristone and misoprostol.
This method is effective in expelling the residual pregnancy tissue in about 92% of cases. Many women find that this method offers a more private and less invasive way to manage miscarriage. If the miscarriage is incomplete, however, additional medication or surgical intervention may be necessary.
Surgical treatments, including dilation and curettage (D&C) or suction and evacuation, is another option for managing a first-trimester miscarriage.
During this procedure, the cervix is gently dilated, and a suction device is used to remove the pregnancy tissue from the uterus. The D&C procedure is highly effective for miscarriages, with a success rate of 97-99%. It is usually performed as an outpatient procedure with oral or intravenous pain medication.
| What People Want to Know... When do doctors recommend a D&C? If medical management doesn’t work, there’s heavy bleeding, or signs of infection appear, a D&C might be the best option. |
A second-trimester miscarriage occurs between 14 and 26 weeks of pregnancy. Although the causes of a second-trimester miscarriage vary, they are often related to factors like maternal health conditions, fetal abnormalities, or issues with the placenta. Let's go over a few of these causes.
Chromosomal abnormalities: About 24% of second-trimester losses are due to chromosomal issues like:
Trisomies 13, 18, and 21 - This is when a foetus has an extra copy of a chromosome, leading to genetic conditions like Down syndrome (trisomy 21).
Sex chromosome polysomies - The foetus contains extra X or Y chromosomes. This abnormality can affect development and learning. Such polysomies can contribute to pregnancy loss in some cases.
Placental problems: The placenta is vital in nourishing and supporting the baby during pregnancy. Any disruption to its function can lead to complications that may result in miscarriage:
Placental Abruption: This occurs when the placenta separates from the uterine wall too early, often causing bleeding and depriving the baby of oxygen and nutrients. This can lead to miscarriage or preterm labour.
Acute Chorioamnionitis: An infection in the amniotic sac, which can cause inflammation and affect the baby’s health, sometimes resulting in miscarriage.
Maternal Vascular Malperfusion: When the placenta does not receive enough blood flow, it may fail to provide the necessary nutrients and oxygen to the baby, leading to growth restriction or pregnancy loss.
In the unfortunate event of a second-trimester miscarriage, your doctors will guide you through understanding the underlying factors that may have contributed to the miscarriage.
The first step often involves a physical examination, and tests to gather information for future pregnancies.
Once the findings are gathered, your doctor will discuss the results with you and provide recommendations for any next steps. This may include monitoring in future pregnancies or specific treatments to reduce the risk of another loss.
After a miscarriage, allowing your body to heal is essential for both physical and emotional well-being. Here are some natural ways to support uterine healing:
| Natural Ways to Support Uterine Healing | How It Helps |
|---|---|
| Rest | Give your body time to recover by taking it easy and avoiding heavy tasks. |
| Hydration | Drink plenty of water to flush out toxins and help your body heal. |
| Nutritious Diet | Focus on fruits, veggies, lean proteins, and whole grains to nourish your body. |
| Iron-Rich Foods | Include leafy greens, legumes, and lean meats to replenish iron and fight anaemia. |
| Herbal Teas | Sip on chamomile, ginger, or raspberry leaf tea to relax and support uterine health. |
| Movement | Gentle activities, like walking or yoga, can boost your mood and circulation. |
| Emotional Support | Don’t hesitate to seek counselling, support groups, or lean on loved ones to heal emotionally. |
Whether it's a loss early on or later in pregnancy, miscarriage is heartbreaking. If your miscarriage happens after the first trimester, it can feel even more difficult. Give yourself space to grieve, no matter when the loss occurs. Allow yourself to feel what you’re feeling—grief, anger, confusion, or all of it—and know that your emotions are valid.
Talking to a counsellor who understands loss can help you process your emotions and begin to heal. Support groups can also be comforting, connecting you with others who’ve been through something similar. Lean on your family and friends for emotional support and help during this tough time.
Remember to keep up with your follow-up appointments. These are important for checking in on your physical and emotional well-being. Healing takes time, so be patient with yourself and seek support when needed.
FAQs
Common early miscarriage symptoms include vaginal bleeding, abdominal pain or cramping, and the passage of fluid or tissue from the vagina. These symptoms usually occur within the first 12 weeks of pregnancy.
A missed miscarriage, also known as a missed abortion, is diagnosed through ultrasound when the embryo has stopped developing but no symptoms are present. Treatment options include expectant management, medication (misoprostol), or surgical intervention (D&C procedure).
Treatment for miscarriage after 5 months, such as a miscarriage at 7 months, typically involves surgical intervention to remove the foetus and placenta, as expectant management carries higher risks. In contrast, early pregnancy loss can often be managed expectantly or with medication.
Bleeding after a miscarriage can last for several days to a few weeks, depending on the stage of pregnancy and treatment method. Most women experience a return of their menstrual period within 4-6 weeks after miscarriage.
While there are no proven natural methods to clean the uterus after a miscarriage, rest, hydration, and a nutritious diet can support the body's natural healing process. Consult with your healthcare provider for personalised guidance on how to heal the uterus after a miscarriage.
