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Miscarriage

Jessica Evert, MD, edited by Benjamin McDonald, MD Updated: Jun 28th 2016

Miscarriage is a common experience that may also be the first sign of a fertility problem. 15-20% of pregnancies are miscarried, often in the first 4-8 weeks (sometimes before a woman even knows she is pregnant). Women who have experienced two miscarriages have a reduced chance of having a normal pregnancy in the future. Therefore, if you have miscarried more than twice in a row, you should seek evaluation by a doctor.

woman in pain on couchThe most common reason for miscarriage is a genetic problem within the fetus, either too many of one gene or not enough of another. It is natural for your body to recognize such problems and terminate the pregnancy, or for the genetic problem itself to stop the normal growth of the fetus. Approximately 15% of miscarriages are due to anatomical (structural) problems of the uterus. This includes an abnormally shaped uterus or growths (such as fibroids) within it. Less common causes of miscarriage include antibodies to the blood supply of the baby, hormonal problems, and other health conditions that affect the body's ability to stay pregnant (such as diabetes, heart disease, and high blood pressure). Miscarriages may also be a common occurrence for a woman undergoing fertility treatment. Often with techniques such as IVF, (described in a later section) the fetus does not implant into the wall of the uterus, or it does not stay implanted and is thus expelled.

Miscarriages are known in the medical community as "spontaneous abortion." They may be further classified as "threatened" (e.g., when they don't actually occur but bleeding does occur when it shouldn't during pregnancy), "partial", or "complete". If you suspect that you have had or are having a miscarriage, it is important to save any tissue that comes out of your vagina and allow a doctor to examine it. This examination will enable the doctor to determine whether the entire fetus was expelled. If it wasn't, s/he will likely schedule you for a D&C (dilation and curettage) procedure to remove all remaining tissue associated with the aborted pregnancy from your uterus. Failure to remove such tissue can lead to a serious infection. Doctors may also do blood tests (to test hormone levels) and/or ultrasound to determine if a miscarriage has occurred. If bleeding is occurring due to a pregnancy which has implanted outside of the uterus (e.g., an ectopic pregnancy) or similar problems, surgery may be necessary.

Miscarriage can be a very traumatic and sad event that is often accompanied by strong feelings of grief and loss. Psychological research suggests that you may feel intensely angry, anxious, depressed, or guilty for six months or even longer after the miscarriage. As with the other stressful life experiences we have been describing, do not feel ashamed if you need help dealing with your emotional response to a miscarriage. Particularly if you have experienced multiple miscarriages, seeking informal (friends and family) and/or formal (specific organizations or psychotherapy) support can help decrease grief and loss reactions, as well as help you to focus on other parts of your life that are positive and enjoyable. Two such support organizations recommended by the American Academy of Family Physicians for women who experience miscarriage are: Compassionate Friends and SHARE Pregnancy and Infant Loss Support.

Unfortunately, there are no failsafe methods to reduce your chance of miscarriage, and some miscarriages are going to be inevitable. However, you can increase the likelihood of conceiving and carrying a healthy baby. The following section is designed to provide you with some "prep work" advice before you and your partner begin trying to conceive.

 

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