Missed Miscarriage - An Overview

Introduction

A miscarriage can be defined as the spontaneous loss of a pregnancy before the completion of the 20th week of the gestation period. It could be a shocking and emotional experience for expectant mothers and all the family members waiting and planning to welcome a baby. It is more likely to occur within the first trimester of the pregnancy. It is not always due to the actions or activities of the expectant mother while carrying the pregnancy; more often than not, it is due to factors beyond one’s control.

What Are the Types of Miscarriages?

• Missed Miscarriage: This type catches an individual unaware since it exhibits no symptoms, and one assumes that all is well until it is diagnosed during a routine ultrasound scan days or weeks after it has occurred.

• Complete Miscarriage: In this type, the uterus appears empty on an ultrasound scan, and fetal tissue is entirely lost through bleeding.

• Recurrent Miscarriage: Three repeated miscarriages constitute a recurrent miscarriage. It is very rare, affecting only 1 % of couples.

• Threatened Miscarriage: This type is not an actual miscarriage; one experiences bleeding and pelvic cramps, but the cervix remains closed. It requires close monitoring for the remaining period of pregnancy.

• Inevitable Miscarriage: It is characterized by bleeding and cramps; the cervix is dilated, ultimately progressing to a complete miscarriage.

The reason why some miscarriages show overt symptoms and some do is not clearly understood.

How Common Is Miscarriage?

Miscarriage is relatively common, occurring in about 10 % to 20% of pregnancies. However, the actual prevalence cannot be known since it can occur at very early stages before a pregnancy is even detected.

What Are the Causes of Miscarriage?

The majority of miscarriages occur due to problems with chromosomes. It is rarely genetic and is more commonly due to some error by chance during the division or growth of the embryo (the baby is referred to as an embryo from conception until the 8th week of development, after which it is called a fetus). Chromosomal abnormalities can lead to the following.

• Blighted Ovum - Failure to form an embryo.

• The Demise of the Fetus Within the Uterus - A formed embryo might stop developing and die.

• Molar Pregnancy - Molar pregnancies occur when both sets of chromosomes are inherited from the father. The fetus does not develop in such cases and is associated with abnormal placental growth. A partial molar pregnancy occurs when the mother’s chromosomes are present in addition to two sets of chromosomes from the father. This results in an abnormal fetus. Both these types of pregnancies are not viable.

Sometimes a miscarriage can be attributed to the mother’s health condition. Such factors include:

• Infections.

• Diabetes that is not controlled.

• Hormonal issues.

• Severe malnutrition.

• Radiation exposure.

• Maternal age.

• Lifestyle factors like tobacco and alcohol consumption.

• Certain drugs.

• Thyroid disorders.

• Abnormalities in the uterus or cervix.

No scientific evidence suggests exercise, sexual intercourse during pregnancy, or stress play a role in miscarriage.

What Are the Features of a Missed Miscarriage?

It is otherwise known as a silent miscarriage or silent abortion. Two reasons why one does not realize they are no longer pregnant are - pregnancy hormones continue to remain high even after the baby dies and pregnancy tests come out positive. When the miscarriage occurs, it is usually too early to feel the baby kick and all are assumed to be well. Occasionally one may experience decreasing pregnancy symptoms or a brownish discharge. An ultrasound scan is the only way to detect a missed miscarriage due to the absence of any other symptoms like cramps or increased bleeding. An ultrasound scan can reveal:

• Whether there is an absence of heartbeat. However, if the miscarriage occurs even before a heartbeat can be detected, then pregnancy hormone levels human chorionic gonadotropin (HCG) are monitored. If there is a rise to expected levels in the coming days or a follow-up scan is prescribed after about one week to check for a heartbeat.

• Whether the baby is much smaller in size than it is expected to be at the given gestational stage.

• When there is an empty sac or no clear sac at all. This occurs if the baby dies during the initial stages of development and the body reabsorbs the embryonic tissue or if the embryo has not formed.

How Is a Silent Miscarriage Treated?

There are three treatment approaches for the management of a silent miscarriage.

1. One may wait for the miscarriage to occur naturally. The fetal tissue is passed out of the body within two weeks. Sometimes it may take much longer. It is a wait-and-watch approach that works in a large number of cases. Should this approach fail, one can go with alternative treatment options.

2. Medical management involves taking medications that trigger the body to expel fetal tissue. It takes about four to five hours to pass the pregnancy tissue and can cause bleeding and cramping. Medicine is taken at the doctor’s office, and one can return home.

These treatment options are typically chosen when the pregnancy is lost within the 10th week. Sometimes the doctor recommends surgical management after the diagnosis when waiting to pass the fetal tissue is unsafe and must be removed immediately. This procedure involves dilation and curettage. The cervix is dilated, and pregnancy tissue is removed by scraping or suctioning it out of the uterus under anesthesia.

What Does Recovery From a Miscarriage Look Like?

Physical recovery from a missed miscarriage can take up to a month or sometimes longer. Menstruation is resumed within three to six weeks. Emotional recovery is essential in addition to physical recovery before trying to conceive again. It is common for mothers to blame themselves, but it is a fact that most miscarriages occur due to unknown reasons. Three months is advised to prepare one’s body to welcome pregnancy after a miscarriage. One miscarriage is not a cause for worry regarding future pregnancies. One can have a successful pregnancy after a missed miscarriage. Two or more consecutive miscarriages must be investigated to identify the underlying cause.

Conclusion

A silent or missed miscarriage involves spontaneous abortion of the baby in utero without exhibiting any symptoms. It usually occurs during the first trimester. Due to the lack of symptoms, one has a false sense of well-being until diagnosed on a prenatal ultrasonogram. It can be mentally and emotionally challenging; looking after one’s emotional health is critical, as taking enough time to grieve the loss with family and friends. Treatment options include waiting for a natural miscarriage and medical or surgical management.