TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Miscarriage An information guide
Miscarriage What is a miscarriage? Miscarriage is the loss of a pregnancy before 23 completed weeks. Miscarriages are very common. 1 in 5 pregnancies ends in a miscarriage in women who know they are pregnant, and many more occur in women who were not aware they were pregnant. A miscarriage occurring before 13 weeks gestation is known as an early miscarriage. After 23 weeks, the loss of a pregnancy is known as a stillbirth. Signs and symptoms The most common symptoms of miscarriage are vaginal bleeding and abdominal pain. The bleeding can range from light brown spotting to heavy bleeding. The abdominal pain can be a dull period type ache or stronger severe pain. Sometimes women have no symptoms at all and it is picked up on a routine ultrasound scan What causes a miscarriage? In the majority of cases we don t know why. Most commonly it is caused by abnormal genetic development of the baby. This occurs when there is a mismatch of the genetic information contained within the egg or the sperm. Usually this is a one-off random occurrence. Other causes for miscarriage include problems in the blood vessels that supply the placenta, infection or long-term health problems of the mother. 2
Are there any tests to find out the cause? Tests are not usually conducted on pregnancy remains unless a woman has had three or more miscarriages in a row (this is called recurrent miscarriage). This is because most women will go on to have a successful pregnancy following one or two miscarriages, and will not require any treatment. Please speak to your doctor if you have any further questions regarding further testing. Types of miscarriage Threatened miscarriage This occurs when a woman has some vaginal bleeding or abdominal pain in early pregnancy but the ultrasound scan still shows a viable pregnancy within the womb. Complete miscarriage A complete miscarriage is when a miscarriage has already occurred and the womb no longer contains any remains of the pregnancy. Incomplete miscarriage An incomplete miscarriage is when a miscarriage has occurred but the womb still contains part of the pregnancy and pain and/or bleeding may persist. You may be offered medical or surgical management to empty the womb. Missed miscarriage This is when a baby has died (sometimes several weeks earlier) and there have been no signs or symptoms of a miscarriage. In these circumstances the miscarriage is picked up on a routine ultrasound scan. As the pregnancy has not miscarried on its own medical or surgical management may be offered (see below). 3
Pregnancy of unknown location (PUL) In some circumstances an ultrasound scan may not show a pregnancy within the womb, but it is not clear if the pregnancy has miscarried, or the pregnancy is in another place, for example in the fallopian tubes. Further investigations will be needed to confirm a miscarriage or otherwise. Management of a miscarriage what are the choices? The choices that are offered are conservative,medical or surgical treatment. Conservative management (letting nature take its course) Miscarriage may take place naturally in one or two weeks with the pregnancy tissue passing by itself. An appointment will be given after three weeks to test pregnancy hormone levels. If the pregnancy test is still positive there may be some remains of the pregnancy that require medical or surgical treatment. Medical management A drug called Misoprostol is given to help the cervix to open and pass the pregnancy. This medical treatment avoids the risks of an anaesthetic and is successful in 85 out of 100 women. If the medication does not work it may need to be repeated or you may require an operation. Further information about medical management can be found in the Medical Management of Miscarriage leaflet. Surgical management This requires an operation under general anaesthetic and is successful in 95 out of 100 women. The aim is to remove all the pregnancy tissue; however, if some tissue remains the operation may need to be repeated. Immediate surgery may be required in cases of continuous heavy bleeding or signs of infection. 4
Some women may require a combination of the above options if one alone is unsuccessful. What happens to my baby after the miscarriage In hospital For babies that die during pregnancy before 24 weeks there are no laws which state that they must be buried or cremated. It is up to you what you would like to happen to your baby s remains: you can choose to bury/cremate the remains yourself (seek advice from the nursing staff), or the remains can be sensitively disposed of by the hospital. More information can be found in the leaflet Making funeral arrangements for a baby born before 24 weeks. At home If you miscarry at home it is likely you will pass the pregnancy remains into the toilet. If you do see the pregnancy sac and the foetus you may wish to return it to the hospital for sensitive disposal. However, you can choose to bury/cremate the remains yourself (seek advice from the Gynaecology Assessment Unit (GAU), Advice and support A miscarriage can be a very traumatic experience, both physically and emotionally. Many women grieve but come to terms with their loss quite quickly whilst others find it difficult to cope. Feelings of loss, disappointment, guilt, anger and sometimes relief will pass with time and good support. 5
There is plenty of support available to help you, your partner and your family deal with your loss. Your GP Gynaecology Assessment Unit 0161 627 8855 (Oldham open all hours) 0161 720 2010 (North Manchester open daily 0730-2100hrs) Pennine Acute Trust Women and Children s Counselling Service 0161 720 2969 Pennine Acute Trust Spiritual & Emotional Team 0161 778 5259 Charity groups such as the Miscarriage Association info@miscarriageassociation.org.uk 01924 200799 NHS Choices www.nhs.uk For future pregnancies Just because you have had a miscarriage doesn t mean you ll necessarily have another. There is no time limit on how long you should wait before trying for another pregnancy but it is recommended that you should wait until you ve had one period after your miscarriage as this makes it easier to calculate dates accurately on your next pregnancy and gives your body time to recover. To reduce the risk of a miscarriage in the future; you and your partner should avoid smoking, drinking alcohol or using street drugs. Eat a healthy balanced diet and be a healthy weight prior to falling pregnant. Seek medical attention if you have signs of a urine infection or vaginal infection in early pregnancy. 6
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If English is not your frst language and you need help, please contact the Ethnic Health Team on 0161 627 8770 Jeżeli angielski nie jest twoim pierwszym językiem i potrzebujesz pomocy proszę skontaktować się z załogą Ethnic Health pod numerem telefonu 0161 627 8770 For general enquiries please contact the Patient Advice and Liaison Service (PALS) on 0161 604 5897 For enquiries regarding clinic appointments, clinical care and treatment please contact 0161 624 0420 and the Switchboard Operator will put you through to the correct department / service Date of publication: January 2016 Date of review: January 2019 Ref: PI (WC) 975 The Pennine Acute Hospitals NHS Trust Wood pulp sourced from sustainable forests www.pat.nhs.uk