| Pregnancy loss
Excerpt from Every Woman’s Body Miscarriage is the most common pregnancy loss, followed by ectopic pregnancy and stillbirth. Other common losses may be caused by a birth defect, especially one that is severe, or take the form of the death of a newborn baby. Also, some birth mothers and surrogate mothers who gave up their babies for adoption and some women who've had abortions experience loss. Miscarriage A miscarriage, medically called a spontaneous abortion, is the expulsion from the womb of a foetus not yet able to survive on its own. About one-third of all pregnancies end in miscarriage, most often before a woman even knows she's pregnant. Most miscarriages occur in the first three months of pregnancy. Only one per cent occurs after 20 weeks’ gestation. Women who don't experience morning sickness during pregnancy are more likely to miscarry for unknown reasons, but this may be related in part to hormonal levels. Of course, many women who don't have morning sickness do not miscarry. Many studies report that women over the age of 35 miscarry at twice the rate of younger women. However, that rate is not the same for all women in that age group. Research usually does not distinguish between healthy women with their first or second pregnancy and those women who have chronic ill health or infertility problems and/or a history of repeated pregnancy loss. Symptoms of a miscarriage are bleeding — which progresses from light to heavy — and usually cramps. The process may take one day or several days. Some women experience pain and others don't. If you think you're having a miscarriage, contact your midwife or doctor. You'll be given an ultrasound and physical examination. If the miscarriage is complete and the uterus is clear, then no further treatment is usually required. Occasionally, the uterus is not completely evacuated and a dilation and curettage (D&C) or a more simple office procedure is performed to remove any remaining tissue. Causes and prevention About half of the miscarriages that occur are caused by genetic abnormalities, which may be hereditary or spontaneous, in the father's sperm or the mother's egg. The other half are caused by a variety of known and unknown factors, including infection (mumps, for instance, in the first trimester increases the risk of miscarriage) and exposure to environmental and work place hazards. Other factors that may cause miscarriage are hormonal irregularities; uterine abnormalities; radiation; and drugs, whether recreational (including alcohol), over-the-counter or prescription. Severe malnutrition can cause a miscarriage, as can a higher blood sugar level in women with diabetes. If dietary problems are the culprit, then an improved diet sometimes helps prevent miscarriage. Induced ovulation with fertility drugs sometimes result in miscarriages, as does in vitro fertilisation. Two antenatal tests, amniocentesis and chorionic villi sampling (CVS), are also associated with a slight risk of miscarrying. To prevent miscarriage, some women are treated with progesterone, a hormone needed for implantation in the uterus. Research is mixed on the effectiveness of this, and researchers believe it should only be done if tests show that the body is producing too little of that hormone in the early weeks of pregnancy. Repeated miscarriages Most women who have miscarriages have subsequent normal pregnancies and births. About one per cent of pregnant women have repeated (three or more) miscarriages, usually without a history of any normal births. Some researchers believe that this is an auto-immune disorder. Starting periods early in puberty, before the age of 11, or late — after 16 — is associated with multiple miscarriages, as are ovaries with many cysts. Women who have repeated miscarriages are four times more likely to have multiple ovarian cysts. Another link to repeated miscarriages is an allergy to the partner's sperm. Some women go on to have normal pregnancies and births after they change partners. Ectopic pregnancy An ectopic pregnancy is one located outside the uterus, usually in one of the fallopian tubes. If a tube is damaged in any way, the fertilised egg may never complete its journey to the uterus. Ectopic pregnancies rarely last past eight weeks. Common symptoms are lower abdominal pain, often on one side at the beginning, light bleeding, nausea and vomiting, dizziness or weakness, and/or pain in the shoulder or rectum. If the fallopian tube ruptures, the pain and/or internal bleeding can be severe enough to cause fainting. Ectopic pregnancy is a life-threatening condition. Although recognised by physicians since at least the tenth century, ectopic pregnancies can be difficult to diagnose, and sometimes an evaluation is made with an ultrasound or laparoscopy. If you suspect that you have an ectopic pregnancy see your doctor immediately, as this problem goes from bad to worse quickly. Treatment varies from drugs to surgery. The rate of ectopic pregnancies increased more than fourfold between 1970 and 1990, partly because of damage to women's reproductive systems caused by sexually transmitted diseases, in particular chlamydia and gonorrhoea, as well as pelvic inflammatory disease, which is often, but not always, sexually transmitted. Other causes of an ectopic pregnancy include a previous ectopic pregnancy, the use of an intrauterine device (IUD), congenital abnormality of the fallopian tubes, prior pelvic or abdominal surgery and a failed tubal sterilisation. Other risk factors associated with an ectopic pregnancy are smoking, regular douching, fertility drugs, in vitro fertilisation and/or GIFT (gamete intrafallopian transfer). Maternal age, number of children, abortion and miscarriage history are not known factors. The consequences of an ectopic pregnancy depend on many factors and range from no damage to your reproductive organs to the complete removal of a ruptured fallopian tube. Overall, women who have had one ectopic pregnancy have a greater chance of a subsequent ectopic pregnancy, and a 20 to 40% chance of infertility. Stillbirth A stillbirth is the birth of a fully formed baby who is dead. The death of the baby in the uterus may have occurred weeks or hours before labour or during labour. The cause is never clear in many stillbirths. A stillbirth is not likely to occur in a subsequent birth. When a cause can be identified it is often traced either to defects in the baby, especially chromosomal, or lack of oxygen, sometimes caused by the position of the umbilical cord. Smoking, cocaine use and high blood pressure may all be risk factors. Sometimes, women who have given birth to a stillborn baby suspect that medical intervention during the birth contributed to the death of their newborn infant. Although it's become common to blame doctors when there's a problem with a pregnancy or birth, there is no research supporting the theory that intervention during birth causes stillbirths. Women are less likely to have a stillbirth if they eat well, get early antenatal care and avoid cocaine and all recreational drugs during pregnancy. Some doctors have suggested that pregnant women count foetal movements several times a day during the last weeks of pregnancy to prevent stillbirths. It's believed that if the baby moves less often than is thought of as normal (one estimate is ten movements within two hours) intervention — often in the form of an induced labour or a Caesarean — will prevent a possible stillbirth. However, research findings are mixed and it isn't certain that counting foetal movements and intervening reduces the number of stillbirths. Pregnancy loss and body grief Years ago a woman was not supposed to grieve after a pregnancy loss. If you have a pregnancy loss, you are entitled to whatever feelings you have, whether they are mild or intense, mixed or very clear. Some women feel as though they're in shock or they feel depressed and guilty. They may feel that way for many weeks or months. If you are told that you're over-reacting or exaggerating your feelings, know that this is not true. On the other hand, some women feel sad for a few days at the most and that's all. Don't feel bad if you don't feel bad. You don't have to believe those who say you are repressing or denying your feelings. Your feelings will vary depending on many factors, including whether this was a planned pregnancy. Another factor in pregnancy-loss grief is how far advanced the pregnancy was. Were you six weeks pregnant or did you go through labour and give birth to a perfectly formed baby who was dead? Often, but not always, the intensity of feeling increases the more real the baby seems. Be aware that your body grieves too. It suddenly has to adjust its hormonal levels and make other changes. The further along you are, the more adjustments your body has to make. This ‘body grief’ affects a woman who gives up a baby for adoption or has an abortion too. Breasts leak and other bodily changes occur. If you have a miscarriage, an ectopic pregnancy, stillbirth or newborn baby death, ask your doctor to explain to you as much as possible about what happened. Ask what may have caused the loss and also clarify what didn't cause it — that glass of wine you had six months ago or the chocolate bars you ate last week. The more you know of the details the more likely it is that you will resolve your grief and move on. It's normal to want to talk about a pregnancy, whether it ended happily or unhappily. Talking about it helps to put it into perspective. If you want to talk to other women who also have had a pregnancy loss, contact one of the miscarriage organisations. These organisations can also give you information on what other parents do when babies die, including holding the baby, taking pictures and funeral arrangements.
http://www.miscarriageassociation.org.uk
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