Miscarriage in Early Pregnancy

Why do early pregnancy miscarriages happen?
Early pregnancy or first-trimester miscarriages (<12 weeks) occur in up to one in five pregnancies. In most cases, there is no identifiable cause for the miscarriages. About half of all early miscarriages are associated with a problem with the baby’s chromosomes (genetic material inherited from one’s parents).

A miscarriage is NOT caused by eating any specific food, stress, strenuous activities, working, travelling, exercise, or sexual intercourse. Bed rest and hospitalisation have not been shown to reduce the risk of a miscarriage and therefore are not routinely recommended. The use of hormonal treatment such as progesterone tablets or injections may not necessarily prevent an early pregnancy miscarriage from occurring.

The risk of a miscarriage may be increased in certain circumstances, such as:

• Maternal age – The risk of miscarriage is one in five (20%) up to the age of 35, and increases to one in two (50%) when over the age of 40
• Medical problems such as poorly controlled diabetes, poorly controlled thyroid problems, infections, or autoimmune diseases such as lupus
• Abnormally shaped womb
• Lifestyle factors such as smoking, heavy alcohol consumption, being very underweight or overweight
  
  

What are the symptoms of a miscarriage?
The common symptoms of a possible miscarriage include abdominal cramps and vaginal bleeding. However, these symptoms are experienced by many pregnant women in their first trimester with no adverse outcomes. Some women may not have any symptoms and may be diagnosed with a miscarriage based on the progress of the pregnancy on an ultrasound scan (“missed miscarriage”). A miscarriage with symptoms of fever and/or offensive vaginal discharge warrants immediate medical attention.

What should I expect during my consultation?
The doctor will ask you some questions to understand your condition better and perform an abdominal and vaginal examination. An ultrasound scan may be performed, either transabdominally (where the ultrasound probe is placed on your abdomen) or transvaginally (where the probe is inserted in your vagina) or both. A transvaginal scan (Fig 1) may be recommended as it gives a clearer image.

What are the treatment options if a miscarriage is confirmed?
Once the diagnosis of a miscarriage has been confirmed, your doctor will discuss the suitable treatment options. Sometimes, you may require follow up with ultrasound scans or blood tests to confirm the diagnosis of a miscarriage.

If your ultrasound scan confirms that you have miscarried completely and the womb is clear (complete miscarriage), you may not need any further treatment. If some or all the pregnancy tissues are still retained inside your womb (missed or incomplete miscarriage), your doctor will discuss various treatment options with you. You may choose to wait and allow nature to take its course, use medications or have a minor procedure done under anaesthesia.

Do I need to be admitted to the hospital?

• This will depend on your symptoms and pregnancy duration. If the bleeding is light and pain is not severe, your doctor may ask you to rest at home, but to return should you experience an increase in vaginal bleeding and abdominal pain.
• You may require admission if you have heavy bleeding or severe pain, or if you choose medical or surgical management for the miscarriage.
• Less commonly, a miscarriage may be accompanied by an infection in the womb. This condition is very serious and can be potentially life-threatening. If your doctor suspects that you may have this condition, you will be admitted to the hospital and started on antibiotics. You may require an urgent surgery (evacuation of the uterus) as a life-saving measure.
  
  

Emotional recovery
A miscarriage affects every couple differently. Some may be emotional for a short time after, while others may take much longer to come to terms with the loss. Reach out to your friends and family, or your doctor for support. If you feel you may need additional emotional support, inform your doctor and you may be put in touch with a medical social worker or our mental wellness team.

When can we try for another baby?
You can have sex as soon as you and your partner both feel ready. It is important that you are feeling well and that any pain or bleeding has significantly reduced.

Your next period will usually be in 4-6 weeks’ time. Ovulation may occur before this so you may conceive in the first month after a miscarriage. You can try for a baby as soon as you and your partner feel physically and emotionally ready. Preconception folic acid of at least 400 mcg per day is recommended for 3 months prior to pregnancy. Some women may require up to 5mg.

If you are not ready for another pregnancy, you can discuss contraception with your doctor. Most contraceptive methods can be started immediately after your miscarriage.

Will I miscarry again?
You are usually not at a higher risk of another miscarriage. Most miscarriages occur as a one-off event and there is a good chance of having a successful pregnancy.

A small percentage of women may have conditions that make them more likely to miscarry. If you have had three or more miscarriages, you may be advised to seek further specialist attention.

Summary of the management options for miscarriage

If you have a rhesus negative blood type (for example, “O negative”), you may be offered an anti-D injection to help prevent problems in the future pregnancies. If you do not know your blood type, you will need a blood test.

Useful contact details:
An appointment to see a doctor:
Central Appointments: 6294-4050
Monday to Friday, 8.30am to 5.30pm
Saturday, 8.30am to 1.00pm
(Closed on Sunday & Public Holidays)

Emotional Support Service
Medical Social Worker: 6394-1028 / 6394-1029
Monday to Friday, 8.30am to 5.30pm
Saturday, 8.30am to 1.00pm
(Closed on Sunday & Public Holiday)

• If you require an urgent consultation and management pertaining to miscarriage, please go to the Urgent O&G Centre (UOGC) located at KKH, Women’s Tower, Basement 1.
  

The information above is also available for download in pdf format.