Types of Miscarriage

There are different types of miscarriage with differing amounts of pain or severity. All miscarriage is sad and means the loss of your precious baby. Whatever your situation, even if you are worried and unsure if you are having a miscarriage you should contact your doctor or hospital.

Going to the hospital and being told you've had a miscarriage at any time can be a confusing and frightening experience. But when you are given facts and information that you've never heard of it can be shocking and it's hard to take in everything you are told. Unfortunately sometimes too we can come across doctors and nurses who don't explain things properly and our minds can be racing so much that we don't ask them to clarify further. We hope some of the explanations below will go some way to helping you understand your situation. Should you need further information please contact us.

Complete Miscarriage
This occurs when all the products of conception are passed from the womb. This type usually occurs before 6-8 weeks of pregnancy or after 14-16 weeks, but rarely in the intervening period. If a complete miscarriage occurs, particularly after 14 weeks, the woman needs to go to the hospital for observation. Usually an ultrasound scan will be carried out to confirm that the womb is empty and that no further tissues remain inside. Where some tissue remains, the retained products of conception will need to be removed. This is done by a short procedure in hospital called an ERCP (or sometimes referred to as a a D&C) and will be carried out under general anesthetic.

Threatened miscarriage
Occasionally a woman will bleed in pregnancy and have cramping pains without miscarrying, and will carry the baby to full term. This is not usually associated with any abnormalities later in the pregnancy or in the baby.

An inevitable miscarriage
Sometimes if a woman has been threatening to miscarry, the inevitable will occur, ie. the neck of the womb (the cervix) starts to dilate and open up. Once this occurs it is unlikely that the pregnancy will be preserved. Bleeding and pain are common symptoms of this. The pain is due to contraction of the womb as it tries to evacuate the pregnancy. Sometimes there can be nausea and vomiting. The woman may notice large pieces of tissue, which appear like blood clots, being passed from the vagina. This can be a very frightening experience. An inevitable miscarriage will either progress to an incomplete or a complete miscarriage. This situation usually requires hospital admission.

Incomplete miscarriage
Sometimes not all the products of conception are passed from the womb. This situation is called an incomplete miscarriage. Usually, when the woman is admitted to hospital an ultrasound scan will be carried out. If there are remains of tissue present in the womb then the woman will usually be taken to theatre for an ERPC (see above). The woman is usually discharged from hospital after a few hours.

Missed miscarriage
In this situation what happens is that the embryo fails to develop fully and, instead of being passed out of the womb in a miscarriage situation, it is retained inside. Sometimes the symptoms of pregnancy such as nausea and breast tenderness will disappear abruptly as the womb becomes progressively smaller. Often there is no bleeding, but occasionally the woman may notice a dark brown vaginal discharge. In this situation an ultrasound examination is needed to confirm that it is a missed miscarriage. Sometimes there may be no signs at all that anything is wrong.
There are two options of treatment in this situation. One is to allow nature to take its course and the woman will inevitably spontaneously miscarry within the next few weeks. However this may not happen for a few weeks, and it can be very distressing for a woman in this situation. Allowing nature to take its course may not be an acceptable option. The alternative is to carry out an ERPC. This will be carried out in hospital under general anesthetic. If the womb is larger than 12 weeks a drug called prostaglandin in the form of a vaginal pessary is inserted near the womb. This helps the woman to spontaneously expel the retained contents of the womb.
Occasionally, intravenous treatment may also be required. This process is completed by carrying out a curettage to ensure that no further tissue remains in the womb. If the womb is less than 12 weeks, medication is taken beforehand and removal of retained products of conception occurs under general anesthetic.

Ectopic (or Tubal) Pregnancy
This situation occurs when the fertilised ovum implants outside of the womb, ie. in a tube or near an ovary. This condition is referred to as an ectopic pregnancy. Because the embryo will not survive outside of the womb, it is unfortunately inevitable that this type of pregnancy will not be viable (also, it can be a difficult condition to diagnose). Bleeding can often be very heavy and is a very serious event and can be life-threatening for the woman if she does not seek medical attention. An ectopic pregnancy is usually confirmed by ultrasound. Usually it means a laparotomy (operation in the abdomen) to remove the ectopic pregnancy from the tube. Occasionally it can be difficult to preserve the tube on the affected side. For further information see link to Ectopic Pregnany Trust.

Anembryonic Miscarriage (formerly called Blighted Ovum)
If you have had a miscarriage and your pregnancy loss has been described as a Anembryonic Miscarriage (or blighted ovum), you may be shocked and confused. In a pregnancy like this no embryo is seen.  Embryo is the term doctors use for your baby if you are less than 10 weeks pregnant.  If you are diagnosed with anembryonic miscarriage this means that, following ultrasound, your doctor saw the tissue which would have formed the afterbirth in your womb and the pregnancy fluid but no embryo. (This can also be diagnosed following pathology in the laboratory) This does not mean that there was no embryo. The embryo is most likely to have died very early in the pregnancy and would have been reabsorbed into the body early in it's development.  Most embryos which are lost this way, would have had severe chromosomal abnormalities and therefore, could never thrive. Anembryonic Miscarriage is typically detected between 8 and 11 weeks into your pregnancy. A D&C is usually necessary in this case.
It may be difficult to take in all the information which is presented to you by medical staff at a time like this. However, you should feel free to ask anything you feel you want to know. In most hospitals, you will be offered a follow-up appointment. Take time to formulate your questions, express you worries and get advice. Sometimes talking to another woman who has suffered Anembryonic Miscarriage can also be of great help.

Hydatidiform Mole
This is a rare form of failed pregnancy in which the placenta starts to grow very abnormally and the embryo dies. Despite this, the placenta continues to grow in a disorganised way, becoming so distended with cysts that it resembles a bunch of grapes ("hydatidiform" meaning blistery and "mole" meaning growth). Going to the hospital and being told you've had a miscarriage at any time can be a confusing and frightening experience. But when you are given facts and information that you've never heard of it can be shocking and it's hard to take in everything you are told. Unfortunately sometimes we can come across doctors and nurses who don't explain things properly and our minds can be racing so much that we don't ask them to clarify further.
In effect, the pregnancy is replaced by a benign tumour of the placenta. For the one in 2,000 pregnant women who get this condition, the first signs are usually vaginal bleeding, a larger than expected womb and severe symptoms of pregnancy, especially morning sickness. These symptoms are all due to the production of excessive amounts of the pregnancy hormone – Human Chorionic Gonadotrophin.
The condition is detected by an ultrasound scan and urine hormone tests. The treatment is to terminate the pregnancy as soon as possible, although in cases like this it happens spontaneously as a miscarriage. As a follow up you may have a urine test to ensure the "mole" was removed and isn't regrowing.There is a slight risk of it happening again with another pregnancy. To reduce this risk, women are usually advised to avoid becoming pregnant again for a year.

Recurrent miscarriage
Recurrent miscarriage is diagnosed when there have been three consecutive pregnancies which end in spontaneous miscarriage. It is a very distressing situation and is poorly understood. Causes can include abnormalities of the uterine cavity, such as fibroids or intra-uterine adhesions. Cervical incompetence, where the cervix dilates and cannot retain the pregnancy, may also be a reason. Infections in the mother account for 15% of recurrent miscarriages. Abnormal development of the foetus and hormonal problems account for approximately 3%. Even though it can be a very depressing situation the probability of achieving a successful outcome in subsequent pregnancies is still more than 50%.
For further information see link for St. Mary's Recurrent Miscarriage Clinic, London.

Stillbirth
This is technically any pregnancy that ends after the 20th week and the baby does not survive. Some babies die in utero and are discovered when the heartbeat is not found. The most common causes of this are: uterine abnormalities, a knot or other umbilical cord accident, infections of the lining of the gestational sac or cord, and placental abruptions that cause the placenta to pull away from the uterine wall. These babies are usually born through the induction of labor, although some babies are small enough to be taken by D&C procedures. For further information on Stillbirth please follow our link to Irish Stillbirth & Neonatal Death Society - ISANDS.

Regardless of how your miscarriage has happened or how many weeks you had carried your baby for we can and should never compare one persons loss to another. No one can judge the intensity of our grief or our feelings for our lost baby except ourselves. Everyone is different, and one parent's grief may be as painful as another's, regardless of the circumstances.



PLEASE NOTE
The information provided on this site is simply to provide an over-view of possible causes for your personal use and is NOT intended as a replacement for medical advice, diagnosis or treatment. It is a general guideline and treatments and opinions can differ between medical practitioners and for individual cases. It is NOT advisable to take any medications or start any treatments without consulting your doctor or specialist practitioner. The Miscarriage Association of Ireland assumes no liability or responsibility for any consequences resulting from the use of any information contained in this site or from any organisations mentioned in this site, including but not limited to errors or omissions, accuracy of information, studies or conclusions. The Miscarriage Association of Ireland is not responsible for, and disclaims all liability for, damages of any kind arising out of use, reference to, or reliance on such information. The Miscarriage Association of Ireland does not endorse or recommend any medications, products, treatments, services, brandnames, manufacturers, practitioners or otherwise which may be mentioned anywhere in this site.