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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. If a complete miscarriage occurs, particularly after 14 weeks, it is advisable to go to the hospital for a check-up. Usually an ultrasound scan will be carried out to confirm that the womb is empty and that no further tissues remain inside.
The physical process of a complete miscarriage will depend on whether the miscarriage is an early loss or later loss.
Early Loss
If you miscarry naturally, even in the early weeks of pregnancy, you are likely to have period-like cramps that can be extremely painful. This is because the uterus is tightly squeezing to push its contents out, like it does in labour – and some women do experience contractions not unlike labour. You are also likely to bleed heavily and to pass large clots. You may pass a recognisable baby or foetus, perhaps still in the pregnancy sac.
You may feel able to manage the pain and bleeding at home or you might feel that you need to go to hospital.
Later Loss
If you miscarry naturally in the second trimester, between 14 & 24 weeks, you are likely to go through a recognisable process of labour and you will probably need hospital care. However, some women don’t have clear signs of labour and may deliver quickly at home.
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. If bleeding occurs at any stage of pregnancy you should contact the hospital and ask for an ultrasound so that the situation can be assessed.
Incomplete Miscarriage
Sometimes not all of the pregnancy tissue is passed from the womb. This situation is called an incomplete miscarriage. Usually, you will be admitted to hospital and an ultrasound scan will be carried out. If there are remains of tissue present in the womb then the treatments options outlined under “What happens when a miscarriage is confirmed” should be discussed with you.
The physical process that you will experience will depend on the period of gestation and which option you choose for the management of your miscarriage.
Missed / Silent Miscarriage
In this situation what happens is that the embryo or foetus fails to develop and, instead of being passed out of the womb in a miscarriage situation, it is retained inside. This can occur in both the first and second trimester of pregnancy.
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 you 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 and the miscarriage is diagnosed only during a routine scan.
The physical process that you will experience will depend on the period of gestation and on which option you choose for the management of your miscarriage.
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 doctor’s 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 can see the tissue which would have formed the afterbirth in your womb and the pregnancy sac 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 its 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.
The physical process that you will experience will depend on the period of gestation and which option you choose for the management of your miscarriage.
Ectopic (or Tubal) Pregnancy
This situation occurs when the fertilised ovum implants outside of the womb, usually in a fallopian tube. 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. It can be a difficult condition to diagnose. Symptoms can include abdominal pain, bleeding and shoulder tip pain. It is a very serious event and can be life-threatening for the woman without medical attention. An ectopic pregnancy is usually confirmed by measurement of pregnancy hormone levels, ultrasound and laparoscopy. Sometimes it means a laparotomy (operation in the abdomen) to remove the ectopic pregnancy. For further information see Ectopic Pregnancy Ireland’s website http://www.ectopicireland.ie
Molar Pregnancy
A molar pregnancy (also known as hydatidiform mole) is a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta.
There are two types of molar pregnancy, complete molar pregnancy and partial molar pregnancy. In a complete molar pregnancy, the placental tissue is abnormal and swollen and appears to form fluid-filled cysts. There’s also no formation of foetal tissue. In a partial molar pregnancy, there may be normal placental tissue along with abnormally forming placental tissue. There may also be formation of a foetus, but the foetus is not able to survive, and is usually miscarried early in the pregnancy. A molar pregnancy can have serious complications — including a rare form of cancer — and requires early treatment.
A molar pregnancy may seem like a normal pregnancy at first, but most molar pregnancies cause specific signs and symptoms, including:
- Dark brown to bright red vaginal bleeding during the first trimester
- Severe nausea and vomiting
- Sometimes vaginal passage of grapelike cysts
- Pelvic pressure or pain
If you experience any signs or symptoms of a molar pregnancy, consult your doctor or pregnancy care provider.
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 urine tests and regular blood tests to ensure the “mole” was removed and isn’t re-growing. 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 until all follow up is completed.
For further Information & Support on Molar Pregnancy please see:
http://www.cuh.hse.ie/Cork-University-Maternity-Hospital/Gynaecology/GTD-Centre/
Late Miscarriage
Most miscarriages happen in the first 12 or 13 weeks of pregnancy. It is much less usual to miscarry after 13 weeks, when many woman and their partners feel that they are safely past any danger period.
The physical experience of late miscarriage can be particularly distressing. Some women miscarry naturally, sometimes without much warning, and this can be shocking and frightening. Others have to have their labour induced before delivering their baby.
Whatever happens, you may have to make very difficult and upsetting decisions about seeing and perhaps holding your baby, about allowing a post-mortem and about what happens to the remains of your baby. In the days after your loss, you may find that your breasts produce milk, which can add to your distress. None of these circumstances are easy to cope with and you may feel both physically and emotionally exhausted.
Recurrent Miscarriage
Recurrent miscarriage means having two or more miscarriages in a row. It affects about one in every hundred couples trying for a baby. Sometimes a treatable cause can be found, and sometimes not. But in either case, most couples are more likely to have a successful pregnancy next time than to miscarry again.
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Testing after Recurrent Miscarriage
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You should be offered tests to try to find the cause. This should happen whether or not you already have one or more children. Testing is not usually offered after one early miscarriage (up to 14 weeks) but you might be offered tests if you are in your late 30s or 40s or if it has taken you a long time to conceive. If you had a late (second trimester) miscarriage, where your baby died after 14 weeks of pregnancy, you should be offered tests after this loss.
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Risk Factors
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Your risk of recurrent miscarriage is higher if:
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- You and your partner are older; the risk is highest if you are over 35 and your partner over 40
- You are very overweight. Being very underweight may also increase your risk
