Dr. Natalia García Montaner, specialist in Gynaecology and Obstetrics at Teladoc Health, answers our questions about miscarriage, a situation faced by many couples but, if it occurs in a healthy couple, does not necessarily prevent the pregnancy from being carried to term in subsequent pregnancies.
When is a miscarriage considered to be a spontaneous abortion and how often does it occur?
A miscarriage occurs when a pregnancy is lost spontaneously before the 22nd week of pregnancy, without any intentional manoeuvre. It occurs in about 15% of pregnancies, 85% of which occur before 12 weeks. The frequency decreases as the weeks progress and it is considered that after week 7, with a normal ultrasound scan, the probability of miscarriage is less than 5%.
Is there a specific cause?
In 40-60% of cases the embryo in a miscarriage has genetic abnormalities, and the main factor related to this is maternal age: the risk of miscarriage increases with age, being 11-15% in women between 20 and 34 years, 25% between 35 and 39 years, 51% in the 40-44 age group and 93% in those over 45 years.
Another important risk factor is a history of previous miscarriages, as one previous miscarriage, and especially two or more, may mean that there is a genetic problem in one or both parents or an alteration in the mother’s immune system or coagulation.
Other causes include abnormalities in the shape of the uterine cavity, maternal pathologies capable of altering the environment in which the pregnancy grows, and exposure to toxic substances.
Are there certain risk factors associated with miscarriage (smoking, alcohol…)?
Yes, there are various factors related to the pregnant woman’s lifestyle which are related to the incidence of miscarriages and are therefore avoidable,: the consumption of cocaine and other drugs, alcohol, caffeine at high doses, smoking, various drugs and toxins related to the pregnant woman’s work environment (some solvents, heavy metals, radiation…), among others.
What signs should alert a woman to the fact that she is suffering a miscarriage?
The majority of miscarriages, as we have mentioned, are of genetic cause, so the pregnancy develops for a few weeks until it stops growing and stops. When the gestation loses vitality, sooner or later blood loss will begin, which usually starts in a mild to moderate form, generally without pain, and progressively increases, adding to the colicky pain, and culminating in the expulsion of the entire gestational product. Therefore, the diagnosis is often made ultrasonographically: without any symptoms, the pregnant woman comes for a check-up and ultrasound diagnoses a gestation that is not progressing, and on other occasions the patient consults due to blood loss. Less frequent are the cases in which the debut is directly with significant bleeding, pain and expulsion of the sac.
It is therefore difficult to identify a warning sign, as the majority do not present any symptoms and if they do, it is only a small amount of bleeding. It should be borne in mind that implantation bleeding also occurs in almost half of pregnant women between the fourth and sixth week in absolutely normal and progressing pregnancies.
Are repeat miscarriages common?
A repeat miscarriage is considered to be the loss of three or more gestations, however, a study to rule out a cause is usually initiated after two miscarriages. The probability of a new miscarriage after a previous one is 20%, 28% after two and 43% after three.
We have already mentioned that there are unavoidable causes, such as maternal age. Others, such as uterine anomalies or maternal pathology, can be treated and can be improved or eliminated, thus reducing the risk of consecutive miscarriages. And finally, there are preventable causes, such as the consumption of toxic substances.
But it is important to keep in mind that in most cases miscarriage occurs randomly, there is no known underlying cause and therefore the probability of recurrence is low.
When can pregnancy be reattempted after a miscarriage?
From a medical point of view, a new pregnancy can be attempted after a normal full menstrual cycle following the miscarriage if it has been a few weeks and without complications. However, the recommendation is that it should not be before the couple has fully recovered physically and emotionally, and sometimes it is necessary to give some time until the emotional loss has been completely overcome.
In the case of repeated miscarriages, it may sometimes be advisable to take a pause in order to carry out all the necessary studies to rule out the cause of the miscarriages before rushing into another unprogressive pregnancy, as the emotional weight is greater with each miscarriage.
What can couples be told to manage the miscarriage emotionally?
Most miscarriages have no identifiable cause, so for me the most important thing is to insist on making it clear to them that nothing they did or did not do had anything to do with it. It is common for the couple, or more often the pregnant woman, to blame themselves or feel frustrated that they have not done well enough. It is necessary to convey to them that if the pregnancy did not work out, it was not because of a scare, an upset or an effort, but because of a cause beyond their control, so that they can face a new pregnancy with as much peace of mind as possible. And to explain the frequency of these miscarriages in absolutely healthy couples who in subsequent pregnancies go on to have healthy children.
Do you think the emotional impact on the couple is minimised, and how can they support their partners?
Definitely! We almost always worry more about the wellbeing of the pregnant woman, leaving aside the fact that the emotional loss is felt by both partners, and the spouse (man or woman) has also seen all the illusions generated with the expectation of having a child interrupted and truncated. In any case, it is the pregnant woman who suffers the physical consequences of the miscarriage and who most often feels guilty for not having been able to carry the pregnancy successfully to term.
The best way to support the partner is to express one’s feelings sincerely, not to appear less sad than one really is, and above all to remove any shadow of guilt from the pregnant woman. And be aware that the pregnant woman’s bond with the pregnancy is different from the first moment she is aware that she is pregnant, and that hormonal changes also affect the management of emotions differently between the two partners.
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