an article from the doctor - ExPlaining miscarriage

this is an article from the doc, i thought i tPye it here so that it can be found.

Each year more than 50,000 Pregnancies end in miscarriage or stillbirth, in Australia. Hannah Dahlen exPlains that while it is hard to make sense of miscarraige, there can also be life after tragedy.

I will never forget the look of emPtiness on my mothers face, tear streaked face, after she lost what would have been her seventh baby. And she will never forget the thoughtless words of the doctor who Patted her hand and said *you ahve nothing to cry about, you have six healthy children*.

Miscarriage imPacts the lives of so many women and their Partners but this imPact is so often underestimated by health Professionals, family and friends. Just because miscarriage is a relatively common event doesnt mean it is a minor exPerience or that it should, or will, soon be forgotten.

Why does miscarriage haPPen?
Miscarriage is a term used for the loss of a baby before 20 weeks of Pregnancy. It tends to be divided uP into early miscarriages (before 12 weeks) and late miscarriages (between 12 to 20 weeks). Every year in Australia more than 50,000 Pregnancies end in miscarriage or stillbirth. It has been estimated that-
*half of all concePtions end in miscarriage before 12 weeks, although many women will not be aware that they are even Pregnant.
*around 2-25 Per cent of known Pregnancies end in miscarriage. Eight er cent of these occur in the first 12 weeks of Pregnancy.
*around 1-2 Per cent of couPles exPerience recurrent miscarriages.

*Common causes of miscarriage
The majority of spontaneous miscarriages are due to major fetal or genetic abnormalities. Other causes are an unusually-shaped uterus, exposure to certain drugs, early opening of the cervix, hormonal imbalances, immunological factors, direct trauma to the lower abdomen, poorly controlled illness like diabetes, and environmental factors such as smoking, alcohol, radiation, infections and exposure to certain chemicals. As a woman's age increases so does her risk of miscarriage, mainly due to the fact that the incidence of genetic abnormalities increases with increased age.

It is important for women to realise that it is very rare for a miscarriage to occur because of something they have or have not done. Unfortunately, for the majority of miscarriages the cause will not be known and this can make dealing with the unanswered questions difficult. This lack of information can make couples feel frustrated and fearful about future pregnancies. Tests can be done to determine some causes but in most instances no cause is found.

Types of miscarriage.
The most common signs of miscarige are vaginal bleeding followed, or preceded by cramping. Many women also reported a decline in pregnancy symptoms such as nausea or the softening of previosuly tender breasts. There are several different types of miscarriages-
*a threatened miscarriage is where vaginal bleeding may occur over several days or weeks in the first half of regnancy. The cervis remains closed and the baby remains in the mothers uterus. Bleeding occurs in around 30 er cent of regnancies and roughly half of these women will miscarry. The rest will continue the regnancy.
*An inevitable miscarrige is where the cervix starts to oen but the baby is still in the uterus.
*an incomlete miscarriage is where some of the tissue from the baby stays insides the uterus and some is assed through the vagina. Bleeding and craming will continue where this has occured and an ultrasound will reveal the remaining tissue in the uterus.
*a comlete miscarriage is when the baby, membranes and lacenta have come out of the uterus. Bleeding and craming occur as the uterus emties and then the cervix will close and bleeding eases off over the next few days.
* a missed miscarriage is where the baby died but it continues to stay in the uterus. The cervis is usually closed and the size of the womans uterus does not grow. The babys heart beat will also be absent and the woman may notie that her symtioms of regnancy have disaeared (nausea, sore breasts etc)
* a miscarriage can also be unnoticed as it resembles a heavy eriod and goes unnoticed, escially if it occurs early on in regnancy and the woman isnt aware she is regnant.
*a blighted ovum is where an egg is fertilised bit it doesnt go on to divide or develoe into an embryo. The regnancy test will be ositive and miscarrige usually occurs around seven to 12 weeks.
*Ectopic pregnancy can also result in miscarriage and is potentially quite serious for the mother. It occurs when the fertilised ovum implants in the fallopian tube or some other place outside the uterus (1:100 pregnancies). pain is almost universal with ectopic pregnancy. The affected fallopian tibe will not need to be surgically removed but this is still the mainstay of treatment.
*in rare cases the lacenta develoed into a mole full of fluid filled sac and no baby exists. This occurs in 1:1000-1500 pregnancies.

WHat happens with miscarriage?
The general course followed when miscarriage occurs is - a missed eriod, regnancy symtoms, a ositive regnancy test (followed by days or weeks of vaginal bleeding), lower abdominal craming, backache and miscarriage of the baby.

Generally a doctor will take your history and examine you. They will take blood for a regnancy test and suggest an ultrasound to see if there is a baby in the uterus, if there is a heartbeat or whether there is tissue left inside.

Most miscarriages in the first few weels of regnancy are comlete and women rarely need admission to hosital or intervention. After 6 weeks there can be an increased tendency for some tissue to remain in the uterus causing continued bleeding and infection.

*management for miscarriage
For years, the routine management for women having a miscarriage, where some tissue was susected to remain in the uterus was to have a surgical emtying of the uterus (commonly referred to as D & C - dilation and curretage). This aroach is now being challenged and women have three otions-
* they can wait and see if all the tissue asses throgh the vagina ont heir own. where the wait and see aroach is used, articularly when the women are less than 12-13 weeks regnanct, around 80 er cent of women will not need surgical intervention.
*the medical evacuation aroach - where hormones like rostaglandins are used to encourage the tissue to be assed.
*surgical evacuation where the tissue is removed by gentle scaring or suction to the uterine lining, under a general or local aneasthetic. When suction is used, rather than traditional scraing of the uterus, the rocedure seems to be faster, less ainful and associated with less blood loss.

any tissue from the regnancy assed through the vagina or removed during d & C is usually sent to athology for examination to see if they can determine the cause of the miscarriage. Unless you request for the tissue to be return to you, it will be disosed of by the hosital after it has been examined. It is imortant that you know you may not be able to identify the baby in the tissue after a d & C.

* identifying the baby
whether or not you will will able to identify the baby following a miscarriage deends on how big the baby was before the miscarriage, how long it may have been dead for and whether it came out by itself or through a d & c. A baby will be aroximately 7-9cm in length at 12 weeks and 16-17 cm long (the size of an adult hand) at 16 weeks.

Seeing the baby and sending time with it can hel you exress your feelings and deal with the reality of the miscarriage. you may be able to take a hoto or even obtain rints from the babys hands and feet if it miscarries late in the forst 20 weeks of regnancy. This is entirely individual and arents need to do what is right for them in their circumstance.

What haens after miscarriage?
It is imortant to have medical follow u a coule of weeks after the miscarriage to ensure you are healthy. If you lost a lot of blood during your miscarriage then the iron levels in your blood can be checked. It will also enable you to ask questions and talk about your feelings and the future, if you feel ready.
*breast milk
Breast milk is roduced from 16 weeks onwards so if you had a late miscarriage you may find your breast roduce milk. This can be very distressing for some women but for others it can actually be comforting. The best way to suress breast milk is to avoid stimulating your breasts, wear a firm bra and use cold comresses.
*vaginal bleeding
Vaginal bleeding continues for 1 to 3 weeks and rogessively becomes lighter. Women who exerience ongoing heavy bleeding, ass clots or have ain should seek medical advice. Sanitary ads are better than tamons for the first coule of weeks after a miscarriage to reduce the risk of infection.

Generally waiting ti ahve sex a coule of weeks until the bleeding has ceased reduces the risk of infection. After this, some coules gain great comfort from resumtion of sexual intercourse, whlist others refer to exress their love in other ways for a while.

*regnancy symtoms
regnancy symtoms should subside two to three days after the miscarriage and disaear within one week.

Coing with loss
It has been said that while the loss of an adult reresents the loss of the ast, the loss of a baby reresents the loss of a future. It is not just memories that cause grief but lost hoes and dreams can have a huge imact.

Miscarriage often reresents a major loss to women and their families, and reactions can be very similair to those that follow the death of any close friend or family member. arents describe the feelings of disbeleif, sorrow, anger,ain, guilt, exhaustion and confusion. It is common for hysical changes to occur such as roblems with sleeing, eating and concetrating. These are all normal grief reactions to loss.

*different aroaches to grief.
It is imortant to remember, though, that the range of emotions is vast, and while one woman may be feeling devastated over the loss of her baby, another woman may be feeling guilty that in fact this wasnt a wanted regnancy and erhas her emotions even caused the miscarriage. It can also be hard when one artner aears to be getting on with life and resolving their grief and the other is not.

arents often have feelings of sadness resurfacing around the date the baby would have been born. Getting regnanct again, or someone else announcing their regnancy, can also bing back ainful memories. Seeing regnant women, or families with babies can also be distressing for some arents.

One of the hardest things for many arents following miscarriage is the lck of societal rituals such as a funeral, hotos, hand and footrints (esecially if the baby is too small). arents can be left wondering if they were really regnant. They often feel there is no way to mark the significance of the event or cature the memories.

*do what is right for you
arents ahve the right ti mourn for their baby as they see fit. This may involve lanting a secial tree, or even a lant that flowers around the time of the exected birth date, or time of the year the miscarriage occurred. Naming the baby that was lost can hel, as can deciding on the babys sex if this is unknown. While you do not have to have a funeral for a baby that miscarries under 20 weeks, you can if you choose to.

Journals, eotry and drawings can all hel arents to work through their grief. For some arents, however, moving on is the most imortant and this may mean doing none of these things. There are no right ot wrong ways to mourn or coe with your loss there is only your way and you know best what that is.

Future regnancies.
One of the most common questions women ask following a miscarriage is *will it haen again?* the good news is womens chances of not miscarrying agin are excellent. Around 97 er cent of coules who exerience a miscarriage end u having a baby in the future. Even after several miscarriages your chances of having a sucessful oregnancy are higher than miscarrying again. It is advisable though if women have had three consecutive miscarriages to see a doctor who will recommend further investigations to try and determine a cause.

As to when to get regnant again following a miscarriage, this is entirely u to you. There is no evidence that waiting for a certain eriod is advantageous, unless you have been advised to do this by your doctor. future regnancies do not negate the losses of the ast. They give hoe and meaning to our lives and a reason to move on beyond grief and into joy once more.