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All [عزيزي الزائر يتوجب عليك التسجيل لمشاهدة الرابط للتسجيل اضغط هنا] you need to know about miscarriageby KEREN WILLIAMS, Mail on Sunday YOU magazine
Miscarriage may be rarely discussed, but the problem is distressingly common for couples who are trying to have a baby.
A staggering quarter of all women who conceive will miscarry, like Changing Rooms presenter Anne Ryder Richardson, who lost her baby in January at five and a half months.
For many, the grief is assuaged by a successful pregnancy, but for others the experience can be devastating.
Why? This is the first question any woman asks herself when she suffers a miscarriage. Again and again, women look for reasons and blame themselves. Did they exercise too much or work too hard?
But there is absolutely nothing you can do to prevent most miscarriages; nor are they due to any underlying health problem. The vast majority of women go on to have a perfectly normal pregnancy next time round.
Only around one per cent of women suffers recurrent miscarriage three or more consecutive miscarriages and of these up to 70 per cent will be successful in the next pregnancy. For most women, the outlook is good.
Is there anything I can do to reduce the risk? There is little you can do to prevent a miscarriage, says Professor James Walker, Professor of Obstetrics and Gynaecology at the University of Leeds. ‘Women often analyse their lifestyle afterwards, but it is highly unlikely to have been caused by anything they have done.’
There is no evidence that exercise, *** or alcohol (under 21 units a week) has an effect, although high impact sports such as [عزيزي الزائر يتوجب عليك التسجيل لمشاهدة الرابط للتسجيل اضغط هنا] horse riding and road running may be unwise if you have a history of miscarriage. Cigarette smoking does increase the risk by a third, however, and it is worth giving up.
What causes a miscarriage? It is highly unlikely that you will ever know the actual cause of a one off
miscarriage, but most are due to the following problems:
Abnormal fetus. The most common cause of miscarriages in the first couple of months is a one off abnormal development in the fetus, often due to chromosome anomalies. ‘It’s not as though the baby is fine one minute and suddenly dies the next,’ says Professor Walker. ‘These pregnancies fail from the outset and were never destined to succeed.’
Most miscarriages like this happen by eight weeks, although bleeding may not start until three or four weeks later, which is worth remembering in subsequent pregnancies. ‘If a scan at eight weeks shows a healthy heart beat, you have a 95 per cent chance of a successful pregnancy,’ says Professor Walker.
Hormonal factors. A hormonal blip could cause a sporadic miscarriage and never be a problem again. However, a small number of women who have long cycles and irregular periods may suffer recurrent miscarriages because the lining of the uterus is too thin, making implantation difficult. Unfortunately, hormone treatment is not terribly successful.
‘There used to be a trend for progesterone treatment, but trials show this really doesn’t work,’ warns Professor Walker. ‘There is some evidence that injections of HCG (human chorionic gonadotrophin, a hormone released in early pregnancy) can help, but it’s not the answer for everyone.’ The treatment must be started as soon as the pregnancy is confirmed, at around four or five weeks.
Age. For women over 40, one in four women who become pregnant will miscarry. [One in four women of all ages miscarry, but these figures include women who don’t know that they are pregnant. Of women who do know that they’re pregnant, the figure is one in six. Once you’re over 40, and know that you’re pregnant, the figure rises to one in four]
Auto immune blood disorders. Around 20 per cent of recurrent miscarriers suffer from lupus or a similar auto immune disorder that causes blood clots to form in the developing placenta. A simple blood test, which may need to be repeated several times, can reveal whether or not this is the problem.
‘One negative test does not mean that a women is okay,’ warns Mr Roy Farquharson, consultant gynaecologist who runs an early pregnancy unit at the Liverpool Women’s Hospital. Often pregnancy can be a trigger for these disorders, so a test should be done as soon as possible,’ he adds.
But it can easily be treated with low dose aspirin or heparin injections, which help to thin the blood and prevent blood clots forming a recent trial also showed that women do equally well on either. ”We have a 70 per cent live birth rate in women treated for these disorders,’ says Dr Farquharson, ‘which is excellent.’
Other causes. While uterine abnormalities, such as fibroids, can cause a miscarriage, many women have no problems carrying a pregnancy to term. An incompetent cervix can also cause miscarriage at around 20 weeks. While this can be treated by a special stitch in the cervix, trials suggest it is not particularly successful, although it may delay labour by a few weeks.
Gene and chromosomal abnormalities, which can be detected by blood tests, may also cause recurrent miscarriages in a small number of couples. A procedure known as preimplantation genetic diagnosis can help. After in vitro fertilisation (IVF), a single cell is taken from the developing embryo and tested for the gene defect. Only healthy embryos are then replaced in the womb. It is an expensive and stressful procedure and pregnancy rates tend to be quite low but for some this is preferable to repeated miscarriages or a genetically abnormal baby.
What are the signs of miscarriage? Period like pain and bleeding are the usual symptoms, and if this occurs at any time during pregnancy, you should contact your GP or midwife. Bleeding during pregnancy is alarming, but not always disastrous. If a scan shows a healthy heartbeat, even if you are bleeding, the outlook is usually good.
Period like pains are common in early pregnancy and nothing to worry about, unless they become severe, in which case you should have an ultrasound scan to ensure that the pregnancy is not ectopic (when the fetus implants outside the uterus). Sickness and breast tenderness are signs that the pregnancy is progressing well, but you shouldn’t worry if you don’t suffer from them. Some women don’t, and they usually subside after the first three months of pregnancy anyway.
Will resting prevent a miscarriage? While resting won’t stop a miscarriage, walking around won’t encourage one, either. Around half of all women who have bleeding and pain in early pregnancy go on to miscarry, and there is nothing they can do about it.
A very early miscarriage may require no treatment at all, other than painkillers. Sometimes it is necessary to clear the uterus using a surgical procedure known as dilatation and curettage, [عزيزي الزائر يتوجب عليك التسجيل لمشاهدة الرابط للتسجيل اضغط هنا] where you might need to spend a night in hospital.
How long does it take to recover? Some women feel perfectly well within a few days, while others might feel tired and tearful for several weeks or even months afterwards. The greatest problem is coming to terms with the loss.
Women often feel numb at first, which usually gives way to an overwhelming sense of grief and disappointment. It is perfectly normal to feel tearful, depressed, anxious, angry, bad tempered, or even jealous. While you [عزيزي الزائر يتوجب عليك التسجيل لمشاهدة الرابط للتسجيل اضغط هنا] won’t ever forget a miscarriage, you [عزيزي الزائر يتوجب عليك التسجيل لمشاهدة الرابط للتسجيل اضغط هنا] won’t always be overwhelmed with feelings of sadness.
An early miscarriage might be just as devastating for some women as a late miscarriage or stillbirth. A recent Australian survey showed that most couples suffer from feelings of sadness and loss for up to four months afterwards, and for some the feelings may persist.
The study also confirmed that men are very much affected by a miscarriage, although they might not show it because they feel they have to be strong and support their partner. If you do find it hard to talk about it, consult your GP or a counsellor.
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