Miscarriage Information and Awareness

I’m wanting to shine some light on a very sensitive subject dear to my heart and the heart of the woman who have suffered a miscarriage/loss. Even with children of my own I’ve had multiple losses and want to share this as a way of putting information under the lime light for those experiencing or dealing with Miscarriage. My heart goes out to you beautiful woman x

I have also posted a blog post of my own detailed experience with loss under pregnancy and parenting in the scroll down menu on the main page x

What really happens during a miscarriage

About 1 in 5 pregnancies ends in a miscarriage, but what actually happens isn’t often discussed. If you are having a miscarriage, you are probably feeling very emotional and apprehensive. This descriptive information aims to give you an idea of what you can expect to happen during a miscarriage and treatment. I hope this helps x

Warning graphic descriptions of what you might see during a miscarriage.

If you think you are having a miscarriage, call your doctor or midwife for advice and support. Go to the Emergency Department if:

  • You are bleeding very heavily (soaking more than 2 pads per hour or passing clots larger than golf balls)
  • You have severe pain in your tummy or shoulder
  • You have a fever
  • You are dizzy or fainting
  • You have a bad smelling vaginal discharge
  • You have diarrhoea or pain when you have a bowel motion (do a poo)

What you may experience or feel during a miscarriage

Many women have a miscarriage early in their pregnancy without even realising it. They may just think they are having a heavy period. If this happens to you, you might have cramping, heavier bleeding than normal, pain in the tummy, pelvis or back, and feel weak. If you have started spotting, remember that this is normal in many pregnancies – but talk to your doctor or midwife to be safe.

Later in your pregnancy, you might notice signs like cramping pain, bleeding or passing fluid and blood clots from your vagina. Depending on how many weeks pregnant you are, you may pass tissue that looks more like a fetus, or a fully formed baby.

In some types of miscarriage, you might not have any symptoms at all – the miscarriage might not be discovered until your next ultrasound. Or you might just notice your morning sickness and breast tenderness have gone.

It is normal to feel very emotional and upset when you realise you’re having a miscarriage. It can take a while to process what is happening. Make sure you have someone with you and try to be kind to yourself.

What happens during a miscarriage?

Unfortunately, nothing can be done to stop a miscarriage once it has started. The treatment is to prevent heavy bleeding or an infection.

Your doctor might advise you that no treatment is necessary. This is called ‘expectant management’, and you just wait to see what will happen. Eventually, the pregnancy tissue (the fetus/baby, pregnancy sac and placenta) will pass naturally. This can take a few days or as long as 3 to 4 weeks.

It can be very hard emotionally to wait for the miscarriage because you don’t know when it will happen. When it starts, you will notice spotting and cramping and then, fairly quickly, you will start bleeding heavily. The cramps will get worse until they feel like contractions, and you will pass out the pregnancy tissue.

Some women opt to have medicine to speed up the process. In this case, the pregnancy tissue is likely to pass within a few hours.

If not all the tissue passes naturally or you have signs of infection, you may need to have a small operation called a ‘dilatation and curettage’ (D&C). You may need to wait some time for your hospital appointment. The operation only takes 5 to 10 minutes under general anaesthetic, and you will go home the same day.

While you are waiting for a miscarriage to finish, it’s best to rest at home – but you can go to work if you feel up to it. You can use paracetamol for any pain. If you are bleeding, use sanitary pads rather than tampons.

What might I see during a miscarriage?

In the first month of pregnancy, your baby is the size of a grain of rice so it is very hard to see. You may pass a blood clot or several clots from your vagina, and there may be some white or grey tissue in the clots. The bleeding will settle down in a few days, though it can take up to 2 weeks.

At 6 weeks

Most women can’t see anything that they can recognise when they have a miscarriage at this time. With the bleeding you may see clots with a small sac filled with fluid. The baby, which is about the size of the fingernail on your little finger, and a placenta might be seen in side the sac. You might also notice something that looks like an umbilical cord.

At 8 weeks

The tissue you pass may look dark red and shiny – some women describe it as looking like liver. You might find a sac with a baby inside, about the size of a small bean. If you look closely, you might be able to see where the eyes, arms and legs were forming.

At 10 weeks

The clots that are passed are dark red and look like jelly. They might have what looks like a membrane inside, which is part of the placenta. The sac will be inside one of the clots. At this age a baby is usually fully formed. with fingers, arms, legs and toes, and might be seen inside the sac.

At 12 to 16 weeks

If you miscarry now you might notice water coming out of your vagina first, followed by some bleeding and clots. The baby will be tiny and fully formed. If you see the baby it might be outside the womb by now.

There are several types of miscarriage – threatened, inevitable, complete, incomplete or missed. Learn about these types below, as well as about other types of pregnancy loss such as ectopic, molar pregnancy and a blighted ovum.

Threatened miscarriage

When your body is showing signs that you might miscarry, that is called a ‘threatened miscarriage’. You may have a little vaginal bleeding or lower abdominal pain. It can last days or weeks and the cervix is still closed. The pain and bleeding may go away and you can continue to have a healthy pregnancy and baby. Or things may get worse and you go on to have a miscarriage. There is rarely anything a doctor, midwife or you can do to protect the pregnancy. In the past, bed rest was recommended, but there is no scientific proof that this helps at this stage.

Inevitable miscarriage

Inevitable miscarriages can come after a threatened miscarriage or without warning. There is usually a lot more vaginal bleeding and strong lower stomach cramps. During the miscarriage your cervix opens and the developing fetus will come away in the bleeding.

Complete miscarriage

A complete miscarriage has taken place when all the pregnancy tissue has left your uterus. Vaginal bleeding may continue for several days. Cramping pain much like labour or strong period pain is common – this is the uterus contracting to empty. If you have miscarried at home or somewhere else with no health workers present, you should have a check-up with a doctor or midwife to make sure the miscarriage is complete.

Incomplete miscarriage

Sometimes, some pregnancy tissue will remain in the uterus. Vaginal bleeding and lower abdominal cramping may continue as the uterus continues trying to empty itself. This is known as an ‘incomplete miscarriage’. Your doctor or midwife will need to assess whether or not a short procedure called a ‘dilatation of the cervix and curettage of the uterus’ (often known as a ‘D&C’) is necessary to remove any remaining pregnancy tissue. This is an important medical procedure done in an operating theatre.

Missed miscarriage

Sometimes, the baby has died but stayed in the uterus. This is known as a ‘missed miscarriage’. If you have a missed miscarriage, you may have a brownish discharge. Some of the symptoms of pregnancy, such as nausea and tiredness, may have faded. You might have noticed nothing unusual. You may be shocked to have a scan and find the baby has died. If this happens, you should discuss treatment and support options with your doctor.

Recurrent miscarriage

A small number of women have repeated miscarriages. If this is your third or more miscarriage in a row, it’s best to discuss this with your doctor who may be able to investigate the causes, and refer you to a specialist.

Types of pregnancy loss
Other types of pregnancies that result in a miscarriage are outlined below.

Ectopic pregnancy

An ectopic pregnancy occurs when the embryo implants outside the uterus, usually in one of the fallopian tubes. A fetus does not usually survive an ectopic pregnancy. If you have an ectopic pregnancy, you may not know it as first, until it bleeds. Then you may get severe pain in your lower abdomen, vaginal bleeding, vomiting or pain in the tip of one shoulder. If you have these symptoms, it’s important to seek urgent medical attention.

An ectopic pregnancy is when a fertilised egg implants itself outside the womb, usually in one of the fallopian tubes. This means the embryo will not be able develop into a baby as the fallopian tube is not large enough to support the growing embryo.
Woman looking at an empty cot
In a few cases an ectopic pregnancy causes no noticeable symptoms and is only detected during routine pregnancy testing. However, most women do have symptoms and these usually become apparent between week 4 and week 12 of pregnancy.

Early diagnosis and treatment is important to prevent life-threatening bleeding and also, if possible, so the tube can be saved and it can continue to work. Symptoms of ectopic pregnancy
One-sided abdominal pain – you may experience pain, typically on one side of your abdomen (tummy), which can be persistent and severe.

Vaginal bleeding – vaginal bleeding is a different type of bleeding from your regular period. It often starts and stops, and can be bright or dark red in colour. Some women mistake this bleeding for a regular period and do not realise they are pregnant.

Shoulder tip pain – shoulder tip pain is felt where your shoulder ends and your arm begins. It is not known exactly why shoulder tip pain occurs, but it usually occurs when you are lying down and is a sign that the ectopic pregnancy is causing internal bleeding. The bleeding is thought to irritate the phrenic nerve, which is found in your diaphragm (the muscle used during breathing that separates your chest cavity from your abdomen). The irritation to the phrenic nerve causes referred pain (pain that is felt elsewhere) in the shoulder blade.

Bowel pain – you may experience pain when passing urine or stools.

Diarrhoea and vomiting – an ectopic pregnancy can cause similar symptoms to a gastrointestinal disease and is often associated with diarrhoea and vomiting.

How is ectopic pregnancy diagnosed?

It can be difficult to diagnose an ectopic pregnancy from the symptoms alone, as they can be similar to other conditions.

Some of the tests used to diagnose an ectopic pregnancy include:

  • vaginal ultrasound
  • blood tests
  • keyhole surgery

How is an ectopic pregnancy treated?

If an ectopic pregnancy is detected at an early stage, a medication called methotrexate is sometimes needed to stop the egg developing. The pregnancy tissue is then absorbed into the woman’s body. Methotrexate is not always needed, as in around half of cases the egg dies before it can grow larger. Ectopic pregnancies detected at a more advanced stage will require surgery to remove the pregnancy sac.

If an ectopic pregnancy is left to develop, there is a risk that the fertilised egg could continue to grow and cause the fallopian tube to split open (rupture), which can cause life-threatening internal bleeding.

Signs of a ruptured fallopian tube are:

  • sudden, severe, sharp pain
  • feeling faint and dizzy
  • feeling nauseous or vomiting
  • diarrhoea
  • shoulder tip pain

A ruptured fallopian tube is a medical emergency. If you think that you or someone in your care has experienced this complication, call 000 and ask for an ambulance.

Why does an ectopic pregnancy happen?

In a normal pregnancy an egg is fertilised by sperm in one of the fallopian tubes, which connect the ovaries to the womb. The fertilised egg then moves into the womb and implants itself into the womb lining (endometrium), where it grows and develops.

An ectopic pregnancy occurs when a fertilised egg implants itself outside the womb. It most commonly occurs in a fallopian tube (this is known as a tubal pregnancy), often as the result of damage to the fallopian tube or the tube not working properly.

Less commonly (in around 2 in 100 cases), an ectopic pregnancy can occur in an ovary, in the abdominal space or in the cervix (neck of the womb). In many cases, it’s not clear why a woman has an ectopic pregnancy. Sometimes it happens when there’s a problem with the fallopian tubes, such as them being narrow or blocked.

Molar pregnancy

A molar pregnancy is a type of pregnancy that fails to develop properly from conception. It can be either complete or partial and usually needs to be surgically removed A molar pregnancy is a type of pregnancy where a baby does not develop. If you have a molar pregnancy, it wasn’t caused by anything you did or didn’t do. A molar pregnancy has no known cause. The long follow-up involved in molar pregnancy can make it difficult to move on.

A pregnancy starts with the sperm fertilising an egg. The fertilised egg travels to the womb (uterus) where it implants. A molar pregnancy occurs when the cells that normally form a placenta grow into a clump of abnormal cells instead. It affects about 300 women a year in Australia. A molar pregnancy can be either complete or partial.

In a complete molar pregnancy, the fetus does not develop at all. It usually occurs when an egg that does not contain any genetic information is fertilised by a sperm. In a partial molar pregnancy, a fetus can develop but it will be abnormal and cannot survive. A partial molar pregnancy develops when a normal egg is fertilised by 2 sperm.

What causes a molar pregnancy

Nobody knows why a molar pregnancy happens. They occur more often in young women up to 20 years of age and in women above the age of 35-40, and in women who have had a molar pregnancy before.

Symptoms of a molar pregnancy

Women with a molar pregnancy usually feel pregnant. This is because the abnormal placenta often produces large amounts of the pregnancy hormone human chorionic gonadotropin, or hCG. Some women have severe morning sickness, and some have a fair bit of bleeding in the first 3 months. For some women, the uterus feels larger than it should be. Some women get high blood pressure and thyroid problems.

Diagnosis

Some women discover they have a molar pregnancy at their first pregnancy ultrasound scan, while others discover it only after a miscarriage or termination.

Treatment

A molar pregnancy usually needs to be removed surgically to avoid complications. This is usually done in hospital where a gynaecologist will remove the tissue from the womb vaginally. If you do not want future pregnancies, your doctor may discuss the option of removing your womb (hysterectomy) as treatment for a molar pregnancy.

In some cases, some of the molar tissue persists, and can grow deeper into the womb and spread, which would need further treatment – this is called an ‘invasive mole’. Rarely, the molar tissue turns into a cancer called choriocarcinoma, which needs further treatment.

Follow up care

To check that the molar tissue is completely gone, your doctor will probably ask you to have a blood test to check your hCG level very often until it decreases to normal. You might be asked to have blood tests for another 6-12 months to make sure all is well.

A molar pregnancy does not affect chances of getting pregnant again. However, you will probably be advised to wait for your doctor’s all-clear to fall pregnant again. A new pregnancy would cause your hCG level to rise, making it difficult to ensure it is not due to the molar tissue growing back.

Emotional support

The loss of a pregnancy can be devastating, regardless of how it happens. The long follow-up involved in molar pregnancy can also make it difficult to move on. You can call Pregnancy Birth and Baby on 1800 882 436 for confidential information and support anytime of the day or night.

Blighted ovum

With a blighted ovum the sac develops but there is no baby inside. It is also known as an ‘anembryonic pregnancy’.

This condition is usually discovered during a scan. In most cases, an embryo was conceived but did not develop and was reabsorbed into the uterus at a very early stage. You should see your doctor to discuss treatment options.

A blighted ovum is a type of miscarriage that can happen early in a pregnancy. It can be very upsetting and unexpected, but there is support available.
Diagnosis of blighted ovum can be particularly difficult when expecting to hear good news.
Diagnosis of blighted ovum can be particularly difficult when expecting to hear good news.

What is a blighted ovum?

A blighted ovum is a pregnancy where a sac and placenta grow, but a baby does not. It is also called an ‘anembryonic pregnancy’ as there is no embryo (developing baby). Because a blighted ovum still makes hormones, it can show up as a positive pregnancy test.

A blighted ovum will cause a miscarriage usually at 7-12 weeks of pregnancy. Your body realises the pregnancy is not developing properly and starts to shed blood and tissue from the uterus.

A miscarriage can be extremely upsetting. Many women need support and time to grieve. There is no right way to feel after a miscarriage. Different people react to a miscarriage with different emotions, including anger, guilt or relief. Pregnancy, Birth and Baby helpline can provide information and support on 1800 882 436.

What causes a blighted ovum?

When the egg is fertilised, cells that make the pregnancy sac and placenta start multiplying. But occasionally, the cells that are supposed to develop into a baby don’t multiply.

The cause isn’t known. It isn’t caused by anything you have done.

How and when is blighted ovum diagnosed?

Sometimes, it is picked up during a routine ultrasound. This can be particularly difficult for women who have gone for the ultrasound expecting good news.

At other times, there may have been bleeding at the start of the pregnancy and an ultrasound is used to investigate.

How is blighted ovum treated?

Your doctor will discuss the options with you. You might choose to allow a natural miscarriage to happen. Once this starts, it can take days to weeks for the bleeding to finish. If the bleeding is getting heavier, if you are in pain or you feel unwell, see your doctor.

You could also have a termination, whether by taking medicines or by a type of surgery known as D & C.

Does it affect my chances of having a baby?

No. Having a blighted ovum in one pregnancy does not alter your chance of having a successful pregnancy in the future.

Thank you for taking the time to read this, I hope the information provided gives a better prospective on miscarriage and the signs to look out for please feel free to leave comments or share your story cassie xo

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