Miscarriage / Blood loss in the first trimester
Why does blood loss occur in the beginning of the pregnancy? Blood loss in the first three months of the pregnancy can have a number of different causes. More often than not it is harmless and stops spontaneously. About half of the cases of blood loss in early pregnancy will result in a miscarriage. This is normally coupled with menstrual cramps and abdominal pain.
What is a miscarriage?
A miscarriage is the loss of an early pregnancy. There are different types of miscarriages depending on the stage of pregnancy in which the miscarriage occurs. In a normal pregnancy an embryonic sack is formed around a vital embryo. In the case of an early miscarriage the growth stops at an early stage of development and no embryo is formed. In this instance when we carry out an (internal) ultrasound scan there will only be an embryonic sack visible. In the case of a later miscarriage, the pregnancy will have developed further and an embryo will be visible on an internal ultrasound scan. The embryo will show no heart activity and will usually be smaller than expected. This sort of miscarriage often occurs without symptoms, or sometimes there may be some blood loss and light abdominal pain. When the uterus expels the pregnancy, the cervix opens and there will be blood loss and abdominal cramps. The chance of this process occurring naturally is high. When the pregnancy is expelled, the pain and blood loss will stop and the cervix will close. Occasionally the uterus will not expel the pregnancy completely and some tissue may remain in the uterus, in this case the miscarriage is incomplete. A miscarriage cannot be prevented or treated.
What happens when is miscarriage is diagnosed?
You can choose to wait for nature to take its course and allow the miscarriage to occur spontaneously or you can choose to have a medical procedure to remove the remaining tissue from the uterus.
A miscarriage will usually occur within a few days of the first signs of blood loss, sometimes it takes longer and can take up to two weeks. Abdominal cramps will increase gradually along with blood loss. The pain disappears immediately after the miscarriage is complete. Blood loss reduces quickly and is comparable to the last few days of a period. In total the process can take up to two weeks, with two days being twice as heavy as a normal period, sometimes with clots. Following this you may have some brown discharge for up to six weeks.
Benefits of waiting
You may prefer to wait for the miscarriage to occur spontaneously as this is a natural process. This will allow for grieving at home and will avoid possible complications of a surgical procedure.
Disadvantages of waiting:
If you choose to wait for the miscarriage to occur naturally, it is advisable to consider how long you wish to wait and to discuss this with a doctor. Waiting holds no medical risk and has no negative effect on future pregnancies. It can however be emotionally difficult. A surgical procedure may also be necessary in the case of heavy blood loss or an incomplete miscarriage. Pregnancy symptoms can remain as long as the pregnancy is not completely expelled from the uterus.
Surgical procedure (curettage)
During a curettage the gynaecologist will remove any remaining tissue from the uterus via the vagina, through the cervix using a thin tube (vacuum curettage) or a curette. The procedure can be carried out under general or local anaesthetic, depending on the hospital. You can discuss this with the gynaecologist. The miscarriage can also be stimulated using medication.
Benefits of surgical intervention
Surgical intervention offers less uncertainty and disturbance to normal life.
Disadvantages of curettage
A curettage is a medical intervention. A rare complication of a curettage is Ashermans syndrome which causes adhesions on the lining of the uterus. These adhesions can affect fertility and have to be surgically removed at a later stage. Occasionally a perforation occurs: this is when the tube or curette penetrates the wall of the uterus. This usually has no consequences, but sometimes requires an extra nights stay in the hospital. Usually antibiotics will be prescribed. Another complication which may occur is that the curettage is incomplete. The remaining tissue may come out spontaneously but it can also be necessary to to a second curettage.
If you have a Rhesus D negative blood group and the embryo is 10 weeks or more, then you will receive an anti-D immunoglobulin injection.
The gynaecologist can prescribe medication to stimulate the miscarriage.
Benefits of medication
The miscarriage does not occur in the same way as a spontaneous miscarriage.
Disadvantages of medication
Because the miscarriage is stimulated by medication then you might experience more pain. We advise the following painkillers: paracetamol (1000 mg. Every 8 hours) and Naproxen (500 mg. every 8 hours) if necessary. Sometimes a curettage is still required after medication if the miscarriage is incomplete.
After the miscarriage
- Physical recovery Physical recovery after a spontaneous miscarriage is usual fast. It is advisable to wait with intercourse until blood loss has stopped. Fertility is not affected after a miscarriage and waiting to get pregnant again is medically not necessary. Your next period will usually come around four to six weeks after the miscarriage.
- Emotional recovery After a miscarriage can be a difficult time. Sadness, feelings of guilt, disbelief, anger and an empty feeling are common emotions in this phase. It is difficult to say how much time you will need to recover from you los. Feelings of guilt are not justified. It is advisable to talk to your partner, family, friends, doctor or midwife.
When should you contact your midwife?
- By heavy blood loss
- If your symptoms last for longer than 2 weeks
- If you have a fever (> 38° C)
- If you are worried or have questions
You can find more information on: De Verloskundige.