5 Things You Need to Know About Having a Miscarriage From a Nurse Practitioner

1. How common is having a miscarriage?

Healing is so important after miscarriage, not just physically but mentally. One in four women will experience a miscarriage. Studies have shown that women who have had two or more miscarriages have a 40 percent chance of having another miscarriage. I have become passionate about empowering patients to be their own advocates with their healthcare providers to have a complete workup performed after ensuring two losses. We often hear that experiencing a miscarriage is common but recurrent miscarriage should not be.

2. Are there different types of miscarriages?

Chemical

I dislike this term, it takes away from the fact a baby was lost. This type of miscarriage occurs very early on before you even learn that you’re pregnant. A chemical pregnancy is most likely the result of chromosomal abnormalities. An embryo is created but is non-viable shortly after implantation.

Blighted Ovum

This is referred to as an anembryonic pregnancy. They occur very early in pregnancy, often before you even know you are pregnant. When this occurs a fertilized egg attaches to the uterine wall, but an embryo does not develop.  It is likely you will miscarry the pregnancy but at times a dilation and curettage (D&C) procedure may be needed.

Molar Pregnancy

This is when an abnormal growth of trophoblasts (cells) that would normally develop into the placenta, occurs instead. There are two types of molar pregnancy, complete and partial.

Complete molar pregnancy: The placental tissue is abnormal and appears to form fluid-filled cysts. There’s also no formation of fetal tissue that occurs.

Partial molar pregnancy: there may be normal placental tissue along with abnormally forming placental tissue. There may also be the formation of a fetus, but the fetus is not able to survive and is usually miscarried early in the pregnancy.

Ectopic

This occurs when a fertilized egg grows outside of the uterus. Approximately 90 percent of the time this occurs in a fallopian tube. If this causes a rupture to happen, this can be life-threatening and requires emergency surgery.

Missed Miscarriage

This occurs when a fetus implants but does not develop into a baby.

Threatened Miscarriage

This occurs when a woman experiences vaginal bleeding during the first 20 weeks of pregnancy. Keep in mind this does not necessarily mean you will have a miscarriage. If you experience bleeding, abdominal pain, or any other concerning symptoms please seek care from your medical provider.

Incomplete Miscarriage

This refers to pregnancy tissue remaining in the uterus. It is often accompanied by heavy vaginal bleeding and intense abdominal pain. During an exam, the cervix will be open.

Complete Miscarriage

This refers to a miscarriage that has had all the pregnancy tissue pass. The bleeding and pain will subside quickly. It can be confirmed and followed by your healthcare provider with ultrasound and blood work.

Recurrent pregnancy loss

This is defined by the American Society of Reproductive Medicine (ASRM) as two or more pregnancy losses. Positive home pregnancy tests are to be included in this count.

CAN I DO ANYTHING TO PREVENT A MISCARRIAGE?

No. It was not the exercise, sex, running, OR anything you did that caused this miscarriage to occur.

We do know that smoking, alcohol, and caffeine have been studied as causes of early pregnancy loss. Some research suggests that smoking increases the risk, while other research suggests that it does not, that’s confusing! I am always going to tell you to stop smoking! Alcohol use in the first trimester may slightly increase the risk of early pregnancy loss, but the research is not clear. Confusing again!  In any case, it is best to avoid smoking and drinking alcohol during pregnancy.

There is back and forth conversations on the topic of caffeine use during conception. The latest recommendation notes consuming 200 mg or less of caffeine a day (the amount in two cups of coffee) does not seem to increase the risk of experiencing a miscarriage. So please do not think that your pumpkin latte or in my case sugar-free vanilla latte is the cause!

Your immune system can play a role in recurrent pregnancy loss. I encourage you to advocate to your healthcare provider to rule out hormone abnormalities that impact pregnancy loss such as thyroid disease, PCOS, and blood clotting disorders.

Should I be monitored after a miscarriage?

It is common to monitor HCG levels with blood draws to ensure they are trending back down to less than 5. Ultrasounds may be done initially and followups. Do not go months and months with these elevated, eight weeks is my max before considering treatment options. There are certain medications that may be used or a surgical procedure called dilation and curettage (D and C).

Testing to consider after two miscarriages

Home testing: This has to be ordered by your healthcare provider. This has a 99 percent accuracy rate and helps determine why a miscarriage has occurred. Tissue is collected from the pregnancy loss and tested for chromosomal abnormalities. The companies I utilize are Myriad and Natera.

I encourage you to have a conversation with your healthcare provider about labs to have drawn if you have experienced two or more miscarriages. These are just a general guideline.

• • Hormonal- full thyroid panel, estrogen, progesterone, prolactin, FSH, LH, AMH.
  • Metabolic – fasting blood sugar, insulin, HDL, LDL, cholesterol, triglyceride level
  • Antibody and Immunologic – anticardiolipin, beta-2 glycoprotein, lupus anticoagulant
  • Coagulation- antithrombin III, PTT, PT, protein C and S, anticardiolipin antibody IgA
  • Other – vitamin D, iron levels and panels, ANA, homocysteine, thyroglobulin antibody
  • Have male sperm checked at the onset of any fertility testing!
  • Home hormone panels such as Dutch Hormone.

I encourage you to have a conversation with your healthcare provider to determine what testing and options are best for you. You are your own best advocate for your healthcare. Never be scared to ask a question or seek a second opinion!

Also Read: Progesterone Levels During Conception and Pregnancy