A miscarriage is the loss of a baby during the early stages of pregnancy. Miscarriages can be emotionally challenging for women and their families, so it is crucial to have a healthy support system to grieve and discuss one's concerns.

Here is a detailed guide on what a miscarriage is, the causes, risk factors and, most importantly, coping strategies for those struggling with losing their baby.

What is a miscarriage?

A miscarriage occurs when one unintentionally loses their baby in the womb before the 20th week of pregnancy. Losses after the 20th week are called stillbirth.

A miscarriage is different from an abortion. An abortion is a medical intervention (procedure involving pill or surgery) for terminating a pregnancy, while miscarriage is an involuntary loss of a pregnancy.

What are the types of miscarriages?

There are different types of miscarriages that an expectant mother may experience. These include:

1. Threatened miscarriage: There are signs of a miscarriage, light vaginal bleeding, lower abdominal pain, but baby’s heartbeat is still present, and the cervix is not dilated.  Therefore, the chance of the pregnancy continuing still exists.
2. Inevitable miscarriage: When vaginal bleeding is heavier and stronger cramps are present along with the cervix being dilated, the chance of a miscarriage occurring is high. This can happen after a threatened miscarriage, or without warning.
3. Complete miscarriage: All pregnancy tissues (the baby and placenta) are expelled from the uterus, usually before the 12th week of pregnancy. Vaginal bleeding may last for a few days. Strong cramps much like labour pain is present.
4. Incomplete miscarriage: The pregnancy tissue is only partially expelled while some remain inside the uterus. Vaginal bleeding and lower abdominal cramping may continu
5. Missed miscarriage: This occurs when the foetus dies without the mother's knowledge and the tissues are still inside the uterus. Signs may include brownish discharge and pregnancy symptoms such as nausea and tiredness may have subsided.
6. Recurrent miscarriage: This occurs when a woman experiences repeated miscarriages. If a third or more miscarriage has occurred in a row, consulting a doctor is important to find out the causes.

What are the causes and risk factors of a miscarriage?

While the exact causes of a miscarriage often remain unknown, the primary cause of miscarriages during the first trimester of pregnancy is typically due to the foetus not progressing as expected.

Research has shown that when first-trimester miscarriages occur without underlying medical reason, 50% of these miscarriages are typically associated with chromosomal abnormalities (extra or missing chromosomes).

In most cases, miscarriages occur due to reasons out of one's control. It has nothing to do with what a mother has or has not done.

Nevertheless, there are risk factors to consider, such as:

1. Age: When the pregnant woman is over 35, this is also referred to as advanced maternal age. Complications during pregnancy, including miscarriages, are higher after age 35. The chances of a miscarriage rise to 50% when the mother is over 45.
   On the other hand, extremely young mothers under the age of 15 are also at a higher risk of experiencing a miscarriage.
2. Individual history of miscarriage: The possibility of experiencing another miscarriage is higher in women who have previously miscarried.
3. Underlying health conditions: Underlying health conditions including but not limited to uncontrolled diabetes, thyroid disease, and PCOS (polycystic ovary syndrome) can increase the risk of experiencing a miscarriage.
4. Uterine or cervical problems: Some women may be at a higher risk of losing their baby due to muscle weakness in the cervical region. This weakness can cause the cervix to open sooner than needed. The weakness can be a result of injury from previous surgeries or even due to genetic disorders.
   Although not much can be done to prevent this weakness, engaging in healthy lifestyle choices can help reduce the risk of miscarriage.
5. Smoking, alcohol, or drug consumption: Engaging in unhealthy lifestyle choices such as smoking, heavy drinking, and consuming recreational drugs can harm the mother and increase the risk of a miscarriage.
6. Obesity: Being overweight or having a high body mass index (BMI) before conceiving may increase the risk of miscarriages, stillbirths, and repeated miscarriages.

Does stress cause miscarriage?

Prolonged high-stress levels may disrupt the body's immune system, hormonal balances, and overall health. A weak immune system can also reduce one's ability to fight off infections.

Although there is no conclusive research to link stress as a direct cause of miscarriages, the effects of stress on one's health can increase the likelihood of experiencing a miscarriage.

What are the symptoms of miscarriage?

The signs of a miscarriage can vary based on how long you have been pregnant. Sometimes, a pregnant woman unaware of her pregnancy can abruptly experience a miscarriage very early in the term.

The primary symptom of a miscarriage is usually vaginal bleeding which can take different forms and may occur at irregular intervals. It could range from light spotting and brown discharge to heavy bleeding and red blood clots. 

It is important to note that apart from being a sign of a miscarriage, vaginal bleeding is also common during the first trimester. Therefore, always consult your doctor if you experience any bleeding.

Other miscarriage symptoms include:

• Mild to severe lower back pain
• Severe cramps/pain in your lower tummy
• Vaginal discharge of fluid or tissue
• Heavy spotting
• Not experiencing pregnancy symptoms anymore

As these symptoms can even occur without having a miscarriage, consult your doctor if you experience them so tests can be taken to determine the cause.

What to do after a miscarriage?

Medical tests are used to verify whether a miscarriage happened. If confirmed, the tests could also help determine whether any pregnancy tissue is left in your uterus. These tests are:

• Ultrasound scan
• Blood test to measure hormones associated with pregnancy

If there is remaining tissue, your doctor may advise the following options:

• Take medication to expel the tissue.
• Surgically remove the tissue (D&C).
• Wait for it to pass out of your uterus naturally.

Typically, no treatment is needed if all the tissue has been expelled.

Following a miscarriage, you should take proper action to reset your body and help with its healing process. This can include:

• Resting well.
• Abstaining from sex.
• Avoid high-impact exercise.
• Avoid demanding or strenuous household tasks.
• Having a sound support system while you are grieving and recovering.

What are the precautions to take after miscarriage (for those planning another pregnancy)?

You may want to start trying to conceive again after experiencing a miscarriage. However, to ensure a smooth and healthy pregnancy, you should give yourself enough time to heal mentally and physically. 

Although the chances of another miscarriage occurring are low, it is best to consult a healthcare professional to tailor a conception plan if you have experienced two or more consecutive losses. 

Your doctor may conduct tests to help determine the causes of your miscarriage(s). Some of these can include:

• Pelvic and uterine exams
• Ultrasounds
• Blood test to check for hormonal imbalances
• Chromosome testing (using blood or a pregnancy tissue sample)

Your gynaecologist will monitor your subsequent pregnancy to help ensure that the foetus develops healthily. 

Make an appointment at Pantai Hospitals

Ultimately, a miscarriage is often beyond one's control and can leave a heavy emotional scar on the parents. However, this does not mean it is the end. There is still a possibility of getting pregnant again. In addition, many women who have miscarried have gone on to have healthy full-term pregnancies. 

It is advisable to consult your doctor to review recommendations and precautions for future pregnancies and to have any questions or concerns addressed to feel secure and self-assured. 

A dedicated and expert team of Obstetrics & Gynaecology specialists at Pantai Hospital is available for consultation to provide the best care and assistance. 

Get in touch with us to book an appointment today if you have concerns or questions regarding your pregnancy. We assure you the best possible care tailored to your specific needs.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.