Hello. I am back again with you. Did you have a great week? I am in the middle of a cold weather now in England. It is winter time here but it is quite enjoyable if you wrap up well. Shall we start again ? The next bits are as follows:
Q.15. You have talked about early pregnancy loss a lot but you haven’t told us why it happens though. Could you tell us now?
A.15. Well indeed, I haven’t. I was simply laying down some basic facts in the beginning so that you can understand me well in the following sections. I thought it was essential for you to know these before I could go in further details. I will say that in most cases it is not actually possible to provide you a reason for an early pregnancy loss. However, mostly the problem may lie in the baby’s chromosomes ( it is the genetic structures within our body’s cells that we inherit from our dad and mom ).These chromosomes are passed on to us through the sperm and egg to the first cell of our body( called a fertilised egg or ovum) at the time of fertilisation( union of sperm and egg ). All the subsequent body cells ( somatic cells ) that come from this ovum have the same number and structure of the chromosomes as that of the ovum. There are exceptions though. Our sperm or egg cell ( gonadal cells ) which we start to produce later on at the time of puberty have half the number of chromosomes than that of somatic cells. It is understood that if the baby does not have the right number or structure of chromosomes at the time of fertilisation, it will not develop properly and the pregnancy can end in a miscarriage. I will talk more about this later on.
Q.16. Could you tell me, what are my chances of having an early pregnancy loss ?
A.16. Sadly,this is very common. Many are lost before one has missed her period or one’s pregnancy is confirmed. In the first three months,10 to 20 percent of pregnancies are lost following a positive pregnancy test.That means one or two out of ten pregnant women in their early pregnancies will lose their babies.
More importantly, the risk increases further with your age, for example, at the age of thirty, twenty percent of pregnancies are lost early but at the age of forty, it is even higher,fifty percent.
Not only that certain medical problems also increase your chance of miscarriage, such as, poorly controlled diabetes.
Lastly ,I may add that a few lifestyle factors such as smoking,being overweight or heavy drinking have been implicated with an increase in early pregnancy loss.
On the other hand, there are misconceptions that stress and sex during pregnancy are associated with early miscarriage. No,they don’t cause early pregnancy loss. Similarly,exercise or eating hot spicy food does not increases the chance of an early pregnancy loss.
Q.17. How do I know that I am having an early pregnancy loss?
A.17. Well, usually the starting point is bleeding from the vagina. Remember a little bit of bleeding or spotting at the beginning of a pregnancy is not uncommon. On the other hand, if the bleeding increases with time and you have started to pass clots ( lumps of blood ) or there is no sign of stoppage of blood loss, it is not a very good sign. Eventually pain or cramping in the lower tummy sets in and the process of loss of pregnancy becomes inevitable. Pain happens as your womb starts to contract in order to expel the pregnancy. Finally, when some yellowish fleshy mass comes out with blood, there is sadly no doubt that miscarriage has happened.This is the most common way an early pregnancy loss may present.
Another subtle pattern of pregnancy loss can confuse us sometimes. Here,a brown and sticky discharge from the vagina goes on for a few days without much pain. It is more often than not one’s suspicion of something not ‘right’ about the pregnancy and the perception of the disappearance of pregnancy symptoms that lead to an ultrasound scan diagnosis of a ‘missed miscarriage’. During the scan the baby’s heartbeat is not visualised and a crumpled sac of early pregnancy is seen lying inside the womb.
Q.18.What should I do if I suspect that I am having an early pregnancy loss?
A.18. Obviously your suspicion is based on bleeding and/or cramping pain that you have noticed in the early months of pregnancy.You may need some help now. In most cases these symptoms are transient and may resolve soon. But these symptoms are also associated with early pregnancy loss.The following course of action may be initiated depending on the clinical situation —
- a) If you are experiencing a small blood loss and you are still in your senses,you may speak to your local doctor or a member of your family or a friend to seek further advice.You may be asked to visit a specialist doctor ( gynaecologist ) for further advice or else you may visit an Early Pregnancy Advisory Unit ( EPAU), usually found in a large hospital.
- b) If you are having brisk and heavy blood loss then perhaps someone else should come forward to help you.You need a quick transfer to a nearby hospital with a good gynaecological service or an accident and emergency service ( A&E ) in an ambulance or other suitable vehicle.Time is valuable here to prevent further blood loss and consequently to reduce risk to your life.
I suggest someone from your family should accompany you to keep up your morale and for support. Needless to say what you pack with you at that time but a large towel to soak the escaping blood will be handy .You may pick up your health card,medication list,blood group card and an extra set of clothes at the same time. I am sure that someone else will deal with the financial side at that time without bothering you.
Q.19. How will the doctors find out whether I am having an early pregnancy loss?
A.19. An early pregnancy loss is usually diagnosed by an ultrasound scan.You may be advised to have either a TVS or a TAS ( please see the meanings in my earlier post) or sometimes both. As I said before a TVS may be recommended as it provides a clearer image of your pregnancy details inside the womb.
You may be also offered some blood tests that could include checking the level of your pregnancy hormone ( HCG ),your blood group and haemoglobin ( the main protein in your red blood cells that carry oxygen )
Sometimes, your doctor may carry out a vaginal examination if you are bleeding or you are in pain.You may wish to bring someone to support you during your examination or scan.
Some patients will miscarry quickly but for others the diagnosis and ongoing management may take several weeks.
Q.20. What are my options if an early pregnancy loss is confirmed ?
A.20. Well,if the scan shows that you have miscarried and your womb is empty of any products of pregnancy ( baby and the placenta ) you may not need any further treatment.You will be discharged.
If the loss of pregnancy is confirmed but some or all of the pregnancy is still inside your womb,your doctor or nurse will talk to you about the best options for you.Generally speaking,they may offer you one of the three options ,wait and let nature take its own course,or to use medicines,or to have an operation to remove the pregnancy tissue from your womb. We will now talk more about these options in the following Q&A s.
Let me stop now.I will write to you soon. Look after yourselves and have a great week.