Miscarriages

The duration of a healthy pregnancy usually lasts 40 weeks; however, when a fetus or embryo is lost before 20 weeks of the gestation period, this is known as a miscarriage. During the early stages of prenatal development is when a miscarriage usually occurs. In fact, 15-20% of all pregnancies end in miscarriages. Miscarriage is often referred to as spontaneous abortion. This term has sparked much controversy around what is considered the correct term for early loss of pregnancy. Usually, miscarriages are due to genetic malfunctions with the development of the fetus or the health of the mother.

Terminology

The use of the word "abortion" can be confusing as miscarriage and abortion are two very different things. There has always been an ongoing confusion between the two as each have their own connotations. Abortion is linked to an act that was once illegal and considered socially unacceptable whereas miscarriage is the natural death of an unborn fetus. Currently, health professionals have become more aware of their language when distinguishing between the two as they have begun to take in mind the perspective of the woman's experience.

Signs and Symptoms

There are many signals that can indicate when a woman is about to have a miscarriage. The most common indication is vaginal bleeding which can range from spotting to heavy bleeding. However, there are many other causes of spotting and vaginal bleeding that can develop into something other than a miscarriage. In fact, spotting is very common during the first 20 weeks of pregnancy and can be classified as a threatened miscarriage. Women that have threatened miscarriages may miscarry however most go on to deliver healthy babies. Even though spotting is common, it is still considered a factor and should not be take lightly, especially when accompanied by abdominal pain and cramping. There could also be vaginal fluid or tissue that is excreted out of the body which can signify a miscarriage as well.

Causes

A miscarriage can happen at any stage of the pregnancy but the first trimester is where the mother is most susceptible to it. After the 20 weeks of the pregnancy, or during the second trimester, a miscarriage is known as premature delivery. Also, if all three terms of the pregnancy are completed and the baby is delivered but has died, this is considered a still birth. There are many causes for miscarriage and some still cannot be determined or are unknown. The most common cause however, is chromosomal abnormality. Others include, hormonal factors, infections, and a variety of risk factors that can increase the chance of miscarriage.

Chromosomal Abnormality

50-60% of miscarriages in the first trimester are due to chromosomal abnormality. Trisomy, monosomy x, or polyploidies are the types of chromosomal defects that can occur during the formation of the sperm and egg cell. These defects usually result in the most common genetic disorders Down syndrome and Turner syndrome in the unborn fetus. Even though the fetus may obtain a chromosomal defect the parents can be perfectly normal in their genetic make up.

Hormonal Factors

Hormonal factors related to miscarriage are hypothyroidism, diabetes mellitus, and luteal phase inadequacy.

• Hypothyroidism: can be a factor for infertility and early pregnancy loss in women
• Diabetes mellitus: women who are poorly controlling their diabetes mellitus can increase their probability of miscarriage
• Luteal Phase Inadequacy: lacking the important hormone progesterone during pregnancy can cause miscarriage. The corpus luteum is responsible for creating this hormone, therefore anything that interferes with the corpus luteum may cause miscarriage.

Infection

Rubella, chlamydia, primary herpes, and cytomegalovirus are some infections that can cause miscarriage. There are other infections such as mycoplasma that are still being studied to verify their effects on miscarriage.

Ectopic Pregnancy

Women who experience ectopic or tubal pregnancy, where the fertilized egg stays in the fallopian tube instead of the uterus, can also result in miscarriages, since it poses a danger to the mother’s health. Since these pregnancies are not detected until around the 8-week mark, the fetus usually do not survive. These losses are generally not noticed by others and often do not seem “real” to many.

Risk Factors

Smoking and Alcohol

The consumption of tobacco and alcohol during pregnancy can increase the rate of miscarriage. The use of cigarettes and alcohol are teratogens which are very harmful to the fetus. If the fetus does not miscarry, these teratogens can have ever lasting birth defects on the baby such as fetal alcohol syndrome. It is also presumed that paternal consumption of alcohol during conception can cause problems with the genetic makeup of the child thus causing miscarriage.

Maternal Age

Women in their twenties are much more fertile than women over the age of 35. The miscarriage rate increases tremendously with women aged 35 and are usually due to hormonal, uterine, and chromosomal factors. By age 38 the miscarriage rate has doubled and possibly tripled by age 40.

Diagnosis

There are a number of important criteria that need to be assessed before classifying a miscarriage. A miscarriage is usually visible through a trans-vaginal ultrasound as it can discover an intrauterine gestation and is able to tell the viability of the fetus earlier on in the pregnancy. Some characteristics looked for are remains of conception which include: villi, and fetal parts such as the amniotic sac and embryo.

The criteria are:

• Empty Sac: there is no noticeable embryo in the womb

• Embryonic or Fetal Loss: there is no cardiac activity in the embryo that is 6mm in length

• Delayed Miscarriage: there is a decrease in cardiac functions; there is retardation of the foetal size, refraining from increasing over 1 week; there is no visible embryo (empty sac) at 12 weeks of gestation

• Complete Miscarriage: there is no remnants of conception and all uterine products have been expelled; however, the whereabouts of the pregnancy are considered to be "unknown" and could be an ectopic pregnancy

• Incomplete Miscarriage: the cervix is opened and there are remnants of irregular pieces of conception still inside the uterus

Effects

For all people involved in a pregnancy, a miscarriage can be one of the most devastating events that can occur. It is proven that a miscarriage can have many psychological effects on the mother and even the father of the lost child. Not only are there psychological effects but there are sociological effects as well, as many women perceive miscarriage as something to be ashamed of.

Psychological Effects

Grief, anxiety and depression are the most common psychological effects of a miscarriage. A loss of an unborn child is the exact same process as losing a loved one; however, the only difference is that most of the pain comes from the loss of an opportunity to give birth and to become a parent. The mother is effected the strongest by the loss and may project her feelings of anger towards her spouse. It is very difficult for some parents to retain what has happened and to realize that the pregnancy is over. However, parents grieve at different rates, and the outcome is different for everyone. Some parents may not mourn the loss and instead come from a place of optimism with regards to future pregnancies. In cases of perinatal loss, there are higher levels of depression in women at 6-weeks postpartum, couple with the deterioration of relationships with partners and family members.

Sociological Effects

There are many social effects that influence the mother's perspective of herself when she has a miscarriage. Since this tragic event is usually concealed, many women end up mourning in isolation. Miscarriage is rarely ever questioned by doctors, family, and friends and therefore can have damaging outcomes on the woman's psyche. Because the societal perception of miscarriage is so harsh, women tend to blame themselves and their bodies for the miscarriage. The question that is often asked by women is "why me?" Women then doubt their womanhood and sexuality because of the societal notion that all women must produce a healthy child. “Producing a perfectly formed and healthy child is seen to be regarded by society as an indication of a person’s biological, sexual and social worth;” therefore, parents who do not produce a healthy baby are deemed by society as not keeping up with the social norm.

Women who experience a miscarriage at the 10-week gestation mark, before pregnancy signs are visible often experience internal losses that are not socially supported since they do not receive social awareness, social and healthcare support, unlike those with losses after the 23th-week mark, which are accompanied by a stillbirth certificate, naming opportunity and burial for the baby. A post by Humans of New York on Facebook captures the struggle of a woman who suffered an ectopic miscarriage and her inner turmoil and feelings of loneliness experiencing the loss of her baby stating, “I felt really alone afterward because most of my friends hadn’t even known the baby existed. They couldn't understand how I felt.” This post sparked thousands of comments showing support, opening up a conversation about untold miscarriages.

Social isolation is a side effect of a miscarriage, for women can experience a feeling of isolation with friends, extended family member, others in their social network and even from their partners. Partnership breakdown can result from poor support from their partner, in correlation with depression and marital disharmony caused by the stress of the loss.