A miscarriage is defined as the loss of a pregnancy before the 20th week. It is usually preceded by heavy bleeding and cramping. According to the American College of Obstetricians and Gynecologists, one in five pregnancies ends in miscarriage; more than 80 percent of miscarriages occur in the first 3 months of pregnancy. The actual number of miscarriages may be higher, however, because so many occur in the first few weeks of pregnancy, before a woman knows she's pregnant or before a pregnancy could be detected.
No matter how early you miscarry, you may feel shock, profound sadness, and anger. The dramatic drop in estrogen after a miscarriage can cause weepiness, but most women feel a deeper sadness as well. That grief is often made worse by the fact that miscarriage is so often dismissed as "a bad period" or a pregnancy that "wasn't meant to be," even by the most well-meaning friends and family members.
Many women also suffer from guilt following a miscarriage, convinced that they did something to cause it. Was it that hour you spent lifting weights at the gym? The computer terminal at work? The glass of wine you had at dinner? No. Remember that the vast majority of miscarriages are attributed to random chromosomal abnormalities. For the small number of women (4 percent) who suffer more than one miscarriage, there may be a medical cause that can often be identified and treated.
It's important to find emotional support following a miscarriage. Give yourself time to go through the four stages of grief--denial, anger, depression, and acceptance--before trying to get pregnant again. Acknowledge how painful it is and communicate that pain to someone you trust. Recognize that your partner will be grieving for this loss as well and tune in to his needs. Finally, remember that in most cases, even women who have endured successive miscarriages go on to have healthy babies.
Possible causes of miscarriage
The following are all possible causes of miscarriage:
- Chromosomal problems. During fertilization the sperm and egg each bring 23 chromosomes together to create 23 perfectly matched pairs of chromosomes. This is a complex process, and a minor glitch can result in a genetic abnormality that prevents the embryo from growing. Researchers blame genetics for most miscarriages. As you age, these glitches are more likely to occur.
- Hormone imbalance. About 15 percent of all miscarriages are attributed to unbalanced hormones. For example, an insufficient progesterone level can prevent your fertilized egg from implanting in your uterus. A doctor can diagnose a hormone imbalance through an endometrial biopsy; this procedure is typically done at the end of your menstrual cycle to assess ovulation and development of the uterine lining. Treatment may include fertility drugs that can improve the quality of egg development and hormone production.
- Uterine problems. Uterine fibroids may be responsible for some miscarriages; most grow on the outer wall of the uterus and are harmless. If they grow inside the uterus, fibroids can occasionally interfere with implantation or blood supply to the fetus. Some women are born with a septum, an uncommon uterine defect linked to miscarriage. A septum is a tissue wall that divides the uterine cavity.
Also uncommon are bands of tissue within the uterus caused by scarring from surgery or second-term abortions. This tissue can keep an egg from implanting properly or may hamper blood flow to the placenta. A doctor can determine uterine defects through specialized X-rays; most can be treated.
- Chronic illness. Autoimmune disorders, heart disease, kidney and liver disease, diabetes--chronic illnesses such as these cause as many as 6 percent of recurring miscarriages. If you have a chronic illness, find an obstetrician experienced in caring for women with your condition.
- High fever. No matter how healthy you are normally, if you develop a high fever--a core body temperature over 102 degrees--during early pregnancy, you may experience a miscarriage. A high core body temperature is most damaging to the embryo before 6 weeks.
Originally published in You & Your Baby: Pregnancy.
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