Late Miscarriage

Though they are rare, affecting only about 2 percent of pregnancies, late miscarriages do happen. Late miscarriages are defined as those that occur between 14 and 20 weeks. It is traumatic to lose a baby you've carried this far. You may have told people about the pregnancy, had reassuring prenatal testing, and already felt the baby moving. Many times it is possible to determine why it happened and predict the health of future pregnancies.

The symptoms of a late miscarriage are similar to those of an early miscarriage and usually include severe cramping and bleeding. You may also notice large clots of tissue passed with the blood. Contact your provider immediately if you have any of these symptoms. Although it may be too late to save your baby, your provider can take important steps to protect your health; for instance, you may be hospitalized to be sure that you don't hemorrhage. If your bleeding and cramps continue after the baby and placenta are expelled from your body, you might have a minor surgical procedure called a D&C (dilation and curettage) to remove any remaining pregnancy tissue in your uterus. Following a late miscarriage, your provider will try to determine the cause of the miscarriage in order to prevent others in the future. For instance, if your cervix dilated too early and provoked preterm labor, your provider may be able to use cerclage (a technique that involves sewing the cervix shut) to prevent late miscarriage during your next pregnancy. Other times your doctor will gain information from the placenta, the autopsy, or laboratory tests. Even though you are grieving, at some point after your loss it is important for you and your partner to review what has happened in order to determine what, if anything, can be done differently with the next pregnancy.

These are some of the causes of miscarriage after the 1st trimester:

• Fetal structural problems like spina bifida and congenital heart defects.
• A maternal anatomical problem, such as a uterus divided in two.
• A problem with the placenta, such as placental abruption or abnormal implantation.
• An infection that kills the baby, such as parvovirus, cytomegalovirus or toxoplasmosis.
• An infection that causes a leak in the amniotic sac or preterm labor.
• An incompetent cervix, which is one that is too weak to hold the pregnancy.
• Antiphospholid antibodies syndrome (APS), which is the condition of having too many antiphospholid antibodies in your bloodstream. About 15 percent of women with recurrent miscarriages have these antibodies; this can cause blood clots in the placenta.

In addition to the medical issues, this is an upsetting experience emotionally. Take as much time as you need to process. Many around you, including your doctor, a social worker, and your family, may provide support.

Originally published in You & Your Baby: Pregnancy.

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