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obstetric - team pink
What is a miscarriage?
A miscarriage is the loss of an early pregnancy, up to 20 weeks gestational age. Usually growth has already stopped in the first 12 weeks.
You can notice a miscarriage by vaginal bleeding (often in combination with menstrual-like abdominal pain or back pain), but often the ultrasound first shows that there is no longer a beating heart before you experience symptoms such as blood loss. And so then you may also have noticed nothing at all. If you have some blood loss, call the midwife. She will discuss with you whether an ultrasound is necessary. We call this a blood loss ultrasound. The ultrasound may show a good pregnancy, but it may also show only an empty amniotic sac without the foetus. The growth of the embryo has then stopped very early in the pregnancy. The ultrasound may also show an embryo, but without a beating heart. The growth of the fetus and the heartbeat have stopped.
How does a miscarriage occur?
Miscarriage is common, with 1 in 4 women experiencing a miscarriage in her lifetime. The cause of a miscarriage is almost always a disposition disorder of the fetus, created during the first divisions after the egg is fertilized. In most cases, a birth defect is a chromosomal aberration in the foetus, which prevents its (healthy) growth. Your body will recognize this, and then reject the pregnancy. A miscarriage is not caused by stress, sex or exercise.
When do you call the midwife?
Call us day or night if:
- If you are concerned.
- Heavy bleeding: When you have a full pad every half hour, or when you notice that the bleeding is so heavy that it looks like a tap is open.
- If symptoms of pain and blood loss persist for more than a week or do not subside.
- Extreme, excruciating pain, despite pain medication.
- Not feeling well/dizzy/fainting.
- Fever: Temperature above 37.5 (measured rectally).
- If you have doubts about the course of the miscarriage and want to consult.
You are pregnant and the ultrasound shows you are miscarrying, now what?
Now that the ultrasound has seen you miscarry, and after the news has landed, you can decide several things. You can choose to:
To wait, until the miscarriage comes on its own. This is the most natural way. In 37% of women, this happens in the week after the miscarriage is established. The advantage of waiting is that it is the most natural way, and waiting does not affect any subsequent pregnancy. For not everyone, wait-and-see is the best choice; for some women, wait-and-see can be emotionally demanding. If you choose to wait and see, you may still make a different choice at any time. We know that in 30% of women who choose to wait and see, medication or surgery is still needed later.
Take medication. For this you will be referred to the gynecologist, he or she can prescribe medication so that the miscarriage will be induced. This means that you will be given two types of medication, which you will take scattered. First you will take one tablet (Mifegyne) orally, then 1-2 days later you will take 4 tablets (misoprostol) yourself at home vaginally. The miscarriage then takes place at home. After 2 weeks, you will have an ultrasound to check if the miscarriage was complete and your uterus is empty. The disadvantage of the medication is that you often have more pain symptoms than if the miscarriage starts on its own. Other disadvantages are side effects, such as: nausea, vomiting, diarrhea, fever. Furthermore, sometimes the medication does not work (immediately), so it may be necessary to take all the medication a second time. In 1 in 5 women, the medication did not help enough, and there is still a miscarriage residue in the uterus. Then a hysteroscopy (keyhole examination, in which water is introduced into the uterus) or curettage (procedure, under anesthesia, in which the uterine cavity is emptied) may be advised.
Do a curettage. This is an operation under anesthesia. The surgery involves sucking out the miscarriage tissue, through a tube. The surgery itself takes 10-15 minutes. You will be in the hospital for about half a day. After the miscarriage has been diagnosed, surgery can usually be scheduled 1-2 weeks later. In 97-99 out of 100 women, the surgery succeeds. The curettage option is usually not recommended because it may affect a future pregnancy. Therefore, it is good to consider the other options first.
Which option suits me?
The choice is a matter of personal preference. All approaches have advantages and disadvantages. We will help you with all explanations, we will also give you these on paper. You decide what suits you best. Also, an in-between solution is always possible, such as waiting a while and if it takes too long, medication or curettage.
Personalized counseling for miscarriage
Going through a miscarriage is a sad, intense and intense event and is often very exciting. We are happy to help you through this and will guide you intensively. The midwife will stay in touch with you even after the miscarriage if you feel the need.
A miscarriage is the loss of an early pregnancy, up to 20 weeks gestational age. Usually growth has already stopped in the first 12 weeks.
The cause of a miscarriage is almost always a disposition disorder of the fetus, which occurred during the first divisions after the egg is fertilized. In most cases, a miscarriage involves a chromosomal abnormality in the foetus, which prevents its (healthy) growth. Your body will recognize this, and then reject the pregnancy. A miscarriage is not caused by stress, sex or exercise.
You can notice a miscarriage by vaginal bleeding (often in combination with menstrual-like abdominal pain or back pain), but often the ultrasound first shows that there is no longer a beating heart, before you experience symptoms such as blood loss. And so then you may also have noticed nothing at all.
A miscarriage happens differently for every woman. If bleeding has already started, in most women it takes a few days to 2 weeks until you go through the miscarriage completely. The In 3 out of 10 women, it takes more than 2 weeks for the miscarriage to get going or the miscarriage does not come on its own.