EXPERT ADVICE: I just miscarried and didn’t even know it!

A miscarriage can occur even without any symptoms ― our expert explains what you need to know about silent miscarriages.

Sad woman

While a miscarriage is a devastating loss, one in which absolutely no symptoms are evident can be even more gut-wrenching.

Also known as a silent or missed miscarriage, it happens when a pregnancy stops developing but the mum-to-be is unaware of what is happening. It commonly occurs in the very early stages of pregnancy ― many missed miscarriages take place before the eighth week of gestation.

As the pregnant woman does not show any symptoms such as bleeding or cramps, it can be tough for expectant mums to tell that they’ve had a miscarriage.

SmartParents expert Dr Freda Khoo, obstetrician & gynaecologist at Thomson Medical Centre, tells you what you need to know about silent miscarriages.

At which point in a pregnancy does a silent/missed miscarriage usually occur?

Silent miscarriages commonly occur in the very early stages of pregnancy. Most of them happen before the eighth week of pregnancy, a small proportion may happen up till 12 weeks of gestation. It is less common for a silent miscarriage to occur beyond the 12th week of pregnancy.

What are the causes of a silent/missed miscarriage?

Most early trimester miscarriages are sporadic, which means that these happen by chance. While the egg is being fertilised by the sperm, sporadic accidents may happen, disrupting the normal chromosome array of the embryo being formed. In such cases, the pregnancy is unable to continue.

If a woman experiences recurrent trimester miscarriages, it could then be due to another recurrent cause. Further testing will be recommended. For example, testing of the chromosome of the foetus and sometimes the parents, doing a pelvic ultrasound scan and some other blood tests to check for any pre-existing autoimmune disorders.

A woman may find out about the missed miscarriage at a routine visit to the gynaecologist. Or she may start having symptoms of bleeding and lower abdominal cramps when the body attempts to expel the pregnancy.

Why aren’t there any symptoms of a miscarriage, such as bleeding or cramps?

When the miscarriage first occurs, it could take a while for the woman’s body to recognise that the pregnancy is not viable. Thus, it takes a while for symptoms such as bleeding and cramps to occur, which could be anytime from a few days to a few weeks.

How does a woman know that she has suffered a missed miscarriage?

She might continue to display pregnancy symptoms as it takes a while before the pregnancy hormones in the bloodstream to decrease. A woman may find out about the missed miscarriage at a routine visit to the gynaecologist. Or she may start having symptoms of bleeding and lower abdominal cramps when the body attempts to expel the pregnancy.

What are an expectant mum’s chances of experiencing a silent miscarriage and who is most likely to have one?

A silent miscarriage is a subset of first trimester miscarriages. First trimester miscarriages are fairly common ― the incidence is 10 to 20 per cent. The incidence decreases after the eighth week of pregnancy to about 10 per cent.

Because such miscarriages are a sporadic occurrence, it happens by chance to anyone. There is actually nothing that one can do to prevent a silent miscarriage from happening, because it is out of human control as to whether the developing embryo is genetically abnormal or not.

The reassuring news is that many couples who have experienced a silent miscarriage before actually go on to successfully conceive and carry a healthy baby to term.

 

Doc comforts sad woman

How is a silent miscarriage diagnosed and what is the next course of action?

A silent miscarriage is usually diagnosed by a doctor at a routine obstetric visit, when the size of the foetus is not growing as expected, or when there is no heartbeat in the foetal pole*, even though the foetal pole measures 6 weeks and above.  

There are usually three viable options when such a condition is diagnosed:

* The first option is conservative management ― which is to await the body to naturally expel the pregnancy and allow the miscarriage to occur spontaneously. This option would mean that the woman may have to wait up to a few days to a week for symptoms like bleeding and pain to start. Once it starts, do expect the bleeding and pain to increase, eventually culminating in the expulsion of the pregnancy sac. Thereafter, the bleeding and pain would subside. Do expect there to be residual bleeding for the next one to two weeks.

* The second option is similar to the first. However, the woman takes a medication to hasten the process of expulsion of the pregnancy. You can talk to your doctor about this if you do choose this option.

* The last option is a surgical evacuation of the uterus. This would mean that the woman would have to be admitted into hospital and undergo some degree of anaesthesia. There are also risks associated with surgery and anaesthesia. However, this option is the fastest and most direct.

It is also important not to blame yourself for the miscarriage – it is not anything that you have done or have not done that caused the miscarriage, as such miscarriages happen by chance.

How soon after can one try conceiving again?

After going through a miscarriage, do allow your body to recover first. I will usually advise patients to at least wait for two cycle of periods to pass first before trying to conceive again.

Are you likely to keep having recurring silent/missed miscarriages?

As previously mentioned, most miscarriages are once-off sporadic events. However, if a woman experiences three or more first trimester miscarriages, it will be considered as a recurrent miscarriage. She should visit a gynaecologist for a thorough check to rule out any other causes of recurrent miscarriages.

Last, any advice for mums who have experienced such a loss?

Any pregnancy loss is heartbreaking, no matter how early in the pregnancy it occurs. It is important to have an understanding spouse. After all, the impact of the miscarriage will affect the woman emotionally much more than the husband.

It is also important not to blame yourself for the miscarriage ― it is not anything that you have done or have not done that has caused the miscarriage, as such miscarriages happen by chance. So, take some time off to heal ― physically, mentally and emotionally. Do your favourite activity, go away for a trip, meet up with your girlies for tea. Do not be affected by the comments of others. And look forward to the future with optimism and hope again.

* The first physical indicator of a developing foetus.

Photos: iStock

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