I’m having a miscarriage – now what?

There’s nothing you can do to prevent the loss of a baby, but here’s what you must know about this life-changing event.

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At seven weeks pregnant, Diane Lim, 32, woke up one morning feeling the same way she did ever since she found out she was going to have a baby – full of joy and excitement. It was her first pregnancy and one that happened really fast. “We basically got pregnant the first time we tried,” Lim says. “I know of friends who had to try for months, even years, so I couldn’t help but feel very blessed.”

All the good vibes came to a screeching halt early that afternoon when Lim started to feel her lower abdomen cramping. Since the pain wasn’t intense, she didn’t think much of it, until she took a trip to the loo. “I saw blood when I wiped myself and more blood came out the more I wiped myself,” she recalls with a slight shudder.  “My colleagues took me to my gynae where my husband was waiting for me.”

Lim was immediately seen by her gynae who did a vaginal scan and then gave her a hormonal injection to help support the pregnancy. “My doctor didn’t want to say too much at that point, because nothing was confirmed yet. She just told me to give her daily updates on the bleeding and when it stops,” adds Lim.

Unfortunately for her, the bleeding continued for days and eventually ended in the loss of her pregnancy. “It was such a confusing time for me, I didn’t know what was happening and what I should be doing,” says Lim. “Once you get pregnant, people only tell you the positive things and that’s what you read up on as well. So, when life throws you a curveball in the form of a miscarriage, you’re so ill-prepared.”

While no one wants to be in Lim’s shoes, it’s always good to be prepared for the unexpected. Here, SmartParent’s fertility experts answer some of your common queries on this sensitive, and rarely-discussed, topic…

Why does a miscarriage happen?

A miscarriage is the spontaneous loss of a pregnancy, usually before the 20th week. An estimated one in six – or 15 to 20 per cent – of pregnancies end in a miscarriage. When it does occur, it usually takes place during the first trimester, which is anytime between the first 16 weeks and happens for a myriad of reasons.

“Once you get pregnant, people only tell you the positive things and that’s what you read up on as well. So, when life throws you a curveball in the form of a miscarriage, you’re so ill prepared.”

There could be developmental issues with the foetus’ organs or genes, the placenta may not be functioning well, or the woman might have a lack of hormones to support the pregnancy, which is especially true for those with infrequent periods. It could also be due to an autoimmune disease where the body has antibodies rejecting the foetus.

“Sometimes, it may well be nature's way of not letting what is not good enough to progress, rather than letting it progress to become an abnormal child who suffers,” adds SmartParents consultant Ob-Gyn Dr Christopher Chong.

How do I know I’m miscarrying?

The most common signs are vaginal bleeding, or a sudden disappearance of pregnancy symptoms, such as nausea and vomiting, and abdominal pain. “You may even start passing out the products of conception,” adds Dr Chong.

However, while spotting can be a warning sign of an impending miscarriage – especially when it happens in the early months of pregnancy – it’s also very normal to experience some discharge and go on to have a healthy pregnancy. The only way to be sure is to see your doctor at once and minimise all physical activities.

How can my doctor help?

Investigations will be done to figure out if the pregnancy is growing normally inside the uterus or if it’s indeed a miscarriage. Normally, scans will determine if there’s still a heartbeat.  But if the pregnancy is too early to be seen on a scan, blood tests will be done to check on the pregnancy hormone levels.

If it’s due to lack of hormones or an infection, your doctor may prescribe progesterone support injections to try to stop the bleeding. Bed rest may also be advised. Dr Chong usually monitors the serial blood human chorionic gonadotropin (HCG) level. A healthy pregnancy will see a consistent rise of the HCG level, usually doubling every two days. If the levels start dropping, it’s usually a clear sign of a miscarriage.

A healthy pregnancy will see a consistent rise of the HCG level, usually doubling every two days. If the levels start dropping, it’s usually a clear sign of a miscarriage.

“Another possible diagnosis to exclude is an ectopic pregnancy, where the pregnancy is growing outside the uterus, usually in the Fallopian tubes,” explains Dr Kelly Loi, an obstetrician and gynecologist at Health & Fertility Centre for Women. “An ectopic pregnancy is not a viable pregnancy and needs urgent treatment.”

A miscarriage can be life-threatening. Look out for the following signs…