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…
How can I see my miscarriage through?
If the miscarriage occurs spontaneously, heavy bleeding may occur for one to two weeks. You’ll be prescribed antibiotics to prevent any infection, and folic acid to build back the blood that you lost and painkillers, if necessary. Unfortunately, there’s nothing much you can do at that point, but to be on bedrest and wait it out.
If your baby’s heartbeat has stopped, there’s no active bleeding and you are generally well, you can either wait for a spontaneous miscarriage to happen or you can have a dilation and curettage (D&C). This is a brief surgical procedure where the foetus’ remains are removed from the uterus, following which you will experience some bleeding for up to two weeks.
There’s always a risk of encountering some health complications during a miscarriage. Severe loss of blood can cause anaemia (a deficiency of red blood cells) which can lead to fainting and even a fall and bodily injuries. If some of the foetus’ remains are not cleaned out properly from your cervix, it can stimulate your nerves, causing your body to go into shock.
Will a previous miscarriage affect my fertility?
A woman who has lost a baby has a very high chance of enjoying a healthy pregnancy after, provided she doesn’t have an on-going health issue that caused the miscarriage.
Having three or more pregnancy losses in a row, without a known reason, is known as recurrent miscarriages and is uncommon, affecting around 1 in 100 women, notes Dr Loi.
If some of the foetus’ remains are not cleaned out properly from your cervix, it can stimulate your nerves, causing your body to go into shock.
However, if you are diagnosed with a medical condition that’s affecting your fertility, such as diabetes, high blood pressure, an autoimmune disease and severe hyperthyroidism – it first has to be treated and controlled before you can try again.
There may even be a chance that your miscarriage was due to an incompetent cervix or womb abnormalities such as a septum in the middle of the womb, says Dr Chong. This will then require more medical intervention and maybe even surgery.
How soon can we try for another baby?
“In most uncomplicated cases, your body usually heals within a week,” notes Dr Chong. In that case you can try for another as soon as your next menstruation happens. This is provided you are emotionally ready. If you still have some reservations, Dr Loi suggests speaking to a therapist first.
If you had to undergo surgery to evacuate the foetus, Dr Chong advises you to not conceive for the next three months. This is to give the lining in the womb, which was scraped during the procedure, a chance to heal and be properly ready to support the next pregnancy.
“It is important to go into pregnancy in good health and correct or stabilise any medical condition before conception,” says Dr Chong. “Take multivitamins to boost your body’s resistance and vaccination for conditions like rubella, which should be done before conception if one does not have immunity to it.”
Once you conceive, your doctor may err on the side of caution and give you regular hormonal jabs to support your pregnancy during the first trimester. After that, your pregnancy will be treated as per a regular one.
Dr Christopher Ching is an obstetrician-gynaecologist who practises at Chris Chong Women & Urogynae Clinic at Gleneagles Medical Centre. Dr Kelly Loi is an obstetrician and gynecologist at Health & Fertility Centre for Women.
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