Miscarriage is one of the most painful experiences a woman can ever have. It has emotional consequences similar to those associated with death, even though a woman has not yet met the deceased little one. Women go through the stages of grief that normally happen with loss of close people. It is very hard on a couple and they require time and space to deal with their feelings and recover. The physical outcomes are not less devastating. It starts from pain and extreme discomfort and could include surgical intervention to help a woman’s body heal. In general, it is never a pleasant thing to go through.
Scientifically, miscarriage is defined as the unintended termination of a pregnancy at 20 weeks or before, with no apparent cause. Of course, there are genetic causes and accidents that may lead to termination of a pregnancy, but sometimes it happens on its own with no known etiology, particularly if it is the first miscarriage. It involves detachment of the fetus and placenta from the uterine lining, thereby losing support and dying. Miscarriage happens over the course of a few days or weeks and is not a single event that finishes within a few hours. Medical care and subsequent self-care are essential to overcoming the symptoms and consequences.
The sequence of events that occur after a miscarriage varies greatly from one case to another. Yet, women face similar problems when they lose a pregnancy. Here, we discuss 15 things that happen after a miscarriage and explain why they happen and how medical professionals deal with them.
14 Decline In Pregnancy Signs
Pregnancy signs in the early phase are numerous and distinctive. From nausea and vomiting to dizziness and exhaustion, there is a lot that changes when a woman is pregnant. Some women who experience miscarriage report that they suddenly feel like the symptoms dissipated, even when they are still in the weeks in which those symptoms are expected. It is usually comforting to feel better, but if miscarriage is suspected, it can be quite scary. Every woman has certain signs that happen to her intensely and continuously. Those are the signs that are easy to detect if they fade away unexpectedly.
Additionally, women who miscarry have many other discomforting symptoms that replace pregnancy symptoms. A woman who suspects miscarriage should report each and every difference to her doctor. In rare cases, early miscarriage can be prevented by medical support. This stresses the importance of getting medical care early on. It is also important for the health of the mother even if the pregnancy discontinues.
Because miscarriage happens in the uterus and involves the fetus being detached from the mother’s body, bleeding is inevitable. Some women bleed slowly and in little amounts, at least at first, while others bleed heavily. Both cases are cause for alarm. Even if the bleeding is not very intense, it could be the start of miscarriage and still calls for medical examination, particularly in the first trimester.
Statistically, many women bleed in their first trimester and continue to have healthy pregnancies. This is especially more common among women who are in their second, third or fourth pregnancies. If the bleeding is sudden, heavy or accompanied by other concerning symptoms, it means that it probably signifies miscarriage. In most cases, the blood is bright red, like period blood. In cases where light bleeding – known as spotting- occurs but the pregnancy is safe, it is usually brownish red and fades within a few days.
12 Passing Tissue
It is not uncommon for women who miscarry to pass visible tissue, not just blood. This is especially expected when the miscarriage is relatively late in pregnancy. It could be a part of the fetus, placenta or both. It may be confusing for women because it is similar to clots that are sometimes passed during periods. Yet, those of miscarriage are usually bigger and more painful. It is painful physically and is a sure sign of miscarriage that makes women miserable.
Often, bleeding begins and then intensifies and leads to the passing of tissue. Sometimes, it is other way round. When this happens, tissue starts passing indicating miscarriage, then bleeding begins and continues until the body heals completely. Whichever is the first to show, any sign of miscarriage, whether bleeding or tissue, requires immediate transfer to the hospital. Usually, if tissue is passed, it means that the miscarriage has progressed and will take less time to heal than a miscarriage that is just beginning.
During a miscarriage, abdominal pain is almost a must. With the events of miscarriage going on inside the uterus, they reflect on the body as severe abdominal pain, often accompanied by contractions. Pain could start before the onset of bleeding or after it and lasts as long as the bleeding does. The contractions also cause pain and they occur intensively and consecutively. Contractions are also late signs of miscarriage that signify that the possibility of survival of the pregnancy is slim to none.
Another common pain is lower back pain. As with periods, the pain from contractions and bleeding could radiate to other body parts, with the lower back being the most common of them. In fact, many doctors think that lower back pain is a warning sign. Women who are pregnant experience lower back pain towards the end of pregnancy because of the extra unbalanced weight. This is why experiencing lower back pain early and without triggers is considered a red flag.
10 Ultrasound Check
When one or more of the above events take place, an ultrasound check is inevitable. An ultrasound check reveals whether or not the pregnancy is still viable and helps the doctor assess the possibility of survival. Usually, when the bleeding is intense, tissue is passed, or severe contractions occur, it is very unlikely that the pregnancy continues. Ultrasounds are still helpful in those cases to decide the medical course of action that needs to be taken.
If the baby had a heartbeat, ultrasounds can include a Doppler examination to see whether the heart is still beating. It is expected for women who hear heartbeats, even when they are bleeding, to continue the pregnancy safely. On the other hand, not hearing a heartbeat means that the pregnancy is over, even without any other sign of problems. Scans can also determine non-fatal problems with fetuses and help doctors decide if any intervention is needed to enhance survival chances.
9 Secondary Ultrasound
A trans-vaginal scan involves insertion of a probe into the vagina and is usually able to clarify pictures that are not attainable by abdominal ultrasounds. Trans-vaginal ultrasounds are less comfortable and convenient than abdominal ultrasounds but sometimes they are necessary. Some women report spotting and pain after vaginal ultrasounds. This is why they are reserved for extreme cases or when the pregnancy is already found to be terminated.
Sometimes, only normal ultrasounds are done and are enough to reveal the case completely. Other times, it may be required to do a vaginal exam to see if the cervix is dilated and determine expected events that will happen in the body as a result of the miscarriage. It is also used to examine the placenta for any complications that could lead to miscarriage and deduce the source of bleeding, if it happens. A clear picture of what is going on in the cervix and placenta help to diagnose miscarriage.
8 hCG Test
Human chorionic gonadotropin (hCG) is a hormone that is released by the placenta and is the primary confirmatory indicator of pregnancy. The mechanism of home pregnancy tests depends on the amount of hCG in urine. The blood tests done in the laboratory to confirm pregnancy also use this hormone. The hormone increases throughout pregnancy.
When a woman goes through miscarriage events, withdrawing a blood sample from her is useful to confirm whether the production of this hormone is still ongoing normally. It is logic that miscarriage starts while the hormones are still high in the blood. This is because hormones, in general, do not drop within a few minutes and need some time to reach the new levels. Usually, this test is done if the ultrasound and the events are not enough on their own to confirm miscarriage.
7 CBC Test
A Complete Blood Count (CBC) is a general test that helps a doctor asses what is going wrong with someone when the symptoms are not making sense. In miscarriage cases, there are more than one reason to do a CBC test. First, miscarriage causes women to lose a lot of blood and it could be threatening for their health and lives. Detecting what the current levels of iron and hemoglobin, for example, gives an idea about what supplementation a woman might need and how much of it.
Second, white blood cell count is also calculated in CBC tests. White blood cells are the immunity cells that are abnormally elevated when the body is fighting an infection. If white blood cells are found to be high, antibiotic treatment may be required. Third, platelet count is monumentally important for blood clotting and wound healing. If the number of platelets in insufficient, there is a tendency to heal from the miscarriage slower.
Psychologically, miscarriage is devastating. Throughout all the worry that a woman encounters at the start of the events and the possible procedures she has to go through in order to heal, a woman experiences sheer shock at the event. It is true that most women are aware of the statistics of miscarriage, that indicated that around 15-20 percent of pregnancies end tragically, but it is a different story when it actually happens to you. She goes through a turmoil of emotions that resemble those of grief.
For some women, the physical aspect of miscarriage carries a huge emotional load. Having to go through medical examinations and possibly surgery within a short amount of time is not something that all women can handle well. Being dragged into hospitals and not having enough space to grieve the loss is emotionally restraining. In most cases, the physical and emotional parts act synergistically against a woman’s wellbeing, making the process a long one that takes time to heal.
Sometimes when miscarriage happens, the uterus is not able to be emptied on its own fast enough. This is known as “incomplete miscarriage.” For regular menstrual cycles to resume, medical assistance may be need to expel the fetus from the uterus. In some cases, medication may be the best option. It is non-invasive compared to surgery and speeds up the expulsion process to prevent complications, such as infection from developing.
The most common medication used is misoprostol, commercially known as Cytotec. It can take several weeks for the uterus to empty on its own, but with this medication, about 80-90 percent of the tissue is removed within one week. The pills are inserted into the vagina and cramps start two to six hours later, accompanied by heavy bleeding. Lighter bleeding can continue for up to two weeks after the medication. Fever, nausea and vomiting are common after the use of misoprostol and should subside gradually.
4 D&C Procedure
In cases when the medication options do not work, or if the ultrasound reveals that the case is too dangerous to wait, opting for a surgery may be the most suitable option. Surgery works to expel 100 percent of the blood and tissue immediately after it is done, which is why it ideal for complicated cases. The procedure done to eliminate the remains of a fetus and a placenta is known as dilatation and curettage (D&C). It involves scraping the remains with a surgical instrument or by suction. It is a one-day procedure that is generally safe.
Like any surgery, it poses some risks. First, development of scar tissue in the uterus can cause future painful periods and possible infertility. Second, damage to the uterus or the cervix may require extra procedures to prevent excessive bleeding. If all complications are avoided, the surgery should heal gradually and bleeding should subside within a few days.
Infections are a common complication of D&C surgery. It could be due to the transfer of bacteria from the vagina to the uterus during the procedure. It ranges from infections that heal by a course of antibiotics to those that need another surgery to remove the cause of infection. This is known as septic miscarriage. The holding period helps keep the reproductive system free of contaminants when it is vulnerable, so it diminishes infection risks.
Interestingly, infections also develop in women who miscarry naturally, without D&C. It could happen due to remains of tissue being stuck in the uterus. Pelvic pain and vaginal discharge are the two main symptoms of infection, but prolonged bleeding and fever are also common. Once the two or three days of cramping due to miscarriage or D&C are done, any extra pain is worth reporting. A uterine infection is life-threatening and must not be taken lightly, because it could lead to shock.
2 Irregular Periods
After the whole miscarriage is over, especially if surgery was required, a woman is advised to go on a two-week holding period. During those two weeks, she is instructed to refrain from sexual intercourse or inserting tampons. This is because the entire reproductive system needs time to rest and heal from the process. It takes different durations for different women and any scenario might happen.
Some women have absent periods and do not menstruate for months. This could be due to lack of ovulation or a problem with the building up of the uterine lining. Others see heavier or lighter periods than before, with less or more days of menses. Leaving a holding period may make recovery easier, but it does predict the nature of future cycles. Miscarriage is a disruption of normal menstrual activity and is not considered a natural thing, even when it happens on its own. This is why women who go through it must record their menstrual cycles and talk to their doctors if they have concerns.
Emotionally, acceptance is the last stage of grief. After procedures and surgeries are done, the emotional work is usually still underway. When a woman is ready, with the help of supporting family and friends and possibly a therapist, she does not forget the experience, but she somehow finds peace. Some women appreciate the thought that they carried a baby and did their best to make things work for that baby, particularly those who had a hard time conceiving in the first place.
Some women find comfort in faith, funerals or grieving activities provided by therapists. Other women are too eager to be mothers that they try to conceive soon afterwards. They consult with their medical professionals and see when it is possible to retry conception without posing risks to the mother or the baby. While it is a harsh unforgettable experience, many women who are able to conceive afterwards are able to get over the sadness and move on.