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Published October 05, 2013, 10:00 PM

What you need to know about miscarriage

FARGO – Dr. Stefanie Gefroh Ellison, an OB-GYN at Fargo’s Essentia Health, says she and her colleagues see at least a couple patients a week for miscarriages.

By: Meredith Holt, INFORUM

FARGO – Dr. Stefanie Gefroh Ellison, an OB-GYN at Fargo’s Essentia Health, says she and her colleagues see at least a couple patients a week for miscarriages.

“It’s much more common than they think – it’s just women don’t necessarily talk about it,” she says.

According to the March of Dimes, 10 to 15 percent of all known pregnancies end in miscarriage, but because many occur before a woman even knows she’s pregnant, it may be as many as half of all pregnancies.

Moreover, it’s difficult to determine why they happen in the first place.

“Everybody wants answers as to why, and unfortunately we don’t always have answers,” Gefroh Ellison says.

Most miscarriages are caused by a genetic or chromosomal problem or an issue with the way the embryo or fetus develops, according to Planned Parenthood.

“It’s like they don’t have the next page in the instruction manual to get to where they need to go,” says Dr. Kristen Cain, a reproductive endocrinologist with Sanford Health in Fargo.

Cain says women often wrongly blame themselves for miscarriages, worrying about something like exercise or sexual intercourse caused the problem.

“We don’t always find an answer, but I think it’s really important for women not to start blaming themselves right away,” Gefroh Ellison says.

Aside from smoking, drinking and drug use, miscarriages are rarely caused by something the woman did, and, in fact, a woman’s body is designed to be able to function normally during pregnancy, especially early on.

“A woman’s body naturally makes a mucus plug in her cervix as soon as she conceives to protect anything inside the uterus,” Cain says.

However, some women are at higher risk of miscarrying. Risk factors include:

Age. Risk increases with age. According to the American College of Obstetricians and Gynecologists, about one-third of pregnancies after the age of 40 end in miscarriage.

Weight. Women who are underweight or overweight are at greater risk. Much below a BMI of 18 (“normal” is 19 to 25), and risk increases. However, Cain says, overweight women really don’t start to see miscarriage problems until they’re in the morbidly obese range.

Thyroid disease.

Poorly controlled diabetes.

Autoimmune disorders like lupus or rheumatoid arthritis.

Severe trauma or very serious infections.

Previous miscarriages. Women who have had two or more miscarriages in a row are at a greater risk of having future miscarriages.

But, “Just because they have one miscarriage doesn’t mean they can’t go on to have a normal, healthy pregnancy,” Gefroh Ellison says.

If you’ve had two or more miscarriages in a row, your health care provider may suggest testing for hormonal imbalances, genetic disorders or other problems.

“If they’ve had several miscarriages, we can start looking into possible maternal causes,” Gefroh Ellison says.

Women with a history of ovulatory, hormonal, tubal or other fertility problems are also at greater risk.

It’s happening – now what?

Symptoms of miscarriage vary greatly between women.

The most common signs of a miscarriage are vaginal bleeding or spotting and abdominal cramping, but many women who experience these symptoms don’t miscarry.

“If you’re bleeding like a period but you’ve got a positive pregnancy test, you could be having a normal pregnancy, or you could be getting ready to have a miscarriage, so that’s a good time to go to the doctor and get checked,” Cain says.

Bleeding and cramping can last for a few hours, days or weeks, and can range from what seems like a regular period to very heavy bleeding and severe cramping.

Not all women experience physical pain during a miscarriage, either, and their physical experience can be affected by their emotional experience.

“If it wasn’t a planned or desired pregnancy to begin with, it’s usually met with a lot more calmness and equanimity than a desired pregnancy from a patient who’s been trying very, very hard to have a baby and finally got pregnant and then had a miscarriage,” Cain says.

For those women, it’s often a lot harder to bear.

“When you add emotional distress on top of pain and bleeding, that makes it that much worse,” she says.

Some women notice their pregnancy symptoms suddenly stop, but again, Cain cautions against panicking if they do.

“I don’t want people to be calling their doctors just because their breasts suddenly aren’t tender anymore,” she says.

A miscarriage can be confirmed with a pregnancy test, hormone level test and/or an ultrasound.

Depending on the type of miscarriage and the stage of pregnancy, there are three options:

• Wait and let the tissue pass naturally.

• Take medication to help expel the tissue.

• Have the tissue surgically removed.

Unless a woman’s hemorrhaging so badly she’s going through more than one menstrual pad an hour, the decision whether to have surgery is often left up to her.

But, if a woman isn’t expelling blood and tissue a week or two after the diagnosis, surgery makes sense, Cain says.

Patients are typically advised not to have sex or use tampons for a couple weeks afterward to help prevent infection.

There’s some ambiguity over when a woman can safely try to conceive again after a miscarriage.

The March of Dimes says she’s more likely medically OK to get pregnant after at least one normal period but should wait 18 months. Gefroh Ellison advises waiting through two or three cycles, or at least until her hormone levels have returned to normal.

So the decision of when to try again, like every other decision made in the process, is best left up to the patient and her medical provider.

Readers can reach Forum reporter Meredith Holt at (701) 241-5590