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Miscarriage: loss occurs within the first 3 months(implantation failure, blighted ovum, genetic problems, etc.)
Midterm Loss: loss occurs within the third to sixth month(incompetent cervix, genetic problems, placenta or uterine problems, birth defects, etc.)
Third Trimester Loss: loss occurs within the sixth to ninth month(genetic, placenta and uterine problems; birth defects; cord accidents; etc.)
Neo-Natal and Early Infant Death: loss occurs at or shortly after birth(birth defects, cord accidents, viruses, genetic problems, etc.)
When we talk about a hormone problem, you have likely miscarried in less than 10 weeks. After that, the placenta has taken over and a hormone imbalance or deficiency will not cause a miscarriage. A miscarriage this early is still very hard to take but it is the most easily treatable. If a blood test or an endometrial biopsy (where they scrape a bit of the lining of your uterus) shows that you have a progesterone deficiency, then you are well on your way to fixing the problem. You can take extra progesterone and odds are quite good that next time you will sustain a pregnancy. Sometimes a hormone problem is a one-time occurrence and will right itself on its own.
Chromosome Defects
There are many factors that come in to play when the egg and sperm unite and form that first cell. Even if both the egg and sperm come with perfect chromosomes, the first few cell divisions can see an abnormality crop up that would certainly be devastating. Chromosome defects that cause a newly fertilized egg to die can account for as much as 60 percent of early miscarriages. After the 2nd trimester begins, however, it drops to less than 10 percent. You can usually find out if you had a baby with a chromosome problem through testing tissue from the miscarriage. This must be done RIGHT AWAY when the tissue comes out or the cells cannot grow and the test won't work. Even when you have a D&C and the doctor sends the tissue immediately, it still might not work. (Mine didn't.) But if you do find your baby had a chromosome defect, find a small measure of comfort in knowing that although you lost this one precious baby, the chances of if happening again are extremely small.
Physical Problem with the Uterus or Cervix
Some women have a uterus that does not have the usual shape. Others have a cervix that may be weakened by a number of causes, including multiple D&C procedures or their mother taking DES when she was pregnant. Both of these problems can cause an early labor, usually during a critical period from 12-24 weeks. This cause is responsible for 12 percent of miscarriages during this time period. What happens is that as the baby grows, especially during the very rapid growth spurt during this time frame, the irregularly shaped uterus may not be able to expand or the weak cervix may start to open up and let the baby out. There are treatments for both of these that are quite effective-corrective surgery on the uterus and a cervical stitch that holds the cervix closed. This problem will reoccur if not treated
A uterine abnormality often causes a miscarriage due to early labor, but it can also cause fetal demise.
Immune Disorders
This is complicated stuff. This is a pretty new cause and affects a very small number of women. The treatments are new and experimental and there isn't a whole lot of good information about it. There are two ways to go with this-lupus anticoagulation antibodies (ending in fetal demise during the 2nd trimester or later) or immune incompatibility (causing miscarriage during 1st trimester). Basically, the lupus anticoagulation has no symptoms in the mother but causes the tiny blood vessels in the placenta to clot, cutting off the baby's supply of food and oxygen. The immune incompatibility causes your body's blood cells to attack the fetus, usually due to a lack of the immune suppression most women experience during pregnancy. Both of these problems can be tested and treated, although it is difficult due to the number of shots, the side effects, and the diligence required. The average OB/Gyn may not be up to date on these issues. Read up on it yourself and find a specialist who can determine if this is a problem that might be affecting your babies. www.inciid.org is a good place to start.
Premature Rupture of Membranes and Early Labor
Many miscarriages begin with cramping and labor-like symptoms, but true PROM and Early Labor are usually associated with babies that are in the second or third trimester. Early labor can often be treated with drugs that relax the uterus and women are placed on bed rest either at home or in the hospital.
Sometimes, however, the baby comes anyway. This is one of the most traumatic of losses, technically a stillbirth and not a miscarriage after 20 weeks, because you will hold and see your baby and beg him or her to breathe. For some women, the baby will even be born alive, but only live for a few minutes, hours or days. There really is nothing harder in life than this.
PROM is defined as your water breaking prior to 37 weeks, the age that is considered full term. Most women who have leaking or gushing amniotic fluid will be placed on antibiotics and placed in the hospital because the risk of infection is very high. Once an infection comes, the baby will almost always have to be delivered.
Babies must weigh 500 grams, or about a pound, to survive. Because I was at high risk for PROM and early labor, I kept this day on my calendar and waited with fear for it to pass. For women expecting a normal pregnancy, suddenly having your water break is very frightening. Your are stuck in the hospital, having to rely on what people tell you, and unable to get information on your own. It is scary.
PROM is thought largely to be caused by infections or inflammation of the uterus or fetal membranes. How these infections come or why they cause the membrane rupture is not completely understood. Pelvic exams and yeast infections are NOT considered to increase your risk for PROM. I do know, however, just in reality through talking with women, including a close friend of mine, that PROM tends to recur. Knowing you are at risk and taking all the appropriate precautions is essential to keeping your baby in the uterus as long as possible.
Fortunately, even though PROM cannot always be treated or prevented, most babies are able to make it far enough to survive and lead normal lives. If you have experienced unexplained PROM, I highly recommend finding a doctor with experience with this sort of pregnancy.
Others -- Infections, Age, Chronic Disease
Many infections can cause miscarriage, but they are the big ones like syphilis, mycoplasma, toxoplasmosis, and malaria. An upper respiratory infection is NOT going to cause a miscarriage, even though it may worry you to death. Viruses are the same. Normal illnesses like the common cold will not cause a problem, but AIDS and German Measles can. Infections that directly affect the uterus are bigger risk. This does NOT include yeast infections, which are extremely common in pregnancy.
Age is only a factor in miscarriage when you consider what aging can do to your body. The first and most common is with chromosomes. It is not YOU who have a problem, it is likely your egg or sperm, which have also aged. Age can, however, bring other problems such as poor health, disease, or hormonal imbalance that can make a pregnancy harder to sustain. You don't start seeing these problems in great numbers, however, until after 40.
Health problems in the mother can create problems with the pregnancy. Diabetes, heart problems, and thyroid disorders are just a few that may complicate the pregnancy. Having these does NOT mean you will certainly have a miscarriage. You will simply have to be more careful.
Accidents typically do not cause a miscarriage. The baby is well protected in its amniotic sac, surrounded by fluid, and even a hard blow to the abdomen will likely only rock it. Most women who have a car accident, even with a certain amount of trauma, have their babies just fine.
The Unknown
The hardest thing to accept is no reason at all. You live in fear, wondering if the same terrible cause of your first baby's death will cause another one to die. You scarcely dare to try again. I have been in this situation and I tossed my doctor's statistics aside. I had already been on the wrong side of the statistics; I didn't care for anymore. But I do know this. One miscarriage hardly raises your chances to miscarry again at all. You are simply back at square one. Try to put the risk as far back in your mind as possible and enjoy another pregnancy. But I understand if you can't.
Blighted Ovum, Ectopic Pregnancy, Molar Pregnancy, and Stillbirth
Sometimes a pregnancy ends unhappily, but it is not technically a miscarriage. This section will touch on these types of situations.
Blighted Ovum is a condition (with a terrible, unfortunate name) where the gestational sac grows, the woman gets all the pregnancy symptoms, but the baby itself never develops. The sac will continue to grow and grow, and most women do not know there is no baby until an ultrasound is done. The bleeding, if that happens before the blighted ovum is found via ultrasound, is slow and brown. Your pregnancy symptoms will seem to go away. A blighted ovum is believed to be caused by an egg or sperm with poor genetic material. When the egg is fertilized, instead of creating both a sac and a baby, the part that should be a baby never grows. A D&C is almost always needed to empty the uterus, because the body is very slow to realize there is no baby. Some women do experience more than one blighted ovum, but most women go on to later have a baby.
An Ectopic Pregnancy is a normal fertilized egg that gets stuck in the fallopian tube (although occasionally it will fall into the abdominal cavity) and implants there. This type of pregnancy cannot survive and puts the mother at great risk for severe hemorrhaging and possibly even death as the baby grows and eventually bursts the tube. When the ectopic is discovered, the mother will immediately have surgery to remove the baby. Things will happen very fast, and most likely if this has happened to you, you are reading this after it is all over. If you are afraid you have an ectopic, the symptoms that you really want to watch for are: sharp, intense pain in your abdomen or possibly in your shoulder; a pregnancy test that is positive, then turns negative a few days later; and spotty red bleeding that continues. Ectopics are usually caused by scar tissue in the fallopian tubes that could have been caused by: previous surgery in the pelvic region, uterus, or tubes; a pelvic infection such as chlamydia or pelvic inflammatory disease; or endometriosis that blocks the entrance to the tubes. If you have had one ectopic, your risk increases for another one. The surgery is usually done by going through a tiny incision in the belly button, and your future pregnancies will have to be carefully watched. If your fallopian tube had to be removed, you have a 40 percent or better chance of having a normal pregnancy in the future. If your tube was spared, your chances are better than 60 percent.
A Molar Pregnancy is a very rare type of pregnancy where an abnormal mass forms inside the uterus after the egg is fertilized. The baby usually does not form, but the uterus is filled with big bubble clusters. A molar pregnancy is caused by a chromosome problem with the egg or sperm. If a molar pregnancy has been diagnosed, your medical condition will be carefully monitored. Sometimes, a molar pregnancy is the first sign of a possible malignant tumor in the uterus, but rest assured that the cure rate for this type of disease is very high. The signs of a molar pregnancy are fairly clear: bleeding in the 12th week of pregnancy and a uterus that is larger than normal. The molar pregnancy is removed by a dilating the cervix and gently suctioning out the clusters. Women who have had a molar pregnancy are usually advised not to get pregnant again for at least a year.
A stillbirth is technically any pregnancy that ends after the 20th week and the baby does not survive. Some babies die in utero and are discovered when the heartbeat is not found. The most common causes of this are: uterine abnormalities, a knot or other umbilical cord accident, infections of the lining of the gestational sac or cord, and placental abruptions that cause the placenta to pull away from the uterine wall. These babies are usually born through the induction of labor, although some babies are small enough to be taken by D&C or D&E procedures.
Other babies are lost through early labor. The causes of early labor are Premature Rupture of Membranes, uterine abnormalities that make the uterus too small to hold the baby, and an incompetent cervix, which opens up and lets the baby out. Sometimes a stillbirth occurs during the birth, by an umbilical cord that gets pinched between the baby's head and the cervix, or the cord wraps around the baby's neck. Repeat stillbirths are extremely rare and are almost all related to uterine or cervix problems, which can be fixed or treated once found.
Most likely, no. The ordinary woman who has never been pregnant has a 10 percent chance of losing her baby once a home pregnancy test is positive. After you have had a miscarriage, the odds only go up to 13 percent. Most of the additional odds go to women with untreated recurring problems, such as insufficient progesterone levels and uterine abnormalities.
Once you have two miscarriages, however, the odds skyrocket to 40 percent. This seems scary, but doctors will get very serious about testing and monitoring you and your baby at this point. Most women will get some answers and some treatment before trying a third time.
