The Science of Making Babies

• Early Pregnancy Loss/Miscarriage
• Early Pregnancy Loss-Introduction
• Diagnosis and treatment of miscarriage
• Possible causes of recurrent miscarriage
• Ectopic Pregnancy
• Molar Pregnancy

HOW IS MISCARRIAGE DIAGNOSED?
Sometimes it is diffi cult to tell if your pregnancy is going to miscarry or not. You and your doctor need to be extra attentive during the fi rst few months of your pregnancy. If concerns such as bleeding and cramping arise, you may be asked to reduce your physical activity and perhaps even rest in bed. It’s also important to avoid sexual intercourse during this time. These precautions may not necessarily prevent a miscarriage, but they may reduce your discomfort and may also provide you with peace of mind, knowing that you did everything within your power to avoid miscarriage.
Your doctor will probably do a pelvic exam to see if your cervix has opened and fetal tissue is passing. In addition, your doctor will likely perform an ultrasound to view the pregnancy. If a developing fetus with a heartbeat is seen, that’s an encouraging sign. However, if no heartbeat is noted, more concern and evaluating are warranted.

If it is still uncertain whether you are miscarrying, your doctor may draw your blood to check your pregnancy hormone levels. During early pregnancy, the pregnancy hormone human chorionic gonadotropin (hCG) rises in a certain pattern. In the case of miscarriage, the hCG level typically does not rise. Therefore, your doctor may draw your hCG level one day and recheck it a few days later to establish a pattern. Within a few days, after pelvic examination, ultrasound, and hormonal level testing, the diagnosis of miscarriage may be confirmed.

HOW IS MISCARRIAGE TREATED?

Once the diagnosis of miscarriage has been made, treatment is largely based on whether tissue is still present in your uterus. If all of the tissue has been passed, the miscarriage is considered complete and no further treatment is needed. Oftentimes some tissue remains within your uterus. This tissue must be removed to avoid future problems with bleeding and infection. In most cases, your doctor will recommend a dilation and curettage (D&C). During this procedure, your cervix is dilated and the tissue is then removed from within your uterus. Anesthesia is typically required, so the D&C is performed in an operating room. In most cases, you may go home within a few hours after the procedure. It’s normal to experience some spotting and mild cramping for several days afterward.
Follow-up care after a miscarriage is very important. Your doctor will want to check on you within a couple of weeks to ensure that you have no remaining problems. Most doctors recommend that you wait about three months before trying to get pregnant again. This time period allows your body to get back into its regular cycle. It also gives you a few months to deal with your emotions from this difficult deal.
About 90 percent of women who miscarry will become pregnant again. However, there is still the normal 15 to 20 percent chance of having another miscarriage.Therefore, you should see your doctor right away when you become pregnant again.

Recurrent Miscarriages
Having one prior miscarriage should not affect your ability to have normal pregnancies in the future. But if you have experienced two or more miscarriages in a row, you may need some special medical attention. Your doctor may want to investigate for possible underlying medical problems. About half of recurrent miscarriage cases have no underlying cause. For the remaining half, certain risk factors have been identifi ed. It’s possible that recurrent miscarriage may be caused by particular lifestyle factors, chromosomal problems, low progesterone, abnormalities of the uterus, or your own medical condition.
Diagnostic tests can be performed to help you and your doctor determine if you have one of these health concerns. In many cases, treatment is available and you can avoid problems in future pregnancies.
Enduring recurrent miscarriages is extremely diffi cult, both from a physical and an emotional standpoint. Keep in mind that even if you have experienced recurrent miscarriages, you still have a good chance to have a baby.