For an expecting mother or couple, a miscarriage can be a traumatic event. In addition to having lost a child who they will never know, the sense of loss, sadness, and despair is often compounded by the confusion and lack of information surrounding miscarriages and their causes.
Understanding the different types of pregnancy loss can help women and couples navigate and endure the emotional roller coaster during this painful time as they recover from any feelings of guilt, hopelessness, and anger.
Miscarriage rates are based on the age of the woman:
- Below age 30 – the miscarriage rate is about 10%
- Between age 30-34 – roughly 12%
- Between age 35-39 – about 16%
- At age 40 – the rate is about 33%
More recently, males who are 40-45 and above have a higher miscarriage rate
In the first trimester of pregnancy, 15 to 25 percent of women may experience vaginal bleeding. While any bleeding is alarming, it usually does not signal a miscarriage unless it becomes heavy. Heavy bleeding carries roughly a 25 to 50 percent risk of miscarriage.
Types of Miscarriage
Two events result in a pregnancy loss – a miscarriage and an ectopic pregnancy (discussed below). Miscarriages are divided into two categories, biochemical (preclinical) vs. clinical.
A clinical miscarriage is defined as a pregnancy determined by ultrasound to be located inside the uterus utilizing an ultrasound.
A pregnancy too early to detect by ultrasound is called a biochemical pregnancy loss, which most women will not be aware they have experienced unless they take a home urine pregnancy test. Often, the woman has a delayed onset but heavier period. Studies have indicated that the likelihood of a biochemical pregnancy loss may, in fact, be lower in women who have undergone IVF (14%) compared to fertile women (18%).
There are no specific signs that may distinguish a biochemical from a clinical pregnancy other than early vaginal bleeding due to the impending loss from a biochemical pregnancy.
An ectopic pregnancy occurs in 1-2% of all spontaneous pregnancies and is defined as a pregnancy occurring outside the normal uterine location. The most common site of an ectopic pregnancy is the fallopian tube, particularly the end closest to the ovary where fertilization takes place. Symptoms of an ectopic pregnancy may include extreme abdominal pain, vaginal bleeding and dizziness.
Early detection with an ultrasound and testing blood hCG levels are vital to allow for conservative treatment with methotrexate injection. Methotrexate injections are effective in approximately 90% of cases, particularly in patients with lower hCG levels. More advanced ectopic pregnancies require surgery to remove the pregnancy, which often may involve removal of the fallopian tube.
Support and Education Are Key
All pregnancy losses are devastating. Women who have suffered a miscarriage need appropriate support their partner and loved ones. Fortunately, following one to two miscarriages or an ectopic pregnancy, the prognosis remains encouraging for an ultimately successful pregnancy and baby.
Having questions or concerns about the causes, signs, symptoms, diagnosis, and treatment of miscarriage is normal. Inform and empower yourself by talking to your doctor so you can put your worries to bed and make informed choices moving forward.