MISCARRIAGE, Causes, Signs and Symptoms, Diagnosis and Treatment.
15 to 20% of all pregnancies end in a miscarriage. And that number only goes up the older you get. As you can see, miscarriages are fairly common, but that doesn’t make it any less painful or traumatic if you are the one going through it, especially if you’ve had multiple losses. In this video, I’m going to summarize everything you need to know about miscarriages. The causes, the signs, the symptoms, and the diagnosis. And then in the next two videos, I’m going to talk about some things that you can start doing to prevent it and how to move forward after you’ve had a loss. So that’s a lot to cover, so let’s get started.
Hi, my name is Dr. Marc Sklar also known as the fertility expert and I’ve been working with couples for over 19 years through my online coaching programs and right here in San Diego at my clinics. And miscarriage is something that we discuss on a weekly basis, unfortunately. So there’s a lot of information to cover, which is why I’m diving deeper in it today. But before I get started on that topic, I want to remind you all that I do have a free fertility guide. It’s an amazing resource for all of you to help you set the foundation, get started. And when you’ve got questions of what you should be doing, where you should get those products and what you really need, then that is why you need this free guide. If you want it, all you have to do is click on the link in the description below to download it.
Okay. So miscarriages also known as pregnancy loss, and if you’ve had multiple losses, recurrent pregnancy loss. There are a lot of definitions that we need to understand when we’re talking about miscarriage. And so I want to start there because that helps set the stage for what it all means, so that you have a better understanding when you are discussing it or discussing with friends, family, or your doctor. So, first and foremost is what’s called a threatened miscarriage. You’re starting to have some signs and symptoms of a pregnancy loss, but you actually have not had the loss yet. And these are times where maybe if things are teetering, you actually have a chance to maybe prevent it or stop it from happening. Now that can’t happen too often, but there is still a potential for that. And so that’s why it’s important to know if you’re having a threatened miscarriage.
I was going to cover the signs and symptoms of a pregnancy loss later on in this video. But now that I start talking about a threatened miscarriage, I feel like this is the right time to talk about it. So these are the standard signs and symptoms. You have some vaginal bleeding, you have pain, abdominal cramping. Now that can mean a lot of different things, but those are the telltale signs. Now I typically ask two questions when someone reaches out to me about a miscarriage, or if they feel like they’re going through one. One is the color of the menstrual blood, the brighter that it is, the more likely that loss is going to happen. And then two, what is the severity of the pain? And are you having any pain or cramping whatsoever? So if those things are happening simultaneously at the same time, then the likelihood of a miscarriage increases. Now just because your bleeding doesn’t mean you’re going to have a pregnancy loss, okay?
I have seen, and I guesstimate, about 70% of all pregnancies do have some form of spotting or bleeding. So again, just because you’re bleeding doesn’t necessarily mean that it’s going to end in a pregnancy loss. Okay? So that next definition that we want to discuss is what’s called an incomplete miscarriage. This is when there is some tissue from the pregnancy that still remains in the uterus and it prolongs the pregnancy or prolongs the miscarriage. So you can have repeated or long term bleeding or spotting. Okay? So a few days after loss is normal. But beyond that, we start to think about that. Now that can happen, whether you pass the miscarriage naturally or through a D and C or medication. So sometimes we just don’t release all the tissue. And if some of that tissue remains in the uterus, then that can cause that HCG level to maintain at a higher level than we want, because we want it to go down to zero and that can maintain that miscarriage, make it prolonged.
So this is what we call an incomplete miscarriage. And then we also have a complete miscarriage, which is what you would normally refer to as a miscarriage. You have unfortunately lost the pregnancy. All the tissue goes out, you’ll spot or bleed for maybe two, three days. And then after that, you’ll move on. One of the questions that often happens to me is when should I get my next period? So I like to tell everyone not to worry too much about when your next cycle is coming, because it might come a little bit early. It might be prolonged and come a little bit late. The more important thing is that you get a cycle, the next one, and that from there, you can start counting where your cycles are and if they’re regular and back on track.
Okay, the next definition is what’s called a missed miscarriage. Now you might be saying, well, how do you miss a miscarriage? How do you not know that you’re having a miscarriage? Well, that’s because you actually haven’t started to pass the fetus yet. What happens here is that the heartbeat stops, but you haven’t begun bleeding. This happens actually fairly common. And it just might take a while, which is where medication might come in or the procedure that’s called the D and C might come in to play, right? Because if you’re not passing it naturally on your own, we do need to get that tissue out so that you can get back on track over time.
So a missed miscarriage is you’re going along, you think the pregnancy is just fine. Unfortunately, at some point in that pregnancy, now this is typically early on in the pregnancy, the heartbeat stops and that fetus doesn’t maintain growth levels, right? That normal growth. And so then when you go in for your next scan, you realize that the pregnancy hasn’t maintained and maybe you were at eight weeks during a scan, but the growth is stunted at six weeks. And the heartbeat’s not there. That’s what’s called a missed miscarriage. And so you may need a little assistance to help pass that.
And the last definition that I want to describe, actually, I’m not going to say the last definition because I’m looking at my notes. There’s a couple others that we need to go over. But in terms of the definitions of what miscarriages are, then the next one is what’s called a recurrent miscarriage or recurrent pregnancy loss. And this is when you have had multiple losses and usually consecutively. Now that definition for defining and labeling someone as recurrent pregnancy loss used to be three losses. Now that’s dropped down to two, thank God that it has, because you all need more support sooner, not later. So that’s what’s considered a recurrent loss or recurrent miscarriage.
All right. So now I want to go over some potential causes of miscarriage. And the first one is placental issues. Maybe the placenta’s not getting enough blood. Maybe it’s not growing properly. Maybe it’s not supplying enough blood and nutrients to the fetus, which stunts the growth and hinders the growth and development of the fetus. So that’s placental issues. I don’t necessarily see this too often with the population that I work with, but I am sure that perinatologists do see this more frequently than I do.
And this next one is what’s called chromosomal abnormalities. These are genetic issues and this becomes more common as we age, right? So the older you are, the more likely that you’re going to have some chromosomal abnormalities in the fetus, and that will prevent that fetus from growing and maturing and would typically also lead to a miscarriage. Part of this abnormality might be what’s called a blighted ovum. Some of you may have been familiar with, or unfortunately experienced this. A blighted ovum is when we have a sack, but no fetus inside. There’s no fetus developing. So we think it’s a pregnancy. But when we go to look, it’s really not.
And then the other one that some of you may have unfortunately experienced, and you all do ask questions about this, is what’s called a molar pregnancy. And a molar pregnancy is when you get both chromosomes passing on from the father and you want one from the father and one from the mother. And so that’s what’s called a molar pregnancy. None of those are viable pregnancies and cannot maintain and grow.
Another cause is cervical issues. So your cervix should be nice and tight during your pregnancy to prevent it from dilating and causing the fetus to come out early. And that’s what’s called an incompetent cervix. Now this typically happens a little bit later in the pregnancy, unless you’ve already had this and then you’re going to be mindful of it in advance. I don’t see this too often, but I have seen it. It does happen unfortunately. And you do want to be mindful of this.
So when you have implantation of the sperm and the egg, a fetus forms and grows and makes its way into the uterus for implantation. So if there’s something wrong inside the uterine cavity, then that could potentially lead to a miscarriage as well. Sometimes we have infections that might occur inside the uterus. Sometimes we have endometriosis that can be an issue. We can have fibroids in the uterus that also could be issues because it could stunt the growth or could be where implantation’s going to happen. Also, we could have what’s called a septum, which is in the back of the uterus. There is an abnormal growth, okay, right in here. And it’s harder to implant there. And unfortunately that’s where, that’s a very common spot, where a fetus will implant. So those are uterine issues, not all the uterine issues that can happen, but those are some of the more common ones that could happen that can lead to a pregnancy loss.
I did just mention infection. So we can’t gloss over this. Rubella, cytomegalovirus, other infections or bacteria in the uterus can cause a miscarriage. And we don’t typically look for this unless you’ve had repeated losses, unfortunately. Now some of you might want to be more proactive. And so then you’re going to want to do more advanced testing to determine and rule that out. And that’s where they take a biopsy or biopsies of the uterine tissue, the endometrium, send it off for testing. And they’re going to start to look for inflammation, infections, or endometriosis that might be in the way.
The next potential cause is medications, medications, depending on the types of medications, can potentially cause a miscarriage. So we do want to be careful of what you’re taking and if you are actively trying and on medication, you do want to just discuss that with your GP and OB GYN and or REI so that everybody knows what you’re taking, if it’s safe for a pregnancy and if you need to stay on it, or if you need to change it.
Two of the more common things that I see and work with one is autoimmune issues like lupus or really any autoimmune issue. But lupus is a fairly common one. Also thyroid autoimmunity like Hashimoto’s or Graves’ disease is also a common reason that you might experience miscarriage, unfortunately, and blood clotting variables that can also impact your ability to hold and maintain a healthy pregnancy. Two other fairly common diseases in our more modern society is diabetes and thyroid disease. Hashimoto’s or hypothyroidism are the more common ones when it comes to thyroid disease. These are very common reasons that could impact your ability to have a healthy pregnancy and hold a pregnancy. So you do want to make sure you get your thyroid checked, your blood sugar checked and make sure if there are any issues there that you are addressing them and addressing them properly.
And last but not least, I cannot ignore this. I sometimes even start here, male factor issues. And I know many of you are going to say this, but if you’ve been watching my channel for a while, you know that I talk about this often is that male factor issues, diseases can be a factor and a variable when we are talking about miscarriage and pregnancy loss, and often I can see it upwards of 40 to 50% of the cases that I work with have some sort of male factor component involved. So we have to make sure we get your partner or husband checked and make sure that everything looks good. And if not that they get the proper support that they need.
That is a lot to cover, but I’m not done. So hang tight and stay with me for just a little bit longer, because we can’t leave out lifestyle factors when we are talking about potential causes that impact your ability to hold and have a healthy pregnancy. So these are lifestyle factors that you have the ability to control, or hopefully you have the ability to control. So smokers, okay, regular smoking, nicotine and tobacco can absolutely be a factor that contributes to pregnancy loss. Alcohol and overindulgence in alcohol consumption. Caffeine. Yes. Now I don’t often talk about this in this case, but if you’ve had recurrent losses, then caffeine is definitely something that you need to be careful of and start to manage a little bit better. And then of course drugs, whether they’re recreational or any other form, drugs can absolutely impact your ability to have a healthy body and have a healthy pregnancy and hold a healthy pregnancy. So those are all some lifestyle factors that absolutely contribute to your ability to hold a pregnancy.
So if you’ve had a loss first and foremost, I want you to know that my heart goes out to you. I know how difficult it is. I ride that journey with so many couples that I work with, and it’s a challenging one. But most of the time, it’s not in your control unless it’s those lifestyle variables. So the thing that you do have control of right now that you can impact and start to change is those last four things that I just mentioned. If you’re a regular smoker, now’s the time to stop. If you drink too much alcohol, slow it down, or get rid of it. If you use drugs, get the help that you need. These are things that hopefully are in your control, but outside of that, these things unfortunately happen.
But it doesn’t mean that you can’t be proactive and start to take control and do something about it. The best form of treatment When we start talking about recurrent pregnancy loss is prevention. And it doesn’t mean starting to take care of those things once you are pregnant, it’s starting to take care of those things before you ever get pregnant. So start now, prevention is the best tool you have. Start to get the proper testing that you need and start to take care of the things that you can control right now before you get pregnant. Because once you’re pregnant, it’s much harder to address those things. And if you are going to have a loss, it’s much harder to stop it.
If you’ve had a loss and a miscarriage, again, my heart goes out to you, but know that you can dive deeper and get answers. And if you want my support and my team support on helping you get to the root cause, figure out what’s going on and then get the plan to support you and hopefully the next time you get pregnant, have a healthy pregnancy, then I want to invite you to join and apply for my Hope fertility coaching program. All you have to do to apply is use the link in the description below. And if you qualify, we’re going to let you know, get you scheduled and see if we can support you. That link again is in the description below.
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