Late Miscarriage
What is late miscarriage?
Late miscarriage is a pregnancy loss between 13 weeks and 24 weeks of pregnancy. It is also known as Second trimester or mid trimester miscarriage. About 98% of miscarriages occur during the first trimester. A pregnancy loss after 24 weeks of pregnancy is known as a stillborn.
What is the cause of late miscarriage?
- Abnormalities with the uterus e.g uterus shape or presence of uterine fibroid
- Weak cervix (cervical incompetence)
- The baby has some genetic abnormalities or structural abnormalities (heart or spine problems)
- Vaginal infections e.g bacterial vaginosis or Group B streptococcus.
- Infections that crosses the placenta e.g toxoplasmosis or listeriosis
- Placenta problems e.g inadequate blood supply
- Medical condition in the mother e.g poorly controlled diabetes, sickle cell disease or high blood pressure.
How do I know that I may be having a late miscarriage?
You may experience some of the following symptoms:
- Labour like pain e.g lower abdominal pain.
- Your waterbag broke
- Vaginal bleeding
- No symptoms but during scan your doctor notice that your baby no longer has any heartbeat.
What is the treatment for late miscarriage?
Most women will present with symptoms of labour and their cervix has already dilated. They will soon deliver their baby. However, those where the diagnosis is being made by scan with no fetal heart seen and not in labour, your doctor will recommend induction of labour by either taking the medication orally or inserting them vaginally. The other problem with late miscarriage is the placenta occasionally does not expel completely requiring a D&C to be done.
What happens after a late miscarriage?
- If you want, you will be encouraged to hold your baby, take the baby’s hand prints or photograph as it has been shown that this will help during the grieving process.
- Several investigations will be done including taking blood samples from the baby’s heart, cord and placenta. In addition, your doctor may offer you to do a post mortem of your baby (autopsy). A blood sample from you will also be taken to exclude underlying auto-immune or connective tissue disease and infections. These investigations could help in determining the cause of miscarriage and for preventing recurrence of miscarriage in future pregnancies.
- If the underlying cause is due to genetic abnormalities you will be referred to a genetic counselor to advice for future pregnancies.
- Your baby’s birth does not need to be registered. However, you may want to arrange a simple burial or cremation service.
- After delivery, you may experience some vaginal bleeding (lochia) which may last several weeks. In addition, your breast may excrete some milk. Your doctor may prescribe a medication to stop the milk production.
- Medical certificate will be given for you to rest at home to recover and grief. It is important that you get as much support from your family and relatives at this time. You could join a support group or read books on how others who have experience the same things as you have. This may help you in your grieving process.
- After 6 weeks, an appointment will be scheduled with your doctor. A review of the investigations will be done to identify any possible cause and arrangement to be done for future pregnancy.
How do I prevent another late miscarriage in future?
This depends on the possible cause of the previous miscarriage that you have. You need to talk to your doctor and discuss the possible strategies to prevent it from recurring. If is it due to medical condition, your doctor may need to optimize or prescribe you some medication to stabilize it. Late miscarriage due to weakness of the cervix (incompetent cervix) may be treated by cervical cerclage (i.e putting a stitch around your cervix to strengthened it in the early second trimester of your next pregnancy)
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