Chromosomes are very tiny packages of DNA. Early after conception, cells start to divide and separate to become specific tissues and organs in your baby's body. In every normal human cell there are 46 chromosomes: 22 pairs from each parent, with the 23rd becoming the chromosome which determines gender.
Every time a cell divides, there needs to be an exact replica of each of the chromosomes in the new cells. If this doesn’t happen, or one pair is incomplete or develops extra chromosomes, then miscarriage often results.
Sometimes miscarriage occurs because of an abnormal sperm or egg cell. Chance plays a huge part in whether faulty chromosomes are the cause for miscarriage. The are not under the control of either parent; they just happen.
Some couples experience repeated miscarriage because of chromosomal defects and then choose to undertake fertility assistance. Embryonic screening can be done to identify the healthiest embryos to be selected for implantation. Pre-implantation genetic diagnosis is usually undertaken with genetic counseling. This is offered to couples prior to this process so they can make an informed decision about what they can do with their embryos that may have genetic abnormalities.
Collagen vascular diseases and autoimmune disorders
Celiac disease is also thought to be a major cause for pregnancy rejection. This is a disorder of the gut where the body is intolerant of the dietary protein gluten and is unable to absorb nutrients properly from food. The immune system may be sensitive to a pregnancy when the immune response has been activated by the woman eating certain foods.
A septate uterus is a common type of congenital uterine anomaly which may lead to an increased rate of pregnancy loss. The main imaging differential diagnoses are arcuate uterus and bicornuate uterus. Surgery to correct uterine shape and size may be an option before trying to conceive again.
Diabetes can lead to complications during pregnancy and delivery. Close monitoring is essential to ensure blood sugars are maintained within a healthy range and do not compromise the health of the baby. Babies of diabetic mothers are often larger at birth and require monitoring of their own blood sugar levels in the early neonatal period.
Infections can occur in the placenta itself or in the embryo. Occasionally, blood-borne infections are the cause. Certain types of bacterial food poisoning, such as Listeria and Salmonella infections, are also tied to miscarriage risks.
Some of the major infections are mumps, rubella (German measles), herpes, and a range of sexually transmitted diseases. Very early in the first trimester, blood tests are taken to screen and assess a mother's immunity.
Symptoms of miscarriage
- Vaginal bleeding is one of the early and most common signs of miscarriage. This can be very slight with only a vague pinkish discoloration to vaginal mucus or it can be a heavy, fresh blood loss.
- Some women pass blood clots, especially after periods of lying down. As they stand up, they experience a gush of blood.
- Abdominal pain with cramping like period pain, or back pain which comes and goes.
- A lessening of pregnancy symptoms. This is usually one of the later symptoms of miscarriage when the woman's body stops producing human chorionic gonadotrophin (hCG), the pregnancy hormone.
When can we start trying again?
For as long as hCG is circulating in a mother's body, she will not ovulate or have a period. In most cases, it will take around ten days for the levels of hCG to subside and for her body's hormone levels to return to their pre-pregnancy state. Many will have a normal period four to six weeks after a miscarriage; this is a sign that ovulation and a return to normal fertility have occurred.
Some clinicians recommend couples try to conceive as early as possible after a miscarriage. They feel there is no benefit in waiting and, in most situations, there is no increase in the likelihood of miscarriage occurring again. Others claim there are benefits to waiting 3or 4 months to allow a couple of monthly cycles to occur, which may help to normalize ovulation and menstruation.
Consistently, advice includes waiting until vaginal bleeding has stopped and the woman feels well enough, both physically and emotionally, to consider trying to conceive again.
If a medical condition or infection were thought to be the cause for miscarriage, then becoming well and stable are essential. Waiting until hormone levels have stabilized, bleeding has stopped, and there has been a chance to restore healthy nutrition will optimize the chances of carrying a healthy pregnancy next time.
Emotions and miscarriage
The information of this article has been reviewed by nursing experts of the Association of Women’s Health, Obstetric, & Neonatal Nurses (AWHONN). The content should not substitute medical advice from your personal healthcare provider. Please consult your healthcare provider for recommendations/diagnosis or treatment. For more advice from AWHONN nurses, visit Healthy Mom&Baby at health4mom.org.