By Wendy HaafNov 27, 2018
Lisa Thompson was undergoing an eight-week ultrasound when her normally friendly, chatty doctor suddenly went silent. “I knew something was wrong right away,” she recalls. When the doctor finally spoke, he told Thompson there was no heartbeat. It turned out the pregnancy had silently stopped developing weeks earlier—a phenomenon commonly known as a missed miscarriage.
Miscarriage (also known as early pregnancy loss) occurs in an estimated 15 to 20 percent of recognized pregnancies, most often within the first 13 weeks. According to one study, about three percent of recognized pregnancies end in a missed miscarriages, which means the mom doesn’t experience typical miscarriage symptoms such as cramping and bleeding.
Consequently, missed miscarriages are often discovered incidentally during a first trimester ultrasound, between 11 and 14 weeks, notes Kathi Wilson, a registered midwife in London, Ont., and assistant professor in the department of obstetrics and gynaecology, midwifery program, at McMaster University in Hamilton.
As for the ultrasound findings, “there might be either an empty sac with nothing inside, or an embryo with no heartbeat,” explains Rhonda Zwingerman, a fertility specialist at Mount Sinai Fertility in Toronto.
As with other types of early pregnancy loss, a large percentage of missed miscarriages are thought to be due to a random genetic error that causes the embryo to receive more or fewer than the usual number of chromosomes. “That can cause the embryo to stop developing,” says Zwingerman. Other potential reasons include uterine conditions (such as fibroids or scar tissue) that interfere with implantation of the embryo, as well as hormonal problems, including uncontrolled thyroid disease. “And the truth is, sometimes we don’t know,” adds Zwingerman.
Your care provider may recommend a repeat ultrasound to confirm the diagnosis. Next, they will outline three possible treatment options, provided you don’t have any medical concerns, or signs of complications, such as infection.
“Option one is what doctors call expectant management,” says Zwingerman, “which means wait and see.” If you do nothing, the body will often start the process on its own, she explains. Every woman’s experience is a bit different, but you’ll likely experience symptoms similar to a heavy period—though it can be more intense depending how far along you are—and the bleeding usually slows down within a week, though spotting may continue for another week or two.
If the process doesn’t start naturally within two to four weeks, or if you can’t bear waiting, you’ll need to try one of the other two options. The other two choices, Zwingerman explains, are medical management and surgical management—in other words, pills or surgery.
Medical management involves taking a pill—either orally or vaginally—called misoprostol, which causes the cervix to open and the uterus to contract and expel the tissue. If the first dose doesn’t work within 24 hours, a second can be taken. Whether cramping comes on naturally, or is brought on by a drug, it can be painful. When the medication kicked in for Thompson, “I decided if I was ever going into labour, I would darn well have the epidural,” she recalls. Your care provider can suggest over-the-counter medications to help manage the pain, and other possible side-effects of the drug, such as diarrhea and nausea.
Misoprostol doesn’t work for everyone, so there’s still a chance you may end up needing to go the surgical route anyway. “Both expectant management and misoprostol tend to be less successful the farther along you are,” Wilson explains.
The surgery—a brief same-day procedure called dilation and curettage, or D&C—involves gently dilating the cervix and removing the contents of the uterus, while the patient is under general anaesthesia.
For some, surgery may be preferable if the thought of passing the tissue at home is too emotionally overwhelming. It also has the advantage of being over with quickly, and recovery is generally shorter. However, there can be delays in getting the procedure scheduled. As well, “there’s a bit more risk related to D&C,” says Wilson. That said, the odds of complications, such as scarring of the uterine lining, are low.
Which option is best is highly individual. “People make different choices for different reasons,” Wilson says. However, what we do know from research is that, in the end, “most women will be happy with whatever they chose, as long as they are counselled well and make their own decision,” says Zwingerman.
So when can you try to get pregnant again? “There’s a common myth that you have to wait a certain number of months,” Zwingerman notes. But most caregivers now give the go-ahead after the first normal period, which will usually appear within eight weeks, because waiting this long will help accurately date the next pregnancy. Although, it is possible to conceive earlier.
Still, some couples may prefer to hold off longer, to give themselves space to grieve. (If you find yourself struggling emotionally after a miscarriage, ask your caregiver to refer you for counselling, or get in touch with an organization that provides peer support, such as pailnetwork.sunnybrook.ca.)
While it can take time, the majority of women who try to conceive after an early pregnancy loss eventually do have a baby. Or, as in Thompson’s case, two—her twin sons are now 11.