by Rachel Burt, Women’s Health Nurse Practitioner at Roswell OB/GYN………………………………….
I wish a positive urine pregnancy test always meant the pregnancy would be fine. I hate that early pregnancy has so much uncertainty associated with it. Some of the new over the counter pregnancy tests can show positive before you have even missed a period. Many of our patients are elated when they see the results. At the sight of the first positive test, they are thinking about maternity clothes, baby showers, due dates, and even school districts. The possibility of a miscarriage is not even a thought on the horizon.
And then everything changes. Unfortunately, approximately 1 in 5 pregnancies ends in miscarriage. The majority of these miscarriages occur within the first 12 weeks of pregnancy. Some women have early signs of trouble such as bleeding. However, early pregnancy is not black or white – sometimes early spotting can be completely normal. Other women might have some cramping, but again some cramping can be the uterus growing with a normal pregnancy. I always advise women with bleeding or any significant pain to contact the office for evaluation to confirm everything is on track with the pregnancy. Depending on the symptoms, we might order a very early ultrasound to confirm the pregnancy is implanted in the correct location – the uterus. If the ultrasound confirms an early normal pregnancy, we often follow women who are bleeding with an additional ultrasound later in the first trimester to confirm the growth of the pregnancy is appropriate. Early bleeding in pregnancy does not always cause miscarriage. It may result from a small collection of blood when the sac implanted in the uterus, low progesterone or other minor issues. However, in other cases the early bleeding can be a symptom of a miscarriage. In these situations, the ultrasound reveals lack of appropriate growth or a fetus without a heartbeat. We will then counsel our patient on what to expect over the next few days. Depending on the situation, the provider will discuss the option for the patient to pass the pregnancy on her own or to schedule surgical removal of the miscarriage – a D & C (dilatation and curettage).
In an uneventful pregnancy, we typically do an ultrasound around 7 weeks of pregnancy to confirm the health of the pregnancy. Unfortunately, some patients find out they have a miscarriage at this visit. Some patients have no bleeding or pain to warn them of a pending miscarriage. The medical term for this type of miscarriage is a missed abortion. The fetus has stopped growing but the body has not yet come to terms with the end of the pregnancy and has not yet started to bleed. Often times the pregnancy hormones are still elevated so the patient still feels all the pregnancy symptoms of nausea, breast tenderness, and fatigue. Sometimes it is very difficult for these patients to come to terms with the loss since they are not having any typical miscarriage symptoms such as bleeding.
Each patient handles early pregnancy loss in her own way. The grieving process is very personal. However, I feel it is very important for our patient to know that she did not cause the early loss. It was not the glass of wine she drank before she knew she was pregnant nor the bike ride she went on last week that caused the miscarriage. The moment the chromosomes come together, sometimes they do not come together quite right. In these situations, the baby would not have survived outside the womb. Nature takes over and stops the fetus from developing any further. The likelihood of a future miscarriage is very low. The majority of our patients go on to have very healthy pregnancies in the future.