Miscarriage in late pregnancy (late miscarriage)
The physical process-
Your miscarriage may have happened naturally,or you may have had to have your labour induced (started off).
If you miscarried naturally, you mayhave had period or labour pains, strong contractions in your abdomenor pain in your back. You might have been aware of your waters breaking,or they might have stayed intact until your baby was born. It might all have happened quite quickly – and once it started, therewouldn’t be any way of stopping it. You might have delivered your baby at home or in the hospital – or perhaps somewhere else.
You may have had no sign that anything was wrong with your pregnancy, but an ultrasound scan showed your baby had died. You will probably have had your labour induced – that is,started artificially –to deliver your baby. Hospital staff might have offered choices about how to manage the labour and they should have told you what was likely to happen. You might have wanted to start the process of labour as soon as possible,or you may have preferred to go home and think about it for a few days. Either way,these may have been very difficult and upsetting decisions to have to make.
Seeing and holding your baby-
With a late miscarriage, you are likely to be able to see your baby and perhaps to hold him. You might be very worried about what your baby will look like and choose not to look. Hospital staff may offer to take a photo of him and save it for you incase you want to look later. It may be that someone else will describe your baby to you and that will help you decide. There is no right or wrong thing to do– it depends how you and your partner feel.
A late miscarriage is the loss of a pregnancy between 13 and 24 weeks. It is much less common than an early miscarriage. It is also called second-trimester or mid-trimester miscarriage as it happens in the middle stage of pregnancy. Doctors divide pregnancy into threestages: the first trimester is up to 13weeks; the second,or middle,trimester is from 14 to 24 weeks; the third trimester is from the startof the 25th week of pregnancy onwards.
Causes of late miscarriage
- Chromosome problems: Examples of chromosome problemsare Downs Syndrome, Edwards Syndrome and Turners
Syndrome.These are usually one-off abnormalities, happening “out of the blue”. But they might be due to a problem that you and/or your partner have, probably without knowing.With a late miscarriage,
it is possible to examine the baby’s chromosomes from samples taken from the placenta and umbilical cord, as long as you agree. Your and your partner’s chromosomes can be examined from a blood test
.This information will help the genetic counsellor to tell you what the risk is of a similar problem happening again. If your doctor thinks that you have a higher risk than most people of having a
baby with a chromosome abnormality, you may be offered extra tests in your next pregnancy
- Genetic problems Our chromosomes carry our genes. We all have many thousands of
genes;we also all have some abnormal genes. Sometimes these genes can cause the baby to die in pregnancy. Genetic problems are more likely to cause early miscarriage. But if your doctor suspects that
a genetic problem caused your miscarriage,s/he might refer you to a specialist to have tests and perhaps advice about future pregnancies.
- Structural:This means problems in the baby’s body, for example spina bifida or acongenital heart defect. These are sometimes seen on an ultrasound scan,but sometimes they are only discovered after the baby is born. If your baby is found to have this kind of problem, you should be offered genetic counselling so that you can find out more about the chances of it happening again. A cervix that is weak or dilates too soon (known as cervical weakness), can lead to late miscarriage. This can sometime occur after surgery on the cervix following an abnormal smear. Women who are known to be at risk will be offered a scan to measure the length of their cervix or may need a stitch in their cervix to help prevent this.
- Anatomical problems If you have an unusually shaped womb(uterus), especially one that is partly divided in two (an arcuate uterus),thismight have caused your miscarriage. Your doctor might suggest anoperation to correct the shape ofyour womb.If you have a weak cervix (sometimes called an “incompetent cervix”),this might have caused your miscarriage.The cervix (the neck of the womb)should stay tightly closed during pregnancy. But if it is weak for some reason, it may open as the baby grows bigger, and it won’t be able to hold the baby inside. If your doctor thinks this caused your miscarriage, s/he may suggest that you have a strengthening stitch, called acervical stitch, in your next pregnancy. This is usually done under a general anaesthetic at 13 or 14 weeks of pregnancy. If your doctor is not sure whether this is the cause,then s/he may decide to monitor you closely in your next pregnancy,with regular scans to check your cervix.
- Infection Any severe infection a woman develops during pregnancy may result in miscarriage. This is relatively rare.
- Infections directly affecting the baby include parvovirus,cytomegalovirus (CMV), andtoxoplasmosis.These infections cancause the baby to die in the womb.They are unusual and do not usuallyhappen in another pregnancY.
- Infections of the amniotic fluid can happen when bacteria(germs) that normally live in the vagina get into the womb. One example isbacterial vaginosis (BV), a common infection which has been associated with premature (early) labour.
- Experts are investigating whether vaginal infection could be a cause.
- Antiphospholipid Syndrome(APS) APS is a condition that increases blood-clotting. It is sometimes called “sticky blood syndrome” or Hughes syndrome. If blood clots too easily during pregnancy, it can cause early or late miscarriage, as well as other pregnancy problems. If you haven’t been tested for APS, you might want to ask your doctor to arrange this test. You will have two blood tests,taken at least twelve weeks apart, and if both are positive,you will be diagnosed as having APS. If you have APS, you will be treated with low-dose aspirin and possibly another blood-thinning drug called heparin in your next pregnancy
- Food poisoning such as listeria and salmonella; along with some infections of the blood, such as hepatitis, cytomegalovirus, human immunodeficiency virus (HIV), rubella and toxoplasmosis, can cause miscarriage or problems within the developing baby.
- Other rare structural problems that can inhibit the attachment of the placenta or baby’s growth and may lead to miscarriage are an abnormally shaped womb and large fibroids that grow in the womb. Pre-pregnancy surgery can sometimes solve these problems.
Late miscarriage: a summary
• Miscarriage late in pregnancy is uncommon. You might have been very shocked when it happened.
• Going through labour and delivery can be very upsetting; and you may not be sure if you want to see your baby.
• You might be asked to make very difficult decisions about a postmortem and/or about burial or cremation.
• It might take time for you to decide whether or when to try again.
• You may be very upset that a late loss is called a miscarriage rather than a stillbirth.
• It can help if you have people around you who can understand; and there are other places too where you can find help and support.