Motherhood is undoubtedly one of the most beautiful experiences any woman can have. Pregnancy losses can be devastating, both physically and emotionally, not only for the women but their families and healthcare providers as well. Despite seeing many women going through miscarriages over the years, every single loss devastates me even now. I have seen couples getting so stressed post-miscarriage that they delay subsequent pregnancies for a long time for fear of having to go through the same pain again.
The incidence of miscarriage varies based on the weeks of pregnancy and the age of the mother. It is important for us to focus on reducing the incidence of miscarriage because almost 30 per cent of pregnancies result in abortion within the first three months of conception, and 15 per cent of pregnancies are lost even after a heartbeat is documented on ultrasound. Let's have a look at the different types of miscarriages and what we can actually do in order to reduce the risk.
Types Of Miscarriages
1. Biochemical Pregnancy
These are pregnancies that are detected only with a urine pregnancy test or your blood pregnancy test, that is BHCG. If a pregnancy loss happens even before it's seen on the scan and after it's confirmed on a home pregnancy test, it's called a biochemical pregnancy. Most of these miscarriages happen because of genetic abnormalities in the embryo that is formed. Women older than 30 have a higher incidence of having a biochemical pregnancy. Taking prenatal vitamins and antioxidants in order to boost the quality of eggs for at least two to three months before actually getting pregnant reduces the chances of having a biochemical pregnancy.
Prenatal vitamins that are rich in folic acid, vitamin D, vitamin B12, vitamin C and minerals such as magnesium, zinc, copper, selenium, and omega 3 reduce the risk of a biochemical pregnancy.
Doctor-recommended prenatals that are available over the counter: Optinatal, Pregnacare, One a day, Sheneeds Prenatal, etc.
Tip: It's always better to consume these prenatals in a tablet form instead of a gummy form for at least two to three months before planning a pregnancy.
2. Blighted Ovum
A normal pregnancy is visualised on scan for the first time anywhere between five to seven weeks. If a miscarriage happens around this time before the appearance of the heartbeat, it is called a ‘blighted ovum’. Most blighted ova are caused due to factors such as advanced maternal age, active or passive smoking by the mother, genetic abnormalities in the embryo, and hormonal abnormalities such as an uncontrolled thyroid, elevated prolactin levels and PCOS. In order to reduce the risk of a blighted ovum, it is advisable to get preconception counselling where hormonal profiling is done in order to ensure that all the hormones are in their normal range.
- TSH (THYROID-STIMULATING HORMONE)
- HBA1C ( evaluates Sugar)
Tip: Get the tests done on fasting for better results. If you test positive for any of these conditions, it is important that you get them corrected before planning to get pregnant.
3. Missed Abortion
The foetal heartbeat appears for the first time around seven to eight weeks from the first day of the last menstrual cycle (LMP). The appearance of the heartbeat on scan is considered to be one of the most important milestones because the risk of miscarriage reduces to 10 per cent after the heartbeat appears. If a miscarriage happens after the appearance of a foetal heartbeat, it is called a missed abortion.
Apart from the aforementioned hormonal abnormalities, structural defects of the uterus such as the arcuate uterus, septate uterus and fibroid uterus are the most common reasons for a missed abortion. Missed abortions can also happen when there is a thickening of the maternal blood because of the presence of certain antibodies called antiphospholipid antibodies that result in reduced blood flow to the growing foetus. It is important to note that abnormalities in the sperms of the male partner can also be responsible for missed abortions.
- 3D Ultrasound (for the female)
- APLA Screening (for the female)
- DNA Fragmentation Index ( for the male)
Tip: While the structural abnormalities of the uterus and elevated DFI of the male partner should be treated before getting pregnant the next time, a woman with APLA positive is treated with blood thinners after she gets pregnant. Stop both active and passive smoking at least two months before planning a pregnancy.
4. Second Trimester Miscarriage
The spontaneous abortions that happen between 12 and 20 weeks of pregnancy are considered second-trimester abortions. The most common reason for these is the structural inability of the uterus to hold the growing foetus, resulting in an early expulsion of the baby. This condition is known as cervical incompetence.
Measurement of the cervical length using transvaginal ultrasonography during the NT scan helps us in screening for women who are at higher risk of cervical incompetence.
Expert Tip: Women with cervical length less than 2.5 cms on one scan or women who show a reducing trend of cervical length are advised to go for a minor procedure known as cervical cerclage that reduces the risk of second-trimester miscarriage.
External Factors Leading To Miscarriages
In our current generation, we normalise stress so much that we fail to acknowledge the impacts that it can have on our health. Men and women who experience higher levels of work-related stress, irregular sleeping patterns with a nocturnal work tendency, and higher body mass index (BMI) are shown to experience a higher incidence of miscarriage as compared to their less-stressed and normal BMI counterparts.
Tip: Even if there is no significant reduction in weight, as long as the body-fat percentage is on the lower side the risk of miscarriage can be averted. Cultivate four to five hours of sweat-inducing exercise per week to not only reduce the stress hormones but also elevate happy hormones that increase the possibility of a healthy pregnancy.
COVID-19 And Miscarriage
Women infected with COVID-19 have a higher risk of miscarriage, pregnancy loss or even preterm delivery at various stages of the pregnancy.
Tip: Plan for at least one dose of the vaccine before getting pregnant. Avoid planning a pregnancy for at least one month after recovery in case of mild COVID, and up to two to three months in case of moderate to severe COVID. Remember that vaccination can be taken not only before getting pregnant but also during all trimesters of pregnancy. There are no studies that show that vaccination can result in a miscarriage.
Talking about miscarriages and making post-miscarriage counselling accessible to all women should be normalised to reduce the trauma that is associated with it.
Also Read: 5 Steps To Take For Your Baby To Have A Good Night’s Sleep