Miscarriage Treatment in Delhi, India

A miscarriage, also known as spontaneous abortion, is the loss of a pregnancy before the 20th week. Miscarriages are common and can be a physically and emotionally challenging experience. They can occur for a variety of reasons, often beyond the control of the individual, and understanding the different types and causes can provide insight and support during this difficult time.

There are several types of miscarriages, each with distinct characteristics and implications for the pregnancy.

• Threatened Miscarriage: In a threatened miscarriage, vaginal bleeding occurs, often accompanied by abdominal pain. Despite these symptoms, the cervix remains closed, and the pregnancy can still continue. However, there is a risk that the situation may progress to a complete miscarriage.
• Inevitable Miscarriage: An inevitable miscarriage is characterised by heavy bleeding and strong abdominal pain, with the cervix being open. In this case, miscarriage is certain to occur, as the cervix's openness indicates that the body is in the process of expelling the pregnancy tissue.
• Incomplete Miscarriage: In an incomplete miscarriage, some foetal tissue has passed out of the uterus, but some remains inside. This type of miscarriage involves heavy bleeding and abdominal pain, with the cervix being open as the body attempts to expel the remaining tissue.
• Complete Miscarriage: A complete miscarriage occurs when all pregnancy tissue has been expelled from the uterus. Initially, there may be bleeding and pain, but these symptoms typically subside after all the tissue has passed. The cervix, which may have been open during the process, closes again once the tissue is fully expelled.
• Missed Miscarriage: In a missed miscarriage, the foetus has not developed or has died, but the tissue remains in the uterus. This type of miscarriage is often discovered during a routine ultrasound, as there may be no noticeable symptoms, and the cervix remains closed.
• Recurrent Miscarriage: Recurrent miscarriage refers to the occurrence of three or more consecutive miscarriages. This type suggests that there may be an underlying health issue that needs to be addressed to prevent further losses and ensure a successful pregnancy.

Here's a breakdown of miscarriage causes:

Primary Causes:

• Chromosomal abnormalities: This is the leading cause, accounting for roughly 50% of miscarriages. These are issues with the number or structure of chromosomes in the developing embryo or foetus. They often occur by chance during cell division and are not influenced by the parents.

Secondary Causes:

• Underlying medical conditions: Certain health problems in the mother can create an environment less hospitable for a developing pregnancy. Examples include:
• Uncontrolled diabetes: Affects blood sugar regulation, impacting fetal development.
• Thyroid problems: Imbalanced hormones can disrupt pregnancy processes.
• Autoimmune diseases: The body's immune system may mistakenly attack the pregnancy tissue.
• Uterine fibroids: Uterine fibroids are benign growths in the uterus that can cause implantation issues or disrupt blood flow.

Other Potential Causes:

• Lifestyle factors: While not as common as the above, certain lifestyle choices can increase miscarriage risk. These include:
• Smoking: Reduces oxygen flow to the uterus and damages fetal development.
• Heavy alcohol use: Can interfere with cell division and fetal growth.
• Drug use: Certain illegal drugs can have detrimental effects on pregnancy.
• Obesity and being underweight: Both extremes can impact hormonal balance and nutrient delivery to the foetus.

Cervical insufficiency: A weakened cervix may struggle to stay closed during pregnancy, potentially leading to miscarriage.

Here are the key risk factors for miscarriage:

• Chromosomal abnormalities: These are the leading cause of miscarriage, occuring in about 50% of cases. Chromosomal abnormalities are problems with the number or structure of chromosomes in the developing baby. They happen by chance and are not caused by anything the parents did.
• Age: The risk of miscarriage increases with maternal age. Women over 35 are more likely to experience miscarriage than younger women.
• Medical conditions: Certain underlying medical conditions in the mother can increase the risk of miscarriage. These include uncontrolled diabetes, thyroid problems, autoimmune diseases, and uterine fibroids.
• Lifestyle factors: Smoking, heavy alcohol use, and drug use can increase the risk of miscarriage. Obesity and being underweight can also be risk factors.
• Previous miscarriage: Having one miscarriage in the past doesn't significantly increase the risk of future miscarriages. However, having two or more miscarriages in a row (recurrent pregnancy loss) may require further evaluation by a healthcare professional.

It's important to note that many women with these risk factors will have healthy pregnancies. If you're concerned about your risk of miscarriage, talk to your doctor. They can help you understand your individual risk factors and take steps to minimise them.

While some miscarriages occur without any noticeable symptoms, there are several signs that might indicate a miscarriage is happening:

• Vaginal bleeding: This is the most common symptom and can range from light spotting to heavy bleeding with clots.
• Pelvic cramps: Pain or cramping in the lower abdomen, similar to menstrual cramps but potentially more intense.
• Discharge of tissue: Passing greyish tissue or blood clots from the vagina.
• Decrease in pregnancy symptoms: Symptoms like nausea, breast tenderness, or fatigue may subside if the pregnancy is no longer viable.

It's important to note:

• These symptoms can also occur in healthy pregnancies.
• The severity of symptoms can vary depending on the type of miscarriage.

If you experience any of these symptoms, especially vaginal bleeding or severe cramping, it's crucial to see a doctor promptly. Early diagnosis can help determine the next steps and provide you with the necessary support.

When diagnosing a miscarriage, the doctors use one or more of the following tests:

• Medical history: Discussing symptoms and pregnancy history can provide valuable clues.
• Pelvic exam: A physical examination to check the cervix and uterus for signs of miscarriage.
• Blood tests: Hormone levels, particularly human chorionic gonadotropin (hCG), can indicate the status of the pregnancy. Levels typically rise in a healthy pregnancy but might drop or plateau in the case of a miscarriage.
• Ultrasound: A painless imaging test that allows visualisation of the foetus and its heartbeat. In a miscarriage, the foetus may not be visible or may have stopped developing.

The specific tests used will depend on the individual’s situation and their doctor's assessment.

A miscarriage itself cannot be reversed or "treated" once it has begun. However, it is important to ensure proper medical care to manage the physical and emotional aspects of the process. Here’s how it is typically managed:

Expectant Management

This approach allows the body to expel the pregnancy tissue naturally. It's suitable for early miscarriages (typically under 12 weeks) where bleeding and cramping are mild to moderate.

• Benefits: Non-invasive, allows the body's natural process to occur.
• Considerations: Can take several days or weeks for the miscarriage to complete. Emotional stress of waiting and potential for incomplete miscarriage.
• Monitoring: Regular doctor visits with ultrasound to track progress and ensure complete miscarriage.

Medication Management

This option involves taking medication to help the body pass the pregnancy tissue. Medications like misoprostol stimulate uterine contractions and bleeding, similar to a heavy period.

• Benefits: Faster completion of the miscarriage compared to expectant management. Can be taken at home or in a clinic.
• Considerations: May cause cramping and discomfort similar to a period. Not effective in all cases, might require additional intervention.
• Monitoring: Doctors may recommend follow-up visits to confirm complete miscarriage.

Suction and Evacuation (S&E)

This is a minor surgical procedure performed in an outpatient setting under general or local anaesthesia. The cervix is dilated (opened), a suction cannula and if needed then curette (surgical instrument) is used to gently remove remaining pregnancy tissue from the uterus.

• Benefits: Quick and effective removal of tissue, reducing risk of infection. Provides emotional closure by confirming complete miscarriage.
• Considerations: Requires a surgical procedure with potential for minor side effects like cramping or infection.
• Recovery: Most women experience minimal discomfort and recover quickly, returning to normal activities within a day or two.

Factors to Consider 

Post miscarriage care and management depends on several factors, including:

• Stage of Pregnancy: Earlier miscarriages may be managed expectantly, while later ones may benefit from medication or D&C.
• Completeness of Miscarriage: If an ultrasound shows remaining tissue, medication or D&C might be necessary.
• Preferences: Discuss comfort level with different approaches and emotional needs with a doctor.

Additional Considerations

• Rh Factor: If a woman is Rh negative and the baby was Rh positive, she might need an Rh immunoglobulin shot to prevent complications in future pregnancies.
• Emotional Support: Miscarriage can be emotionally challenging. Seeking support from a partner, family, friends, or a therapist is important.

While some miscarriages resolve without complications, others may lead to further health issues that require medical attention. Understanding these potential complications can help in seeking timely treatment and support. Here are some common complications that can arise from a miscarriage:

Incomplete Miscarriage

An incomplete miscarriage occurs when not all pregnancy tissue is expelled from the uterus. This can lead to complications such as heavy bleeding or infection if the remaining tissue is not removed. Treatment typically involves medication like misoprostol to help expel the tissue or a surgical procedure called dilation and curettage (D&C) to remove it manually.

Heavy Bleeding

Heavy bleeding during or after a miscarriage can be a serious complication. It can lead to anaemia or, in severe cases, shock. If a woman experiences excessive bleeding, medical attention is necessary. Treatments may include medications to stop the bleeding, and in some cases, a blood transfusion might be required to replace lost blood.

Infection

Infection can occur if retained tissue becomes infected after a miscarriage. Symptoms of infection include fever, chills, abdominal pain, and foul-smelling vaginal discharge. If an infection is suspected, it is crucial to seek medical attention promptly. Treatment usually involves antibiotics to clear the infection, and sometimes surgical removal of the infected tissue is necessary.

Emotional Impact

The emotional impact of a miscarriage can be profound, leading to feelings of grief, guilt, or depression. This can affect mental health and relationships. It is important for individuals experiencing these emotions to seek support. Counselling, support groups, and mental health services can provide significant help and aid in emotional recovery.

Asherman's Syndrome

Asherman's Syndrome is a condition characterised by the formation of scar tissue in the uterus after a surgical procedure like a curettage. This scar tissue can lead to fertility issues and menstrual irregularities. Treatment for Asherman's Syndrome typically involves hysteroscopic surgery to remove the scar tissue and restore normal uterine function.

Unfortunately, not all miscarriages can be prevented. However, there are steps one can take to lower the risk:

Healthy Lifestyle

Maintaining a healthy lifestyle can significantly reduce the risk of miscarriage. This includes eating a balanced diet rich in vitamins and minerals, engaging in regular moderate exercise, and avoiding harmful substances such as smoking, alcohol, and illicit drugs.

Prenatal Care

Regular prenatal care is crucial for monitoring the health of both the mother and the developing baby. Regular check-ups with a healthcare provider can help detect and address potential issues early on. Screenings for infections and other conditions that could affect pregnancy are also important components of prenatal care.

Managing Chronic Conditions

Proper management of chronic conditions such as diabetes, thyroid disorders, and high blood pressure is essential for a healthy pregnancy. Keeping blood sugar levels under control, ensuring thyroid levels are within a normal range, and monitoring and managing blood pressure can all help prevent complications.

Avoiding Environmental Risks

Limiting exposure to harmful chemicals and toxins is important for reducing the risk of miscarriage. This includes avoiding known environmental hazards and unnecessary exposure to radiation. Taking steps to ensure a safe and healthy environment can contribute to a healthy pregnancy.

Healthy Weight

Maintaining a healthy weight before and during pregnancy can improve pregnancy outcomes. Being either overweight or underweight can increase the risk of miscarriage and other complications. A balanced diet and regular exercise can help achieve and maintain a healthy weight.

Genetic Counselling

For individuals with a family history of genetic disorders, genetic counselling can provide valuable information and guidance. Genetic testing may also be recommended to identify potential risks and help plan for a healthy pregnancy.

Stress Management

Managing stress is an important aspect of a healthy pregnancy. Practising stress-reducing techniques such as yoga, meditation, and deep breathing exercises can help maintain emotional well-being and reduce the risk of complications related to stress.

Avoiding Certain Medications

It is important to consult with a healthcare provider before taking any medication during pregnancy to ensure it is safe. Some medications can increase the risk of miscarriage, so it is crucial to get professional advice.

Vaccinations

Ensuring vaccinations are up-to-date before becoming pregnant can help prevent infections that could lead to miscarriage. Vaccinations against diseases like rubella are particularly important, as these infections can have serious consequences for pregnancy.

How long does it take to recover physically from a miscarriage?

Physical recovery time can vary, but most women feel better within a few weeks. The body might need several menstrual cycles to return to its normal rhythm.

When can I try to conceive again after a miscarriage?

Many healthcare providers recommend waiting until after at least one normal menstrual cycle before trying to conceive again. However, it’s best to consult with a doctor for personalised advice.

How can I cope emotionally after a miscarriage?

Coping strategies include talking with a counsellor or therapist, joining support groups, leaning on friends and family, and allowing oneself time to grieve.

Is it normal to feel guilty after a miscarriage?

Yes, many women experience feelings of guilt even though miscarriages are rarely caused by anything they did or didn’t do. Seeking support can help in managing these emotions.

Can I have a normal pregnancy after a miscarriage?

Yes, many women go on to have healthy pregnancies after a miscarriage. Most miscarriages are isolated events and do not indicate an underlying problem that would affect future pregnancies.

What should I expect during a follow-up visit after a miscarriage?

A follow-up visit typically includes a physical exam to ensure that the miscarriage is complete, discussions about emotional well-being, and conversations about future pregnancy planning and any necessary testing.

How do I tell people about my miscarriage?

Telling others about a miscarriage is a personal decision. Some people find it helpful to share their experience for emotional support, while others prefer to keep it private.

Are there any specific lifestyle changes I should make after a miscarriage?

It's important to focus on overall health and well-being, which includes a balanced diet, regular exercise, and avoiding alcohol and smoking. Consult a healthcare provider for specific recommendations.

Can stress cause a miscarriage?

While extreme stress is not a known cause of miscarriage, managing stress is important for overall health and well-being during pregnancy. Relaxation techniques and stress management strategies can be beneficial.

What should I do if I experience another miscarriage?

If a woman experiences multiple miscarriages, it’s important to consult with a healthcare provider for further evaluation and testing to identify any potential underlying causes.

How can partners support each other after a miscarriage?

Partners can support each other by communicating openly, listening without judgement, seeking joint counselling if needed, and giving each other time to grieve.

What are some ways to honour and remember a lost pregnancy?

Some people find comfort in creating a memorial, planting a tree, writing a letter, or participating in a remembrance ceremony. Finding a personal and meaningful way to honour the loss can aid in the healing process.

How can I support a friend or family member who has had a miscarriage?

Offer a listening ear, avoid offering unsolicited advice, respect their grieving process, and provide practical support like helping with chores or providing meals.

Can certain foods or activities help in recovery after a miscarriage?

Eating a nutrient-rich diet, staying hydrated, and engaging in gentle physical activity as recommended by a healthcare provider can support recovery. Rest and self-care are also crucial.

What is the impact of a miscarriage on future fertility?

Most women who experience a miscarriage go on to have successful pregnancies. However, if there are concerns about fertility, it’s advisable to consult with a healthcare provider for further evaluation.

Reviewed By Dr. Shilpa Ghosh, Senior Director - Obstetrics And Gynaecology on 23 Aug 2024