The first thing most women do is wonder if they could have prevented the miscarriage or go searching for reasons on why it happened. Self-blame and sometimes denial accompanies the feeling of loss making it hard for many to move on. The truth about pregnancy loss or miscarriage is in over 50% of cases it is not preventable. Because in most situations of miscarriage the doctor is unable to provide explanations as to why it happened, most women tend to feel their loss is being taken lightly.


It is NOT your Fault

About 50% of miscarriages lie in the obscure area in which doctors are not able to specify, the most common being problems with the chromosomes of the fetus. Chromosomal problems occur randomly; if there is a problem with the number of chromosomes or the structure of a chromosome then a miscarriage is most likely. Daily activities or events such as work, sex, stress, exercise, morning sickness etc do not contribute to the occurrence of miscarriage. When a miscarriage happens it is wise to view it as an act of nature because in most cases the abnormality is severe enough to be incompatible with life. (Harsh but true).



Miscarriage Treatment

When miscarriage is confirmed either by ultrasound or by clinical assessment, the next step is to check on remnant tissues in the uterus; this would need to be expelled. Miscarriage is considered complete if all the tissue has been passed and no further treatment is required. In situations where some tissues remain a D & C will be recommended.


Follow up care with your doctor is necessary to check on ensuing problems, if any (usually 6 weeks post the procedure). A three month wait is mostly suggested to allow the physical and emotional healing, and for the regular period cycle to resume. Statistics indicate that 90% of women go on to conceive after suffering a miscarriage, although about 15-20% face the possibility of a miscarriage reoccurrence. It is advisable to see your doctor right away when you become pregnant again.



A Word on Recurrent Miscarriages

Recurrent miscarriage is hard on the woman both physically and emotionally. Unfortunately evaluation is only performed after having undergone 2 or more miscarriages in a row. As mentioned about half of recurrent miscarriage cases have no underlying causes. For the rest, the cause can be pinned on medical conditions, hormonal problems, chromosomal problems, lifestyle issues or abnormalities of the uterus.

You on your part should work with your doctor by providing details on your history, any medical condition you may have developed and experiences during your past pregnancies. In repeat miscarriages, tests are often conducted to check on possible causes. Some conditions are treatable so the chance of having a successful pregnancy greatly improves the next time round.



Diagnostic Tests

Your doctor may suggest a complete physical check and this may include many diagnostic tests (blood tests and/or pelvic ultrasound) to understand the cause and possibly provide the treatment. It is important to understand and accept that despite careful investigations doctors may not be in the position to provide the cause of recurrent miscarriage nor guarantee the outcome of the next pregnancy when it happens. Here is a checklist of the possible tests in brief:

Blood Tests	Blood work is done to check for progesterone level, thyroid function, diabetes, certain viruses, blood-clotting disorders and other immune disorders
Genetic Evaluation	You, your partner and the miscarriage tissue will be tested for the presence of abnormal chromosomes. The placenta and embryo will be assessed through karyotyping although it is not always possible to get a result.
Ultrasound	Your pelvic anatomy can be evaluated for possible problems using ultrasonic sound waves.
Pelvic infection Testing	Swabs from the vagina and the uterus will be sent to the lab to test for infection, especially if you miscarried in the 4-6 month period.
Hysteroscopy	A device resembling a narrow telescope will be inserted into the uterus to view the insides of the cavity and check for abnormalities.
Sonohysterogram	This involves the use of ultrasound where sterile water is injected into the uterus for better viewing and evaluation of the uterine cavity.

Actions to REDUCE the chance of Early Pregnancy Loss

You have a right to be hopeful despite having suffered a miscarriage or recurrent miscarriage by incorporating certain positive actions as those outlined below:


• Before attempting pregnancy, schedule a complete medical checkup. Use this opportunity to discuss risk factors and causes of past pregnancy loss (es).



• A healthy lifestyle is elementary to a healthy pregnancy: a healthy food regime, staying away from alcohol, nicotine, unprescribed medications and illegal drugs, working towards a stress-free life, and incorporating some regular exercise helps.



• Be vigilant about your prenatal vitamins, especially folic acid and all other medications that have been prescribed by your doctor for any prevailing medical conditions.



• The physical health of both parents can influence future pregnancies. It is known that sperm abnormalities increase the risk of miscarriage. Therefore not only women but even their partners should work at staying fit and healthy in the interim period. A 3-month wait is also important as this time-frame allows for sperm replenishment; quality sperm will replace any damaged sperm, if present.



• Plan your pregnancy. Keep a close watch on your menstrual cycle and gain a better perspective of your ovulation.



• See your doctor at the earliest if you suspect you are pregnant for an early diagnosis. An early scan determines the viability of pregnancy and offers assurance, where necessary. Remind your doctor on past loss (es) and share your concerns and queries. Ensure your well-being and pregnancy is being monitored.



The Final Word

Don't give up. If having a baby means a lot to you and you have the financial and other necessary resources, then take your time if you have to but don't give up. Remember that you have a good chance for a successful pregnancy following a pregnancy loss even if the cause of the previous loss cannot be established, even if this is your 5th miscarriage because many women who have persisted after disappointments have been rewarded for their tenacity. Your future pregnancy will surely demand special care, supervision and sometimes medication.



Don't rush into things. Take your time and try for another baby when you feel ready. You may need 3 months, 6 months or more than that but the truth is different intervals are appropriate for different women. Statistics also show that women who miscarried early in pregnancy were as likely to have a successful pregnancy as those who waited longer.