Most people assume that miscarriages are relatively straightforward and obvious – you start feeling cramps that become stronger, begin to bleed heavily and, at some point, the pregnancy is lost. However, this is not always the case – sometimes you can have no sign whatsoever that the pregnancy has failed for a few weeks and even up to a few months. This type of miscarriage is called a missed miscarriage and it occurs when your body fails to recognize the pregnancy loss and to expel the pregnancy tissue.
This is what happened to me at the beginning of what ended up being a long road to conceive a child. It was my first pregnancy and I had gotten pregnant straight away. Maybe because it had been so easy, I just assumed that the pregnancy would be straightforward and that nothing would go wrong. I had even rung friends asking about midwives at around the six-week mark because I was so confident that the pregnancy was healthy and would reach full-term. At around 12 weeks, I started getting worried because I hadn’t felt any pregnancy symptoms at all and so I ended up getting an ultrasound done. Instead of seeing a baby on the screen, there was nothing – not even a gestational sac – and, as you would expect, I was pretty devastated. I had no idea that this type of miscarriage even existed until that scan.
Missed miscarriages are thankfully rare, affecting around 1 percent of all pregnancies, a much lower rate than the overall rate of miscarriages which is 20 percent. Missed miscarriages can be symptomless from the beginning, as in the case of my missed miscarriage, or the placenta can continue to function, releasing hormones which can continue the pregnancy symptoms. In addition, some women may feel pregnant for a while and then symptoms, such as fatigue, nausea, and breast tenderness, can disappear overnight.1
What causes missed miscarriages?
In early pregnancy missed miscarriages occur due to the same reasons as other miscarriages – most often a chromosomal abnormality in the embryo. This can either be the wrong number of chromosomes – there should be 23 pairs in a normal embryo – or pieces of a chromosome can be missing or duplicated.1
Later in a pregnancy, missed miscarriages can be caused by infections due to viruses such as rubella, parvovirus, or cytomegalovirus or parasites such as toxoplasma gondii. If your doctor suspects an infection he or she will order a test in order to provide you with some answers.2
Treatment for missed miscarriages
After receiving the diagnosis of missed miscarriage, you will be given the option of letting nature run its course and to eventually have a natural miscarriage. If you take this course you should be aware that it might be a while before this happens. If you don’t want to wait it out, you will be offered a drug to speed things along. This medication is usually a drug called misoprostol and used at the recommended dose it has a success rate of between 66 and 93 percent. Misoprostol causes the uterus to contract and is generally regarded as being a safe drug, with prolonged or serious side effects being rare.3 Mild side effects include:
- Nausea and vomiting, usually lasting between two and six hours
- Cramping, usually beginning within a couple of hours of taking misoprostol and may be stronger than regular period cramps
- Chills, a common side effect of misoprostol
- Diarrhea, usually occurring following administration of misoprostol and should stop within a day3
Another option you may be offered is a minor surgical procedure done under general anesthesia called dilation and curettage, also known as a D and C. Dilation refers to opening of the cervix and curettage refers to the removal of the pregnancy tissue in the uterus. Curettage may be performed by either vacuum aspiration or with a curette instrument that scrapes the uterine wall.4
Risks of a D and C include:
- An adverse reaction to the anesthesia
- Hemorrhage or heavy bleeding
- Perforation/puncture of the uterus
- Infection of the uterus or other pelvic organs
- Weakening of the cervix
- Scarring of the uterus or cervix4
However, bear in mind that these risks are very small and a D and C is almost always a safe and straightforward operation.
Coping with life after a missed miscarriage
Going through a missed miscarriage can result in feelings of anxiety and depression but you should remember that you are not alone. Seek out support from close friends and family and if you feel like you need additional help, consider going to see a therapist.
Time is the biggest factor in coping with a missed miscarriage, as it is for most traumatic life events, and in time you will be able to start to think about your next steps in your reproductive future.
Most importantly, realize that you did nothing wrong and that there was nothing that you could have done to prevent your missed miscarriage. Talk to your doctor and ask him or her lots of questions as this can help put your mind at ease about the reasons it occurred.5