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Tag Archive for: miscarriage

Posts

Pregnancy after Miscarriage

Family Planning, Pregnancy

Experiencing a miscarriage is an emotionally challenging, often devastating experience for women and their partners. A miscarriage, also called early pregnancy loss, is the loss of a pregnancy within the first 12 weeks. Everyone reacts differently after an early pregnancy loss. It’s important to give yourself time to grieve and to recognize that the loss was not your fault.

When you feel ready to start trying to conceive again, you may have many questions like  —  Why did I have a miscarriage this time? How soon can I get pregnant after a miscarriage?  Can I prevent another miscarriage from happening?

Let’s start with one of the most common questions our providers are asked:

Why did the miscarriage happen?

As advanced as modern medicine is, we still don’t know the exact cause of most miscarriages. About half the time, the miscarriage happened because the embryo didn’t form correctly. This is called a chromosomal abnormality. It can mean that the embryo had either too many or too few chromosomes or even though there is the correct number of chromosomes, something about one or more of them is not normal.

Other times, we simply do not have an answer.

What we do know, however, is the following activities do NOT cause miscarriage:

  • working
  • exercising
  • falling
  • feeling upset
  • or having sex.

Will I have a successful pregnancy after a miscarriage?

After an early pregnancy loss, it’s common to worry if it will happen again. Getting your hopes up again after a loss feels risky. But we have some good news for you — most women (about 85%) go on to have a successful pregnancy after a miscarriage.

Recurrent miscarriage, which means two miscarriages in a row, happens to less than 5% of women. Three miscarriages in a row are even more rare, occurring less than 1% of the time.

Are special tests recommended before trying to conceive after a miscarriage?

If you have had two miscarriages in a row, then we recommend evaluation which will include genetic testing for you and your partner. Tests can help us discover the reason for recurrent miscarriages about 50% of the time.

How long do pregnancy symptoms last after miscarriage?

After a miscarriage, you may still have some pregnancy symptoms, like nausea and vomiting, breast tenderness, and fatigue. These symptoms are related to the amount of beta HCG (pregnancy hormone) that is still in your bloodstream, and they usually go away after about two weeks. If you’re still experiencing pregnancy symptoms after two weeks, it is important to contact your doctor.

Pregnancy symptoms typically stop sooner for women who have a DNC (dilation and curettage), which often causes beta HCG levels to drop more quickly.

Bleeding and cramping can also vary greatly from woman to woman. It could feel like a heavy period at first. But heavier bleeding should only last a few days at most. Although Some women may experience lighter bleeding for up to a month. As long as the bleeding appears to be decreasing, this is normal. If bleeding or cramping increases instead, call your doctor.

About 90% of the time, a woman’s body will resume its typical cycle within 8 weeks.

How soon after a miscarriage can I start trying to get pregnant?

You may have been told that you should wait a certain number of months or menstrual cycles before trying to conceive. However, there aren’t any large, quality studies that suggest it’s beneficial to wait after a first-trimester miscarriage. (Second- and third-trimester losses require a more personalized plan.)

Instead of recommending patients wait a specific number of months or cycles, we track beta HCG levels after any kind of pregnancy loss. When these levels return to pre-pregnancy levels, your body is ready to try to conceive again.

If you experience a first-trimester loss, talk to your OBGYN about whether you want to track labs early in the next pregnancy. For example, your doctor might track your beta HCG levels to indicate whether the pregnancy is likely to be viable. If the beta HCG level doubles every 48 hours, then there is a good chance that the pregnancy is on the right track.

When will you begin ovulating or menstruating after a miscarriage?

The body usually reacts to a miscarriage as if it’s a “period.” Some women’s bodies will resume ovulation right away, meaning they do not miss an ovulatory cycle after having a miscarriage. Others may miss one ovulation cycle. Sometimes the stress of miscarriage or surgery might affect ovulation and push it out a week or so.

Can you test false-positive for pregnancy after a miscarriage?

Pregnancy tests measure the amount of HCG in a woman’s blood or urine. Once beta HCG numbers are normal (close to zero), you would not get a positive pregnancy test. However, it could take about 2-4 weeks for those numbers to return to pre-pregnancy levels. While waiting for the beta HCG level to return to normal, you might get a positive pregnancy test. For that reason, we don’t recommend testing at home.

If you get a positive pregnancy test after a confirmed miscarriage, it may be due to testing too early. If beta HCG levels stay the same and do not decrease, your OBGYN may check to see if tissue is still present in your uterus. Sometimes, a prescription can help the tissue pass, but other times it may need to be removed with surgery (D&C).

What can I do to improve the chances of a healthy pregnancy after a miscarriage?

Remember, a miscarriage is not your fault. There’s nothing you can do to prevent a first-trimester loss.

While you can’t prevent a miscarriage, you can prepare your body for a healthy pregnancy. Be physically active. Nourish your body with whole foods and a balanced diet of carbohydrates, fats and protein. Read more about preparing for pregnancy.

We’re here for you

We’ve talked a lot about how to know if your body is physically ready for pregnancy after miscarriage. But it’s just as important to consider your mental health. Give yourself time to grieve after a miscarriage and seek therapy to help you process your loss. And when the time is right, we’ll be here for you to try getting pregnant again.

Dr. Beth Wiedel, M.D. | Founding partner of Madison Women's Health OBGYN ClinicDr. Beth Wiedel has been providing healthcare to women in Madison since 2002 and is a founding partner of Madison Women’s Health.  She shares the vision of all the partners of being a strong healthcare advocate for her patients, emphasizing compassion and communication throughout her practice.

June 25, 2023/by Dr. Beth Wiedel
https://madisonwomenshealth.com/wp-content/uploads/2023/06/pregnancy-after-miscarriage.jpg 800 1200 Dr. Beth Wiedel https://madisonwomenshealth.com/wp-content/uploads/2017/09/mwh_logo-300x177.png Dr. Beth Wiedel2023-06-25 13:40:462023-06-08 14:43:35Pregnancy after Miscarriage

Recurrent Pregnancy Loss: Causes & Treatments for Multiple Miscarriages

Family Planning, Fertility, Pregnancy

No matter how far along you are in your pregnancy, learning that you have lost your baby can be devastating. When it happens more than once, it can be even more discouraging. You may wonder if you’ll ever hold your baby in your arms.

You aren’t alone.

Recurrent pregnancy loss is when a woman experiences two or more clinical losses before 20 weeks gestation. While up to 50% of recurrent pregnancy losses do not have a clear cause and treatment, there is hope for women who have experienced multiple losses. In fact, there is still a 60-80% chance of conceiving and carrying a baby to full term, even after three losses.

Let’s take a look at what we know about recurrent pregnancy loss, ways to prevent miscarriages, and where you can find support as you seek answers.

How Common are Miscarriages?

Early pregnancy loss, or miscarriage, happens in about 9-12% of pregnancies that have been clinically confirmed by an ultrasound before 20 weeks gestation. The rate of early miscarriages can be as high as 26% for pregnancies that are considered biochemical, that is, the pregnancy was diagnosed only with a urine or blood pregnancy test or not diagnosed at all.

In women 40 and older, however, the rate of miscarriage increases dramatically. Up to 50% of women over 40 experience miscarriage.

When it comes to multiple miscarriages, less than 5% of women under age 35 experience two or more clinical losses, and less than 1% experience three or more.

Causes of Miscarriages

Age & Chromosomal Abnormality

The most common cause of recurrent pregnancy loss is chromosomal abnormalities in the developing embryo due to the age of the mother or father. As people age, the quality of the egg and sperm degrades, resulting in genetic abnormalities that can lead to spontaneous miscarriage.

Treatment: Unfortunately, there is no treatment for aging. However, using donor sperm for intra-uterine insemination (IUI) or donor eggs and/or sperm for in-vitro fertilization (IVF) can be an option. Assisted Reproductive Therapy (ART) can be used to test embryos so that only healthy embryos, free of genetic defects, are transferred.

Anatomy

About 18% of recurrent pregnancy losses can be traced to a uterine abnormality. Abnormal uterine shapes include uterine septum, bicornuate uterus, unicornuate uterus, and didelphic (double) uterus.

The woman may have a septate uterus (or uterine septum), which means a septum, a thin tissue or membrane, divides the uterus. This is the most common uterine abnormality. When a fertilized egg implants on the septum, it doesn’t have enough blood supply to grow properly. A septate uterus can be diagnosed by magnetic resonance imaging (MRI), ultrasound, or hysteroscopy.

Treatment: Septate uterus is treated with an outpatient surgery that cuts or removes the septum. If left untreated, the risk of another miscarriage or preterm labor remains high (67%, according to one study).

Another anatomical cause for miscarriage is uterine fibroids. Uterine fibroids, or leiomyomas, are small tumors or bumps that grow in the uterus. They are usually benign (not cancerous). Fibroids may be diagnosed during a pelvic exam, ultrasound, MRI, hysterosonography, hysterosalpingography, or hysteroscopy.

Treatment: Fibroids can be treated with medication that includes either hormonal or non-hormonal methods. If you have more severe symptoms, surgery may be recommended.

Medical

Some medical conditions, such as thyroid disease, diabetes, blood clotting disorders, immune system disorders, hormonal disorders, and other metabolic disorders, can increase the risk of multiple miscarriages. These disorders could include antiphospholipid syndrome (APS), an immune system disorder that increases your risk of blood clots, and polycystic ovarian syndrome (PCOS), a hormonal imbalance that can also cause other fertility problems.

Treatment: If you have a thyroid condition or diabetes, adjustments can be made to your medication to help prevent future miscarriages. Blood clotting disorders can also be treated with medications such as Lovenox, Heparin, or aspirin, which are designed to thin the blood to prevent clots. Progesterone supplementation, including Prometrium or progesterone suppositories, may be helpful in addressing hormonal issues.

Lifestyle

Obesity, using illegal drugs, drinking alcohol, smoking cigarettes or marijuana, and even drinking too much caffeine (over 300mg/day, the equivalent of one large energy drink) can all increase your risk of miscarriage.

Treatment: Your OBGYN can connect you to resources so you can make the lifestyle changes you need to prepare your body for a healthy pregnancy.

Diagnosing Recurrent Pregnancy Loss

Blood Tests

Blood tests are typically the most cost-effective and least invasive testing options. For that reason, you will most likely undergo a number of blood tests to determine what may be causing your multiple miscarriages.

To determine if you have APS, your OBGYN would run three lab tests:

  • beta 2 glycoprotein
  • lupus anticoagulant
  • and cardiolipin antibody.

A test for diabetes would include the hemoglobin A1C test. A snapshot of your current hormone levels could be taken by testing your TSH and prolactin. If you have a family history of clotting disorders, you may have additional blood tests drawn.

Anatomical Tests

Your uterine cavity can be evaluated by a physical exam, hysterosalpingogram, hysteroscopy, or saline-infused sonohistogram (SIS). Sometimes, but not often, an MRI will be used to get a picture of your uterus.

Genetic Testing

Chromosomal testing can be done on both partners. If the male is found to have a translocation of chromosomes that are then passed on to the embryo, IVF and ART can be used to find an unaffected embryo. If a dilation and curettage (D&C) procedure was done after a miscarriage, the tissue could be tested for chromosomal disorders.

Couples who are diagnosed with genetic disorders may be referred to a genetic counselor. Read more about at-home genetic testing kits.

What if the cause is “unexplained?”

Unfortunately, even after all of these tests have been done, sometimes we simply can’t explain why a pregnancy ended in loss — up to 50% of recurrent pregnancy loss cases remain unexplained. Unexplained losses can be the hardest of them all, because if you don’t know the “problem,” it’s easy to think there isn’t a solution.

Many women still blame themselves, even after they have done everything they could to be healthy and take care of their baby. However, miscarriages are not because of something you are doing wrong. And there really is hope: even after three miscarriages, there is still a 60-80% chance of conceiving and carrying to full term.

When to ‘Try Again’

After a pregnancy ends, you might want to try to conceive again as soon as possible. If you didn’t have a D&C procedure, it is safe to have intercourse as soon as you feel up to it. If you did have a D&C or another procedure like a myomectomy to remove fibroids, you may be instructed to not have intercourse for at least two weeks.

Your body will need some time to “reset” hormonally to prepare for another baby. You will know if your body has “reset” by testing your beta HCG levels. A blood test after a miscarriage will determine your beta HCG level. Once that number is essentially zero, you can start trying to conceive again the following cycle.

However, while your body may be ready to conceive, it’s important to be sure that you are mentally and emotionally ready to try to conceive. Talking to other people who have experienced pregnancy loss can be very helpful. Ask your OBGYN for recommended support groups.

You can also find support for recurrent pregnancy loss at www.bereavedparentsofmadison.com or www.mikaylasgrace.com/resources. https://starlegacyfoundation.org/awareness-month/

At Madison Women’s Health, we will do everything we can to help you carry and deliver a healthy baby. Our OBGYNs and nurses care about you, your partner, and your dreams to hold your child in your arms. We are with you every step of the way.

 

 

October 27, 2021/by Madison Women's Health
https://madisonwomenshealth.com/wp-content/uploads/2021/10/multiple-miscarriages-recurrent-preganancy-loss.jpg 800 1200 Madison Women's Health https://madisonwomenshealth.com/wp-content/uploads/2017/09/mwh_logo-300x177.png Madison Women's Health2021-10-27 09:53:232024-01-23 13:18:23Recurrent Pregnancy Loss: Causes & Treatments for Multiple Miscarriages

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