When most people think of pregnancy loss, they automatically think ofmiscarriage. Miscarriage is the most common type of loss but it is notthe only one. Ectopic pregnancy, stillbirth and neonatal death fallinto the same category also. Regardless of what type of loss you havesuffered, the death of a child can be one of the most devastatingevents in your life. Unfortunately it is a common event. About 1 in 5women suffer a pregnancy loss. Many of these occur before the woman iseven aware that she is pregnant. Regardless of when it occurred, it isstill a very heartbreaking experience. It causes you to lose faith inyour body and its ability to function properly. You feel let down,cheated somehow. For many women, it is a difficult experience toovercome.

SIGNS & SYMPTOMS OF MISCARRIAGE

If you are at all concerned about anything you may be experiencing with you pregnancy, contact your doctor immediately. A miscarriage can be prevented if the baby is healthy and the problem is caught in time. Some common signs of miscarriage are:

• Bleeding, especially bright red blood
• Abdominal / pelvic pain
• Sudden backache
• Sharp, one-sided pain in the lower abdomen
• Sharp pain in the neck or shoulder
• Passing blood clots or tissue
• Excessive nausea or vomiting
• Severe headache
• Pregnancy symptoms suddenly vanish
• Fever
• Fainting
• Rupture of membranes
• You have not felt your baby move recently
• You are experiencing regular contractions and your due date is a long way off

If you experience any of these symptoms, call your doctor immediately.

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WHAT YOU SHOULD DO IF YOU EXPERIENCE SYMPTOMS

If you experience any of the above listed symptoms or you are concerned about your pregnancy for any reason, call your healthcare provider immediately or go to your local emergency room. If you are in the early stages of pregnancy, these symptoms may also indicate an ectopic pregnancy which can be life-threatening if left untreated.

What will happen when you go to your doctor? It will vary depending on how far along you are. If you are early in your pregnancy, your doctor will want to run serial quantitative hCG (human chorionic gonadotropin) panels. The hCG panel checks your actual levels of hCG in your bloodstream. This panel may be rechecked every 48 hours. In a healthy pregnancy, your hCG levels will double approximately every 48 hours for the first few months of your pregnancy. If your levels are not doubling in this time period, it may indicate an impending miscarriage. If your levels are increasing but suddenly plateau you may have an ectopic pregnancy. Many ectopic pregnancies plateau around 1,500 mI/U. Symptoms of an ectopic pregnancy are usually obvious by 8 weeks into the pregnancy and can be life-threatening. If your hcG levels fall in the course of testing, then you are experiencing a miscarriage. Your doctor will also want to do a pelvic exam. He will want to check your cervix and palpate your uterus, uterine tubes and ovaries. If you are experiencing sharp, one-sided abdominal pain he will feel for masses in the uterine tubes and ovaries to rule out the possibility of an ectopic pregnancy. An ultrasound will be done to look for a viable pregnancy. In an early pregnancy, a viable pregnancy is any pregnancy that has implanted properly in the uterus and is developing normally. Always remember that bleeding, cramping, etc is not a good sign during pregnancy. However, it does not necessarily mean that you will miscarry without a doubt. Sometimes a few weeks of bedrest can help your pregnancy progress. No matter what happens, always check with your doctor is you are concerned.

If your baby has suddenly stopped moving or you are experiencing other symptoms during the second half of your pregnancy, your doctor will want to check your cervix to see if you have begun to dilate. If you have begun to dilate, it is possible that you are going to miscarry or have your baby prematurely. A baby has a chance at survival if she is born after 25 weeks. If you have not begun to dilate but are experiencing other problems, your doctor may simply put you on bedrest until the symptoms subside or may treat you with medications to prevent a premature birth. Your doctor will do an ultrasound to check for a heartbeat and to look for any fetal abnormalities. If a heartbeat is found and everything checks out normal, you may be put on bedrest temporarily until your symptoms are no longer a problem. If a heartbeat is found but you are concerned because your baby is not moving as much as she used to, your doctor may order a fetal nonstress test. This test measures the baby's heartbeat in reaction to fetal movement using an external monitor that fits around your belly like a belt. If no heartbeat is found, then sadly your baby has passed. Your doctor will be able to discuss your options from here.

As with any devastating medical diagnosis such as an inevitable miscarriage or death of a fetus, a second opinion is always justified. If you trust your doctor and are confident in his findings, then by all means, no second opinion is necessary. But if you feel uncomfortable with your diagnosis, go with your gut instinct and seek a second opinion.

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TREATMENT OPTIONS FOR MISCARRIAGE

If the doctor determines that your baby has already passed away, there are several things that can happen. The course of action depends on how far along you are.

There are three types of miscarriages that you can experience. The first is termed an incomplete abortion (doctors refer to miscarriages as abortions or spontaneous abortions). In an incomplete abortion, part of your baby and placenta remains in your uterus. Your doctor will need to perform dilatation and curettage (D & C) or dilatation and evacuation (D & E). Another type of miscarriage is termed a complete abortion. In this case, the fetus has been expelled on its own from the uterus. There is usually no further treatments for this type of miscarriage. The last type of miscarriage is termed a missed abortion. This is when your baby remains completely intact in your uterus. If your body does not expel it on its own, you will need to have a D & C or D & E to remove it. If a missed abortion is left untreated and tissue is left in your uterus, infection and sepsis can occur, which can be dangerous to your health.

If your body is able to expel the baby on its own, it usually takes 3-7 days to occur. During a miscarriage, you will probably bleed heavily and pass many clots and tissue. You may also experience severe cramping. If you do not miscarry on your own, your best option is to have a D & C or D & E. With either of these procedures, your will be put under anesthesia. Your cervix will be dilated and your uterus will be suctioned to remove any remaining tissue. This is usually done on an outpatient basis and physically, you will be able to return to work and normal activities within a few days. Emotionally, your recovery time will be much longer and for many, can be indefinite. If you are over four or five months along when a miscarriage occurs, your body may go into labor on its own or your doctor may have to induce labor.

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CAUSES OF MISCARRIAGE

Chromosomal abnormalities are responsible for a large percentage of miscarriages. When an egg is fertilized, it contributes 23 chromosomes and the sperm contributes 23 chromosomes alike to make 23 pairs. If either the egg or sperm donates abnormal chromosomes or too many or too few chromosomes, it can create an embryo that is not capable of developing properly or sustaining life. Many times a chromosomal abnormality will be fatal for the baby. This is nature's way of keeping a species strong. Some chromosomal abnormalities can still produce a baby that will survive. Down Syndrome is an example of this. In this abnormality, there is a third chromosome in one of the pairs.

Sometimes hormonal imbalances can cause a miscarriage. Low progesterone levels can cause a miscarriage, even if the baby is healthy. Your doctor can supplement these imbalances with hormone injections if the problem is caught in time.

There are many diseases that can affect your ability to carry a baby to term. Diabetes, lupus, rheumatic heart disease, kidney disease and sickle cell anemia are just a few examples of diseases that can put you at risk. Tell your doctor of any medical conditions you may have or are at risk for when you go for your first pre-natal visit. If your doctor is aware of your condition, he can take steps to help prevent miscarriage.

Abnormalities with your uterus and cervix can cause miscarriage. Excessive scar tissue or lesions in the uterus can put you at risk for a miscarriage. Cervical problems can prevent your body from carrying a baby to term as well.

Infections can be dangerous and may threaten a pregnancy if not treated properly. If you suspect an infection, see your doctor immediately.

Alcohol and drug use can certainly put your pregnancy at risk. Anything that you expose your body to, you are also exposing your baby to. Drugs and alcohol can also cause severe birth defects. It is wise to cut out these substances while you are pregnant.

Women in their forties have an increased risk for miscarriage.

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RECURRENT MISCARRIAGES

Some women miscarry continually, never able to carry a pregnancy to term. About 50% of these women experience miscarriages because of a medical condition, such as disease or chronic infection. The other 50% experience this phenomenon without cause. The more miscarriages your body experiences, the greater your risk becomes for future miscarriages. If you have had three or four miscarriages, your doctor should look into why this is a chronic problem for you. Discuss your options with your doctor. There are things that you or your doctor can do to help minimize your risk for future miscarriages.

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ECTOPIC PREGNANCY

An ectopic pregnancy occurs when a fertilized egg implants somewhere other than the uterus. Most often, it will implant into the lining of the uterine tube. The uterine tube is too small to support a pregnancy. The result can be a ruptured tube and the loss of your baby. Listed below are several factors that can put you at risk for an ectopic pregnancy.

• Previous history of an ectopic pregnancy
• Sexually transmitted diseases
• History of infertility
• Smoking

There are two treatment options for ectopic pregnancies, drug therapy and surgical intervention. The method of treatment depends on how far along you. Ectopic pregnancies can be very dangerous if left untreated. It can even cause death. Here are some warning signs that may indicate that you are experiencing an ectopic pregnancy.

• Sharp, one-sided pain in your lower abdomen
• Bleeding
• Feeling faint
• Severe backache
• Fever
• Pain that radiates down one leg
• Excessive nausea and vomiting

If you experience any of these symptoms, contact your doctor immediately.

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STILLBIRTH

Stillbirth occurs when a baby dies before she is born. It can happen anytime during the third trimester or as a result of complications during labor. Sadly, most of the babies that are lost to stillbirth were perfectly healthy. The causes of their deaths are usually related to umbilical cord or placental problems. In some cases, disease or congenital abnormalities are to blame.

If your baby died prior to labor, you will have the following treatment options:

• You can wait to go into labor naturally. Be aware that your body may take weeks to go into labor on its own. This can pose serious health risks to you if you carry your baby for an extended period of time after her death.
• Your doctor can induce labor. This is the most preferred method. Some couples prefer to witness the birth of their baby and spend time with her after she is born. This helps some people through the grieving process.
• You can discuss the option of a cesarean section with your doctor. Many women are so shattered by the death of their baby that they do not want to be awake when the baby is delivered. They think it will be harder on them emotionally to witness the birth of their deceased baby.

You need to decide which option is best for you and your emotional well-being. Your doctor may be able to share experiences of other women to help you decide what is best for you.

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NEONATAL DEATH

Neonatal death is the death of your baby after she is born. Sometimes this can be the result of chromosomal abnormalities, illness or SIDS (Sudden Infant Death Syndrome). It can occur within a few minutes after birth or even weeks or months later. If it is a result of severe illness or chromosomal abnormalities, the parents are usually aware of it before the baby is even born. As the name denotes, Sudden Infant Death Syndrome is very sudden and unexpected. Unfortunately, the cause of SIDS has yet to be discovered. Doctors strongly recommend you have your baby sleep on its back to reduce the risk of this devastating event.

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SUDDEN INFANT DEATH SYNDROME (SIDS)

As the name denotes, Sudden Infant Death Syndrome is very sudden and unexpected. Unfortunately, the cause of SIDS has yet to be discovered. This is something that all mothers worry about. Unfortunately there are no warning signs that this may occur. There are a few things you can do to help lower the risk.

• Do not smoke around your baby.
• Do not allow your baby to sleep on her stomach. Always have her sleep on her back.
• Do not use pillows or sheets that can entangle your baby in her crib.

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HOW TO COPE WITH THE GRIEF

An important part of recovering from the loss of your baby is to allow yourself time to mourn. It is not an overnight recovery. An important thing to remember is that it is not your fault. Do not blame yourself for what has happened. Many people will try to look for something to place the blame on. Unfortunately, many times it winds up being on themselves. They blame their bodies for letting them down, for not doing what it was supposed to. They also go over the events of the past few weeks wondering what it was exactly that brought this on. Was it from hiking too long or exercising too vigorously or from that one beer that you drank? A miscarriage usually occurs because there is something wrong with the baby and it is nature's way of letting you know something was wrong. Just remember that sometimes things happen for no reason and no one is to blame.

You will need to build a support network, if you do not have one already. Many women feel alone and do not feel comfortable talking to family or friends about the death. They think that no one understands and that they are the only ones on the planet who have experienced this horrible event. If you find yourself in this situation, find women who have been through an infant death. You can look around in your community for support groups or get online and find one. Visit our pregnancy loss message board or follow one of the links below.

Coping with the Emotional Aspects of Pregnancy Loss
Grief-Support Site for All Types of Child Loss
Pregnancy Loss
Ectopic Pregnancy - A Comprehensive and Compassionate Information Resource
Stillbirth Service Program
SIDS Network

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