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Natural Miscarriage

Osher Ben Or, Certified Midwife
13 June 2024

Approximately one-third of pregnancies end in a natural miscarriage. For some women, the miscarriage happens spontaneously, and occasionally, they may not even recognize that they have experienced a miscarriage, mistaking it for a late period or heavier bleeding. Some women will need medication treatment or curettage to empty the undeveloped pregnancy tissue from the uterus. The treatments for a natural miscarriage are safe and practically complication-free. In a short time, you will be able to try and get pregnant again. In most cases, a healthy pregnancy occurs after a miscarriage.

If you are experiencing bleeding, it is advisable to seek medical consultation. However, it is important to note that bleeding does not necessarily indicate a miscarriage. If you have undergone two consecutive natural miscarriages, consider seeking medical advice regarding recurrent miscarriages.

A natural or spontaneous miscarriage occurs in about a third of pregnancies. 35% of women experience a natural miscarriage during their fertility years. In many cases, women may not even realize that they have experienced pregnancy because of a natural miscarriage, which will be felt as a slight delay in menstruation or heavier bleeding than usual. This is also called chemical pregnancy.

It is important to note

It is important to note

In most cases, miscarriage occurs for reasons we cannot control. Therefore, physical activity, work, stress, arguments, sexual relations, and more do not lead to a miscarriage, and you should not feel guilty when a miscarriage occurs.

A natural miscarriage is defined as a pregnancy loss until the 22nd week of pregnancy (prior to the stage when a fetus can survive on its own, which is also called the threshold of viability), as most miscarriages occur in the first trimester of pregnancy. Usually, a healthy pregnancy occurs after a miscarriage. Therefore, in most cases, there is no need to find out the reason for the miscarriage. If you have undergone two consecutive natural miscarriages or if there was a cessation of fetal heartbeat after the 10th week, it is recommended to seek further medical consultation regarding recurrent miscarriages.

Reasons for a natural miscarriage

In the first trimester, it is usually a fetal chromosomal problem that leads to a cessation of development. There are additional factors that may have an effect, including the mother’s age, the age of the father, obesity, smoking, drug abuse, overconsumption of caffeine and alcohol.

If a miscarriage occurs in the second trimester, medical conditions such as diabetes, hypertension, lupus, renal illnesses, or thyroid dysfunction may also be the cause of miscarriage.

In rare cases, infections and illnesses, including rubella and specific viruses, may also cause a miscarriage. Furthermore, factors such as the structure of the uterus, scars on the endometrium, or benign tumors can also cause a miscarriage in the second trimester.

Bleeding in the first trimester

Usually, bleeding is the first symptom of a pregnancy that does not develop well. However, it is essential to remember that bleeding is also a common phenomenon in the first trimester of pregnancies, and a healthy pregnancy can develop even with bleeding. In the event of bleeding, pain, pressure, or contraction in the lower abdomen, seek medical consultation.

Delayed miscarriage

Delayed miscarriage is a condition where the pregnancy has ceased to develop. Typically, during a routine ultrasound examination, retrained products of conception are observed in the uterine cavity, but the fetus no longer exhibits a heartbeat. You may sense that the pregnancy has not progressed, or there might be clues such as mild bleeding, lower abdomen contractions, or a reduction in pregnancy symptoms, such as the cessation of nausea and vomiting.

A miscarriage can be treated using one of three methods. Each of them has pros and cons. The appropriate method will be recommended according to your medical and emotional state:

  1. Waiting for a natural miscarriage: generally, it is not recommended to wait too long because a long wait may cause a uterine infection. If you decide to wait for a natural miscarriage, make sure there are no signs of infection. After the miscarriage, it will be necessary to verify that the uterus is indeed completely empty. If bleeding is heavy and prolonged, or if you experience severe pain, seek medical attention at a gynecological emergency room.
    In cases where the uterus retains products of conception after a natural miscarriage or if bleeding does not subside, it may be necessary to complete the treatment with a curettage.
    The process of natural emptying of the uterus can take several weeks. Some women find it difficult to cope with the feeling of carrying a pregnancy that is not developing. It is perfectly acceptable to choose not to wait for a natural miscarriage.
  2. Medication treatment with a medicine called Cytotec. This medicine induces uterine contractions until the uterus expels the products of conception. This treatment is successful in 80% of cases and has a higher success rate the earlier the pregnancy has ceased to develop. If the medication treatment is not entirely successful, it may be necessary to complete the treatment with curettage.
  3. Curettage is a medical procedure conducted under full anesthesia. During curettage, the products of the pregnancy are removed from the uterus, in a relatively short surgical procedure. Afterwards, you will stay to rest for 2-4 hours as an outpatient. It is likely you will be advised to rest for two or three days. Curettage is considered a safe medical procedure with very low risks of complications.
    Following anesthesia, you may experience nausea or vomiting. You may also have pain and uterine or vaginal contractions, and it is considered normal to have mild to moderate bleeding for about two weeks.

Returning to normal after a miscarriage

Unless a medical professional recommends otherwise, you can resume your routine within two or three days following a natural miscarriage. It is normal to experience mild bleeding and contractions during this time, and these symptoms should gradually resolve. After a few days, you can gradually return to physical activity and your regular routine. Consult the attending medical professional who took care of you about sick leave for the admission day and additional rest and recovery before returning to work.

Resuming sexual activity and conceiving after a miscarriage

After a miscarriage, it is recommended to refrain from sexual activity for at least a week. If the bleeding has not stopped, you should wait even longer. Before you resume sexual activity, make sure there has been no bleeding for at least two days.

The first ovulation after a miscarriage typically occurs within two to four weeks. It is generally recommended to wait for the first menstruation after the miscarriage before attempting to conceive again.

The emotional impact of a miscarriage

Experiencing a miscarriage, regardless of the method, has emotional repercussions alongside its physical effects. Studies have shown that a significant number of women undergo depression following a miscarriage. It is important to recognize that this is a normal and common experience. Post-miscarriage depression stems from various hormonal changes within a short timeframe. You may experience challenging sensations such as sadness, mourning, anxiety, guilt, fear, and shame. If you need to talk to someone, do not hesitate to seek assistance. Reach out for professional mental support, both before and especially after a miscarriage.

In addition, it is crucial to keep in mind that your partner has shared the loss of the pregnancy with you. Therefore, being attentive to your partner's emotional well-being is important, and addressing any difficulties that may arise is essential.