Early Pregnancy Loss

Pregnancy loss is a far too common issue and a devastating one, no matter when it occurs in your patient’s pregnancy. Simultaneous miscarriage occurs in 15 percent of known pregnancies and, although it can cause physical symptoms such as cramping and heavy bleeding, its emotional effects can be just as trying for patients as its physical ones.

An early pregnancy loss can occur at 20 weeks or sooner and more often than not, an early pregnancy loss has nothing to do with anything the expectant mother may have done. Rather, it often has to do with the fact that there was an abnormal number of chromosomes when the embryo formed. Because of the abnormal number of chromosomes, the embryo isn’t able to survive. The patient’s age is also a factor in pregnancy loss. About one-third of all pregnancies conceived after the age of 40 result in pregnancy loss.

Detecting Pregnancy Loss

How can you instruct your patients to watch out for the warning signs of miscarriage? The most common signs she will see are bleeding and clotting, along with cramping or pains in her lower back. Not all signs of bleeding signify pregnancy loss, however, so be sure to verify other indicators before coming to a conclusion. Spotting is fairly common in the first trimester; but if she is experiencing bleeding or cramps that resemble menstrual cramps, then action should be taken immediately. Any amount of blood or cramps is enough reason to examine the patient more thoroughly.

Upon encountering the warning signs, perform a pelvic exam to assess whether the cervix is dilated or changed. If the pregnancy is advanced enough to do so, order an ultrasound to detect and monitor the heartbeat.

Responding with Care

After a miscarriage, be sure that the patient has passed all of the fetus and tissue, as infection can occur from residual matter in the uterus. If there aren’t any signs of infection, the patient should wait two weeks for the tissue to pass on its own. If necessary, medicinal aid can be prescribed to encourage complete passage of all tissue. Make sure to remind the patient that symptoms of miscarriage are normal; she will have bleeding during this time, and in some cases, it may be quite heavy. If there is still uncertainty, approach the option of surgical intervention with extreme care. Procedures such as vacuum aspiration may cause internal organ damage, infection and bleeding.

In addition to the physical trauma, pregnancy loss also initiates a strong emotional response from the mother. Be sure to advise her that, in addition to seeking medication attention, she needs emotional support as well. If possible, have trusted resources on hand in your practice to make available to your patient as she recovers from the devastating loss of her pregnancy.

We’re now registering for our Columbus Comprehensive Review, September 19-26, and our Annual Review of Obstetrics & Gynecology in Kissimmee, Florida, October 12-16.