AND PREGNANCY LOSS
loss is a sad and difficult event, no matter how early in
pregnancy it occurs. Even if the pregnancy was not planned
it is often emotionally difficult when it does not continue.
Below is a summary of some causes of loss in each trimester
and some ideas about ways loss might be prevented.
can be related to several factors, including fetal (problems
with the baby), placental (problems with the placenta or
cord which provide nourishment and oxygen to the baby) or
maternal abnormalities (mother’s illnesses, infections
or health conditions). In many cases the reason for a miscarriage
cannot be determined. Miscarriage (also referred to as spontaneous
abortion) occurs in one out of five conceptions; about 90%
of miscarriages happen during the first trimester of pregnancy.
Current thinking is that at least half of early pregnancy
miscarriages happen because the developing embryo (first
eight weeks after conception) is not normal.
most cases, women who experience one miscarriage go on to
have successful pregnancies in the future. Even a second
miscarriage does not necessarily indicate a problem. But
women who have had two or more known miscarriages in the
first trimester, or one miscarriage in the second, may benefit
from a visit with their health care provider before trying
to get pregnant again. There are some tests that can be
done to check for immune disorders, hormone levels, chromosome
problems, clotting factors, and other conditions which appear
to be associated with miscarriage. Even if no clear reason
is found, 60 to 70% of women are able to carry a pregnancy
full term in the future.
cause of second trimester pregnancy loss is cervical incompetence,
also called cervical insufficiency. This may account for
up to 25% of the occurrence of all second trimester miscarriages.
Cervical incompetence is when the cervix (opening of the
uterus) is too weak or too short to stay closed after the
growing weight of the pregnancy begins pushing on it. This
loss usually occurs between the 16th and 24th week of pregnancy,
with the vast majority occurring between 18 and 22 weeks.
Most women have no symptoms prior to being found with a
bulging bag of waters (amniotic fluid sac) in the vagina,
rupture of membranes (gush of fluid from the vagina), or
advanced dilation (opening) of the cervix which results
in the preterm delivery of a baby too young to survive.
Most women first hear the term “cervical incompetence”
after losing a pregnancy in the second trimester.
this has happened to you in the past, there are some things
you should discuss with your doctor or midwife early in
your prenatal care. First, you should make an appointment
as soon as you become aware of the pregnancy. Your provider
can arrange for an ultrasound exam no later than 12 weeks
to determine the length of your cervix as a baseline measurement.
Follow-up ultrasounds may be done periodically during the
pregnancy to check whether the cervix is getting shorter
or beginning to open, or for any other changes. In some
cases it is possible for a doctor to place a cerclage, or
stitch, into the cervix to help hold it together as the
uterus and fetus grow, and this can be done as early as
12-14 weeks of pregnancy. A test for the presence of fetal
fibronectin, which helps to predict preterm labor, may also
be done after 24 weeks.
has not been shown to improve pregnancy outcomes for women
with cervical incompetence but you should discuss this with
your provider. Some women are advised to avoid sexual activity,
as this may cause the uterus to contract or the cervix to
thin. At times, certain medications are prescribed to decrease
uterine contractions. Also, it is important to make sure
you are free from vaginal and pelvic infections throughout
the entire course of the pregnancy.
If in the past you have
given birth to a preterm baby (before 37 weeks), it is important
to discuss this with your doctor or midwife at your first
prenatal visit. There is a new medication, progesterone
(also called 17 P), which is given as weekly injections
beginning week 16 - 20 in pregnancy. 17 P is showing good
results in many cases for prolonging pregnancy in a woman
who has previously given birth to a premature baby.
early miscarriage is more common, tragedy sometimes strikes
even in late pregnancy. This could result from genetic problems,
trouble with the umbilical cord or placenta, or other (often
unknown) events. In these cases there is little that can
be done to prevent the loss.
best way to decrease the chance of losing your pregnancy
is to attend early and regular prenatal care appointments.
You should always report any symptoms such as vaginal bleeding,
leaking of fluid, back pain with uterine pressure or cramping
to your care provider.
some cases, doing regular fetal kick counts can help the
mother to be aware of changes that may not be obvious even
at a doctor visit. If the baby is in distress he/she may
not be as active, or in some cases may become extra-active.
Being aware of your baby’s typical movement patterns,
beginning at week 28 (around the seventh month) in your
pregnancy can give you peace of mind. Abnormal activity
should be reported to your care provider and may be a reason
to go to the hospital for evaluation.
to Do Fetal Kick Counts
down with your feet up or lie down on your left side after
a full meal, when babies are usually most active. Make sure
you are not distracted by television, cell phone or ipod.
Write down the time and start counting your baby’s
movements. After you feel 10 distinct movements, write down
the time again. If you count movements after a meal or during
the time of day when your baby is most active, this often
takes much less than one hour. If you do not feel 10 distinct
movements in two hours, contact your provider or the hospital
where you plan to deliver. It is recommended you do this
daily beginning in the 7th month of pregnancy. This is a
good reason to relax, put your feet up and will also help
reduce swelling in your legs.
Kick Count Record to record your baby’s movements
may be downloaded here.
Sunday, October 14th, you begin counting your baby’s
movements at 7:05 PM. By 7:40 PM you have felt your baby
kick or move 10 times. You would fill in your chart this
to reach 10
a baby dies either before or after birth in spite of the
best prenatal care. This may happen even to women who have
never used tobacco, drugs or alcohol, and who exercised
and ate well. These are tragic accidents. Loss of a child
is devastating for the family. If you experience a loss,
it is important to take care of yourself and seek the help
of loved ones and/or professionals during this difficult
time. You and other family members may suffer from depression.
valuable resources include mental health therapists (may
be provided through insurance), employee support programs,
community mental health clinics or grief services associated
with hospitals. You will have lots of questions and others
who have experienced a similar loss can often help. There
are also some good online resources where you can go for
information and support. Each person’s needs are unique
but it is important to realize you are not alone in your
Missing Angel Foundation
& Infant Loss Support
Support for Trisomy 18,
13 & Related Disorders
Birth and Death Certificate information