One in ten women has had a miscarriage. What are the risks during pregnancy? What are the typical symptoms and pains? All the answers with Dr. Thierry Harvey, gynecologist-obstetrician and Adélie Michau, gynecologist specializing in high-risk pregnancies.
What is a miscarriage?
A miscarriage is a pregnancy that ends spontaneously. Miscarriages affect about 20% of pregnancies, ie one in five pregnancies end in this way. “It is therefore an extraordinarily frequent event. It occurs most often between the 8th and 9th week of amenorrhea. It is often detected during the first ultrasound of pregnancy, without any symptoms.“, explains Dr. Thierry Harvey, gynecologist-obstetrician and head of the maternity department at the Hôpital des Diaconesses, in Paris.
What causes a miscarriage?
If miscarriages are very frequent, especially in early pregnancy and can affect all women, certain factors increase the risks:
- The age of the future parents. Lhe age of the mother is generally the cause of miscarriages caused by genetic abnormalities of the embryo, explains Dr Adélie Michau, gynecologist and specialist in high-risk pregnancies. If very young women, i.e. under 30, have a low risk of miscarriage, between 10 and 15%, the latter increases to 30% at 39 and even reaches 75% for women aged 42 years old. In question: the oocytes, more and more deteriorated as time goes by. Indeed, women are born with a certain number of oocytes, and over time, “the structure that organizes the genetic material of the remaining oocytes is degraded”. If these abnormalities are responsible for miscarriages, they are sometimes viable, such as trisomy 21.”To reduce the risk of miscarriage, women need to know that the best time to have a child is between 25 and 35 years old, and that after 40 it’s more difficult. It’s physiological, their body functions optimally between the ages of 25 and 35, so the risk of miscarriage is lower.” completes Dr. Thierry Harvey.
- The weight. A very low (-18) or too high (25 or more) body mass index (BMI) can also prevent the pregnancy from being carried to term.
- Previous miscarriages. Unfortunately, having experienced a miscarriage can predict an increased risk of having others. Indeed, the risk increases by about 10% for each additional miscarriage, reaching 42% in women who have had three or more miscarriages.
- Tobacco and alcohol. We keep repeating it to pregnant women and for good reason, consuming tobacco or alcohol during pregnancy increases the risk of miscarriage. As well as excessive consumption of coffee.
- The environment. Other environmental factors also impact. Thus, a woman subject to significant stress, working at night, highly exposed to air pollution or pesticides can also be the victim of a miscarriage.
- Chromosomal and embryonic abnormalities. Chromosomal abnormalities such as autosomal trisomy are found in 60% of miscarriages but in less than 1% of live births. Similarly, abnormalities in the development of embryos are frequently observed during miscarriages.
- A disease that promotes miscarriages. Autoimmune diseases for example, but also poorly controlled diabetes or thyroid disease can be a cause. Likewise, an untreated coagulation defect (thrombophilia), or a bacterial cervico-vaginal infection (vaginosis, sexually transmitted infection).
- Bacterial infections. Infections such as herpes, papillomavirus, HIV, dengue fever, hepatitis B and C, rubella, Covid-19, malaria or even toxoplasmosis also increase the risk of miscarriage.
What are the symptoms of a miscarriage?
The bleeding in early pregnancy are common whether the pregnancy is going well or not. Similarly, some women will experience pelvic pain, others will not. There are no symptoms unique to miscarriage. In all cases, it is the ultrasound which makes it possible to confirm the end of the pregnancy. For a very recent pregnancy, it is necessary to carry out a blood test for betaHCG, specifies Doctor Adélie Michau, which the gynecologist can complete some time later with an ultrasound, the cardiac activity not being visible at the very beginning of pregnancy.
What are the risks of having a miscarriage?
A bad lifestyle
There are also exogenous factors, favoring miscarriages. Thus, a lifestyle and nutrition are to be closely monitored, by opting as soon as possible for healthy and balanced meals, just as in terms of lifestyle are to be adopted as soon as the pregnancy is announced. The daily overconsumption of coffee should be reviewed, especially if it is coupled with the intake of aspartame, and obviously, no unpasteurized raw milk cheese. And even more than reason, smoking, drinking, or taking drugs should be totally banned. In the event of addiction, do not hesitate to talk to your gynecologist about it, for personalized follow-up and support, conducive to the smooth running of the pregnancy. Also note that theenvironment can also be a risk factorsuch as repeated contact with bisphenol A.
In addition to age and lifestyle which are important factors, the management of bacterial infections can also help:Screening is important. By treating vaginosis, for example, we can prevent it from inducing a miscarriage later on.“, says Dr. Harvey. Other infections, like toxoplasmosis – that we check each month of pregnancy in case of non-immunity – or listeriosis, can cause miscarriage. Furthermore, there is no proven medical treatment for decrease the risk of spontaneous miscarriage. A study compared the effect of aspirin, which has often been said to be effective, with a placebo; result: no decrease or increase in the number of miscarriages.
Do sports and transport pose a risk of miscarriage?
Dr. Thierry Harvey returns to a received idea: “We must stop saying that sport increases the risk of miscarriages : it’s wrong. Likewise, the car, the plane, the subway, the motorcycle, the train, the vibrations on the pavement absolutely do not lead to miscarriages. Anyway, a long drive with a pregnant woman is not possible: she has to stop every two hours to pee!” On the other hand, “in case of bleeding in early pregnancy or membrane abruption (and not of the placenta), you must be careful and rest to allow the hematoma to coagulate“, he warns.
Late miscarriage: what follow-up?
We distinguish on the one hand the miscarriages of the first trimester of pregnancy, called early (before 3 months), and on the other hand the second trimester miscarriages (before 5 months). In the event of a late miscarriage, a complete medical check-up will be carried out through an interrogation, to know the gynecological history, a clinical examination, an ultrasound or pelvic MRI to detect possible uterine malformations, and a vaginal swab for a bacterial investigation.
There are many pains associated with miscarriage. In general, they are manifested by bleeding, uterine pain such as contractions, lower back pain or cramps in the lower abdomen. If the pain is intense, it is recommended to go directly to the nearest emergency room, where the medical team will take care of the rest of the process. Otherwise, and for many early miscarriages, these are asymptomatic, or said to be silent. For many women, they occur in the toilet, and even if the physical pain is moderate, the phenomenon can be traumatic.
How long does a miscarriage last?
When the body considers that the embryo is not viable, it interrupts the pregnancy process itself, especially in the case of chromosomal abnormalities. This is where the miscarriage comes in, but between the stoppage of the development of the embryo and its elimination, several days may pass before its voluntary expulsion. To cause it quickly, physical activity such as walking or running may be appropriate. In case of curettagethe intervention in the operating room lasts about twenty minutes, and the hospitalization half a day.
What to do after a miscarriage?
Are miscarriages common?
First trimester miscarriages are common, especially in the first pregnancy, but not serious for the woman. “Without denying the miscarriage, there is no need to do tons of examinations after a single miscarriagee,” says Dr. Harvey. Second trimester miscarriages are more rare, but can take place after a first ultrasound at 2 and a half months. “In this case, examinations can take place to look for a cause, but after a single miscarriage it is not systematicadds the gynecologist. It also depends on the woman, her personality, her age, etc..”