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Saturday, November 19, 2011

Early Pregnancy Loss

Pregnancy is an emotional roller-coaster under the best of circumstances, but when you add some problems with bleeding early on, every woman will wonder "am I having a miscarriage."  Sometimes, the person is already emotionally invested in the pregnancy and has told multiple friends and family, so if an early pregnancy loss occurs, that attachment and connection with family can double the pain.  
Pregnancy loss in the first trimester can happen in 20% of all recognized pregnancies. Most will occur before 13 weeks, and actually, the majority will happen prior to 8 weeks. Some women won't even recognize that they are pregnant, believing that their menses has just come a little late and is heavier than normal for them when in actuality, it is a very early pregnancy failure.  The cause of such early losses is thought to be largely due to chromosomal problems in the developing embryo.  This does not usually mean that the woman or her partner have a genetic disorder (although it can signify that such a problem exists in rare cases).  Typically, it is a random event in nature whereby the tissue was not going to develop properly into a baby that can survive, and miscarriage is nature's way of disallowing the pregnancy beyond a very early phase of life.  The chance of early miscarriage due to chromosomal problems increases with increasing age of the woman.
Other factors can put a woman more at risk for pregnancy loss prior to the second trimester including untreated thyroid disease, diabetes, high blood pressure, and rheumatologic or autoimmune diseases like lupus.  Clearly, most women who seek to have a baby despite having any of those diagnoses can do so without a miscarriage, but the risk does increase nevertheless.
The signs of early pregnancy loss include bleeding and cramping; but some women will have absolutely no clue that their pregnancy has arrested in development until long after the event occurs.  Typically, a woman will miss her regular menses, which will prompt her to do a urine pregnancy test at home.  She would then begin the process of initiating a doctor's visit to confirm the positive result and date the pregnancy.  The gestational age is based on the first day of the last menses, and there are online pregnancy calculators to help figure that out.  Usually at around the 8th to 10th week of gestation, the woman is having her first health provider visit including a physical exam to determine the uterine size and potentially listen for a fetal heartbeat with a Doppler device.  If the gestational age is supposed to be over 10 weeks, but no heart beat is located, an ultrasound can be done to look for a heartbeat in the developing embryo.

The hardest thing in the world is to be the one holding that ultrasound and having to tell an expectant mother and her partner that the pregnancy has ended...the tears might not come immediately, but the grief process for early miscarriage of pregnancy is exactly the same as for other losses of life for many couples.  It is important to offer grief counseling to couples going through this emotional time and to be sensitive to their issues. 

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