05 Aug Missed miscarriage – the essential facts
A missed miscarriage, sometimes called a silent or delayed miscarriage, can be devastating. You’ve lost your longed-for pregnancy. Your hopes and dreams are shattered. To make matters worse, you probably had no miscarriage symptoms at all.
If you conceived naturally, you may not know you had a missed miscarriage for weeks. But if you had fertility treatment, your pregnancy test was in the diary. Two weeks after the positive test you have an early pregnancy scan. There’s no heartbeat or sign of life. You got the good news early – then the bad news early.
For non-IVF patients, or those who didn’t have an early scan, missed miscarriages are usually picked up at the routine 12-week scan. It’s the day you expected to hear your baby’s heartbeat and to get that first glimpse of movement on-screen. Instead, you’re dealt the bitter blow that your baby hasn’t made it.
It’s normal to think you should have realised something was wrong. But the frustrating and cruel nature of a missed miscarriage is that it happens without you even knowing it. At the beginning of your pregnancy you may have had the usual symptoms, like swollen breasts and morning sickness. Your pregnancy hormones will have kicked in. Your home-pregnancy test was positive and your blood-HCG numbers were looking good. To all intents and purposes, everything seemed fine.
Unlike other miscarriages, where there’s usually an indication something is wrong, a missed miscarriage makes no announcement. No bleeding. No spotting. No pain. Nothing to indicate a problem. You may still feel the elation of your pregnancy. The high levels of HCG in your blood are there because the placenta can still function after the embryo dies.
It’s worth pointing out that a missed miscarriage is different from a blighted ovum. The latter is when the embryo didn’t develop at all and the pregnancy sac is empty. With a missed miscarriage, your embryo did exist. In some ways, that makes it harder to come to terms with. Ignore anyone who says you’ll get over it because it happened early. Not true.
Why does a missed miscarriage happen? Sometimes, the embryo just stops growing (i.e. for no clear reason). There may have been a chromosomal issue, meaning the genetic makeup wasn’t right for your baby to develop. An infection, like rubella, can sometimes cause it.
You then need medical help. After a missed miscarriage the embryo and sac cannot remain in your womb due to a risk of infection. Medical intervention can be as follows:
1. Non-surgical – where you’re given medication in the form of tablets (mifespristone) and/or pessaries (prostaglandin) to start the process of getting your uterus to contract.
2. Surgical – where a procedure called evacuation of retained products of conception (ERPC) is carried out under local or general anaesthetic to remove the remains.
3. Natural – where you wait for nature to take its course and for your body to ‘naturally’ miscarry.
Each approach has its own pros and cons. You’ll be guided by your doctor on which is the most suitable for you.
Like all miscarriages, a missed miscarriage can be devastating and leave you with a profound sense of loss. You and your partner may feel numb, shocked, angry or distressed at what’s happened. Support for women after a miscarriage is out there. Researchers are still debating whether psychological support such as counselling speeds recovery. But it’s important to look after yourself mentally and physically. Take things slowly. Allow yourself time to recover.
One final point. You may feel very alone after your experience. This is normal. Just remember: a missed miscarriage shouldn’t adversely affect your ability to get pregnant again.