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Miscarriage is sadly more common than is often appreciated affecting approximately 1 in 6 pregnancies. Miscarriage also becomes more common with increasing maternal age. Recurrent miscarriage (three miscarriages in a row) is much less common but affects 1 in 100 women.

 

Symptoms of miscarriage

  • Bleeding
  • Crampy pain
  • Loss of pregnancy symptoms

Although any of these symptoms will clearly be worrying they do not mean there is always a problem and very often the pregnancy will continue without complication.

If you do experience any of these symptoms or are otherwise worried the most important test is to arrange a pelvic ultrasound scan. Typically this will be an internal (transvaginal scan) which gives a particularly good view in early pregnancy.

This scan cannot harm your baby or affect the chance of miscarriage. Before 6 weeks from the first day of the last menstrual period it can be too early to see your babies heartbeat. In these circumstances it may be appropriate to do blood tests to measure the amount of pregnancy hormone (HCG) and progesterone. A second test 48 hours later can help show whether hormone levels are rising normally. A second ultrasound scan a week or so later may also be needed.

 

Causes of miscarriage

Evidence suggests that the majority of miscarriages in the first trimester are caused by random chance (typically a chromosome abnormality that occurs at the point of conception) and cannot be predicted or prevented. More rarely (but more commonly in recurrent or late miscarriage) there is an underlying medical problem that can be identified by tests.

 

Treatment of miscarriage

Although it makes sense to be as healthy as possible in terms of diet, weight and exercise most miscarriages are not preventable. In early pregnancy avoiding alcohol and reducing caffeine are also sensible steps. You should also be taking folic acid. If you do start bleeding or have pain then you should seek medical advice but there is no evidence that resting in bed or avoiding physical activity makes any difference to the chance of miscarriage or the amount of bleeding. In women with a known medical problem such as diabetes or thyroid disease it makes sense to optimise treatment before trying to conceive.

Some women have an underlying medical problem that would benefit from specific medical treatment and you should discuss this with Mr Miskry

If miscarriage is confirmed there are a number of decisions to make about what to do.

Often, particularly very early in pregnancy, miscarriage may have been confirmed to be complete on ultrasound scan. In this situation no medical treatment is needed.

Increasingly miscarriage is diagnosed on ultrasound scan before there has been a lot of bleeding (this is sometimes called a ‘missed miscarriage’) and there are then three options:

Waiting for a natural miscarriage – sometimes called conservative management. It can be difficult to predict when heavier bleeding will happen and it can be days or even weeks later. When bleeding does start it is typically like a heavier more painful period. Simple painkillers such as ibuprofen or paracetamol can be very helpful and most women will not need to go to hospital.

Medical management – there are drug treatments that can bring on the bleeding of miscarriage. These have the advantage that a more invasive medical treatment can be avoided and the uncertainty of how long before bleeding starts is removed.

Surgical management – in about 10-15% of times a wait and see or medical management approach is unsuccessful (either because nothing happens or the miscarriage is incomplete) and a small surgical procedure becomes necessary. This is usually performed under a short general anaesthetic using a small suction device. The advantage of this approach is that the timing can be planned and in addition tissue can be sent to the laboratory to potentially help understand why the miscarriage happened.

There are a number of different pros and cons to each approach and advice will depend on your particular situation and concerns. Mr Miskry recommends that following a miscarriage (whichever approach has been taken) it is sensible to do an ultrasound scan immediately after the first period to ensure that there is no retained tissue and that physically the womb has recovered and it is safe to try to conceive again.

Whatever the approach to practical management of a miscarriage, it is always a time of sadness and many women will find it helpful to have the option of counselling.

 

Tests

Women having a surgical approach can have tissue sent to assess the chromosomes (cytogenetics). If this confirms an abnormality then it completely explains why the miscarriage happened which can be very reassuring.

In women with recurrent or late miscarriage there are further blood tests that would normally be arranged – in particular to look for treatable subtle blood clotting disorders.

Further information:

The miscarriage association – www.miscarriageassociation.org.uk
NHS Choices – www.nhs.uk/conditions/Miscarriage

Request an appointment

Clinics are three times a week and Gail will help you arrange a time to see Mr Miskry and if necessary a scan on the same day.

If you are pregnant, you can expect to have a number of routine tests and appointments and you can find out more about the schedule of care here.

Appointments can be arranged by phone or email.

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FAQs

These are some of our most commonly asked questions, but you can see all of them here

Do I need a GP referral for private treatment?

No. However if you have private medical insurance please check with your insurer as they may require a GP referral in order to provide cover.

Where does Mr Miskry see patients?

All clinics are held at 148 Harley Street.

Where does Mr Miskry perform operations?

The Lindo Wing, St Mary’s Hospital and The Wellington Hospital.

If I have a private consultation will this alter my care in the NHS?

No. Your treatment or position on an NHS waiting list will not be affected by having had a private consultation/surgery.

Are tests included in my consultation fee?

Any tests Mr Miskry recommends as part of your care are payable directly to the clinic/lab/hospital where they are carried out and are not part of our fees.