One of the most distressing aspects of our work as gynaecologists is the management of early pregnancy loss.
Often the awareness is made at a routine scan when the fetal heart is not seen to be beating.
Sometimes this is preceded by a brownish discharge or some abdominal cramping.
One of the most important signs is that the woman no longer feels pregnant.
A very important fact is that usually the woman has done or could have done absolutely nothing to cause the death of her foetus. The pregnancy is a bad one very often a severe chromosomal abnormality and by natural selection has died.
The big debate is what to do next. Should one undergo a surgical evacuation or wait for nature to take its course. We as gynaecologist’s more often than not opt for the surgical emptying of the uterus. The operation is relatively safe (although complication may occur) and it finalizes the event so one can move on. The other advantage is that there is much less risk of infection.
The operation is usually done under general anaesthesia and takes about 15 minutes to do. After the procedure there may be some bleeding and cramping bet that settles fairly quickly.
Afterwards your doctor would probably want to see you. I call it a “debriefing” where we discuss the operation, the outcome, possible causes and most importantly what about the next time.
My plan that I propose and very often do is as follows:
- One can try again whenever. There is very little evidence to show that waiting is of any benefit at all. In fact recent evidence shows the sooner the better.
- Once the pregnancy is suspected an early HCG (pregnancy hormone) blood test should be done.
- If this is positive then I like to do these twice weekly on a Monday and a Thursday. They should approximately double every 2 and half days until the level plateaus.
- I then do a six week scan to try and see a fetal heart.
- As many scans as indicated until we are sure that all is well
Remember that this plan does not improve outcome but does give us peace of mind and will alert us early on if things are going wrong.
More often than not the cause of the miscarriage is never found.
If one has had 3 or more consecutive miscarriages we call this a habitual abortion and we would then instate a number of tests to try and identify the cause.