Your TTC Strategy 9: Understand Pregnancy Loss

The anticipation and thrill of a positive pregnancy test, a heartbeat on ultrasound, or the first fleeting sensation of the baby's movement can sometimes be followed by emotional devastation of pregnancy loss rather than the joy of the birth of a healthy baby. Often women are unaware of the possibility of having a pregnancy loss and are caught off guard when one occurs.

The truth is that pregnancy loss is much more common than the birth of a healthy baby, but fortunately, most of these losses occur before a woman suspects she might be pregnant. It has been estimated that 60 percent of couples achieve a pregnancy each month that they try, but two thirds of the pregnancies fail to continue. Once a woman misses a period and has a positive pregnancy test, there are an additional 20 percent of pregnancies that are lost.

Miscarriage is the general term for the loss of a pregnancy before 20 weeks. The earliest type of pregnancy loss is called a "chemical pregnancy," when a pregnancy test may be transiently positive, but a period begins as usual.

Some women experience signs and symptoms before a miscarriage occurs; others do not. Some of the signs that a miscarriage may be about to start are:

• vaginal spotting or bleeding
• a decrease in breast tenderness or fullness
• an absence of fetal movement, heart sounds, or heart motion on ultrasound.

Cramping and vaginal bleeding are signs that a miscarriage is occurring.

If you do begin bleeding, it is very important to call your doctor and to keep track of the amount of bleeding that occurs. If tissue is passed, try to save it. Many doctors will want it for laboratory evaluation to help determine the cause of the miscarriage.

If you have symptoms of a possible miscarriage, your health care provider may measure and monitor progesterone and hCG levels as well as perform a pelvic exam and an ultrasound to assess the status of the pregnancy. Unfortunately, there is no way to prevent a miscarriage once the process has started.

If the miscarriage is complete and the uterus is clear, then no further treatment is required. Occasionally, the uterus is not completely emptied, so a dilation and curettage (D&C) procedure is performed to remove any remaining fetal or placental tissue.