Everything you need to know about miscarriage
What is the most common week for a miscarriage?
Even though the happiness it represents is immense, pregnancy can also be a source of many apprehensions, sadness and questions. "Are these pregnancy ailments normal?", "What are the symptoms of a miscarriage ?", "What medication can I take?". So many usual questions that everyone asks themselves during these 9 months of intense discoveries. The greatest fear remains miscarriage, defined by the natural termination of the pregnancy before the fetus is viable (it is considered so from 22 weeks of amenorrhea (20 weeks of pregnancy) . Here is what you need to know about spontaneous abortion.
When can you have a miscarriage?
In most cases, miscarriage is said to be early and occurs in the first month of pregnancy. However, it can occur later in the first trimester of pregnancy. A late miscarriage is when a miscarriage occurs between the 14th and 21st week of amenorrhea inclusive, which affects less than 1% of pregnancies. Thus, miscarriages can affect embryos as well as fetuses, since the term "fetus" is used once the embryonic phase is complete, that is, from the 10th week of pregnancy, or the 12th week of amenorrhea .
What are the different types of miscarriages?
There are therefore 3 different types of miscarriage:
- Complete miscarriage : when it is accompanied by blood loss and pain and the symptoms fade after evacuation.
- Hyperalgic miscarriage : when the pain is almost similar to menstrual pain, but more intense. The latter often persists, because the uterus tries to evacuate, via contractions, the last debris. Heavy bleeding and contractions are typical signs of this case.
- Hemorrhagic miscarriage : When vaginal bleeding fails to stop on its own. Surgery is then required to empty the uterus. This is a medical emergency.
What are the causes of miscarriage?
There can be many causes of early miscarriage , but the most common reasons are:
- Chromosome abnormalities in the embryo.
- Uterine malformations.
- Immunological causes.
- Maternal pathologies.
As for late miscarriages, the causes include:
- Chromosomal abnormalities.
- Immunological problems.
- Infectious causes.
- Cervical gaps.
What are the symptoms of a miscarriage?
Early or not, miscarriage usually has the same symptoms, starting with bleeding and pain in the lower abdomen, corresponding to intermittent contractions. Although vaginal bleeding is not always a sign of miscarriage (1/3 of pregnancies include vaginal bleeding during the first trimester), it must be reported without delay to the doctor or health professional who is monitoring the pregnancy. An abdominopelvic ultrasound is necessary to check for the presence of a gestational sac and the heartbeat. Sometimes the gestational sac is present but does not contain an embryo inside, this is called a blighted ovum . As soon as the gestational sac measures more than 2 cm and there is no heartbeat, the pregnancy is no longer able to develop and spontaneous termination of pregnancy is observed.
Sometimes a patient with a miscarriage has no symptoms. Indeed, abdominal and pelvic pain are not always noticed, as is bleeding, which is why some women discover the termination of their pregnancy during a follow-up abdominopelvic ultrasound, without having the slightest suspicion. The healthcare professional present must then show extreme tact in announcing the news. Which, suspicion or not, should always be the case.
What are the consequences of a miscarriage?
In addition to the trauma that this can cause to the body and mind, women who have suffered a miscarriage sometimes develop concerns about their chances of becoming pregnant again in the future . Fortunately, this has no impact on fertility! It is only after 3 consecutive miscarriages that in-depth examinations are carried out in order to determine the possible link they could have between them and thus understand the cause. Repeated miscarriages should always be the subject of special attention from the doctor.
Furthermore, let's not forget the effects that a miscarriage can have on partners , they too must overcome the grief of this interrupted child project.
What treatment in case of miscarriage?
- When a spontaneous abortion has occurred, the doctor does not prescribe any particular treatment. The embryonic tissues will normally evacuate on their own, within the next two weeks. The disappearance of pain and bleeding will confirm that the miscarriage is over. An abdominopelvic ultrasound should then be performed to check that the uterus is indeed empty.
- On the other hand, when the natural termination of the pregnancy is observed (via an abdominopelvic ultrasound) but the miscarriage is not complete, then it is possible that your healthcare professional will prescribe treatment. This treatment aims to accelerate the natural expulsion of the gestational sac, if you do not wish to wait for this to happen naturally. Sometimes, even with this desire, the reality of bleeding and abdominal pain can push you towards this treatment. There is no need to be ashamed of it, this ordeal is difficult and it is human to want to shorten the moment and the suffering. Most often, the treatment in question takes the form of medication, however it can be a surgical procedure, which remains rarer. This option is more reserved for women whose ultrasound performed two weeks after the spontaneous abortion shows that embryonic tissue remains in the uterus, although drug treatment can, again, be proposed.
In addition to drug treatment, psychological support can be of great help. For this, do not hesitate to talk to your doctor or midwife, he/she will probably be able to direct you to a competent person. At the same time, some women find comfort in books dealing with miscarriage without mincing words , or even in films, although they are rarer. Others, on the other hand, prefer to take their minds off things as much as possible. The presence of their loved ones is then key.
Work stoppage in the event of miscarriage
Since January 1, 2024, women who experience a miscarriage in France are entitled to a work stoppage. Previously, as with many work stoppages, they had a three-day waiting period, or salary deduction, for private sector employees, and a one-day waiting period for public sector employees. The provision of the law that came into force provides for the elimination of the waiting period in the event of work stoppage for spontaneous termination of pregnancy . Health Insurance compensation therefore begins on the first day of stoppage and concerns employees, craftswomen, shopkeepers and self-employed professionals, subject to conditions of entitlement. To benefit from it, a medical consultation is necessary, whether it is an early miscarriage or a late miscarriage (or a miscarriage that does not meet either of these categories).
Only a healthcare professional such as a general practitioner, gynecologist or midwife can note the incapacity for work following a spontaneous termination of pregnancy and prescribe a work stoppage for this reason. During the 10 weeks following the medical confirmation of the spontaneous abortion, the woman cannot be dismissed (except in the case of serious misconduct or for another reason making it impossible to maintain her employment contract). In addition, in order to deal with the moral and physical pain caused by the situation, specific support has been available since September 1, 2024. It is aimed at women who have suffered a spontaneous termination of pregnancy and their partners. This specific system brings together doctors, midwives and psychologists. To benefit from it, you must contact a regional health agency (ARS). Midwives can also refer their patients to psychologists as part of the Mon Parcours Psy system , which allows reimbursement of eight sessions per year. This is, again, a limited step forward because the list of approved mental health professionals is restricted.
How to explain miscarriage? Why are some pregnancies, such as late pregnancies, factors that promote miscarriage? How to recover from a spontaneous abortion? Discover below the answers from our experts to guide you through this ordeal , which is certainly difficult to overcome, but which should not prevent you, one day, from becoming the future mother you have always dreamed of.
