WOMENS-HEALTH Messages for July, 1997: Re: Another Miscarriage

Re: Another Miscarriage

From: D. Ashley Hill, M.D. (anonymous@obgyn.net)
Thu, 31 Jul 1997 23:08:14 -0500 (CDT)

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Previous message: D. Ashley Hill, M.D.: "Re: Post Endometrial Ablation Pain"
In reply to: jamie: "Another Miscarriage"

At Thu, 31 Jul 1997, jamie wrote:

I found out last >Wednesday that I was pregnant again, and exactly one week
>later(yesterday) I had another miscarriage. I was going to be 6 weeks
>today. The doctor seems to think that two miscarriages in a womens life
>is very common. I would like to know if this would be true.

Jamie-

I'm sorry that you have suffered another miscarriage. Losing a pregnancy is always difficult, and the issues you bring up must make your pain even worse. Let's go through them one by one. First, since about 1/2 of all pregnancies end in miscarriage (either the silent type where the woman didn't even know she was pregnant, or the type you had where there are symptoms), it is entirely reasonable to expect a normal, healthy woman to have had 2, or even more, miscarriages. In the past a woman was called a "habitual aborter" (the medical term for miscarriage is spontaneous abortion) if she had 3 or more miscarriages in a row. She was then offered an evaluation to determine the cause. Since women are now often waiting until they are older to get pregnant, many of us offer an evaluation after a couple of 1st-trimester losses, or after 1 2nd- or 2rd-trimester loss.

You have had a 14 week loss, which would cause me to institute a medical evaluation, including some specialized blood tests, an x-ray or ultrasound of the uterus, and perhaps a chromosomal determination of both parents. This will determine the cause in about 50% of cases.

Plus the >doctor said that I probably wouldn't need a D&C since I was so early. Could someone please tell me if it is really safe to wait that
>long. I don't want to hemmorage.

There are many common myths associated with miscarriages, and 2 of them are that you must have a D&C (dilatation and curettage) to "clean things out", and that awaiting spontaneous passage of the remaining placental tissue will lead to hemorrhage. In fact, neither are necessarily true. Hemorrhage seems to be very unusual (I can recall seeing only 1 such case, and the bleeding wasn't even that severe) and spontaneous passage is usually medically preferable to a D&C, since a D&C can, in rare circumstances, lead to complications like infection, scar tissue formation, incompetent cervix, and even hemorrhage. Most miscarriages before 6 weeks gestational age and after 14 weeks are complete, while those in between often require a D&C. For psychological reasons many patients will not await spontaneous passage, and ask for a D&C. In other cases an early D&C may allow for chromosomal evaluation of the placenta.

I would suggest that you discuss your concerns with your doctor. Having a 2nd-trimester loss is certainly cause to consider an evaluation, unless the cause was obvious. I'm sure I speak for everyone here at the forum in wishing you success in having a baby, and in healing from your losses.

--
Ashley Hill
D. Ashley Hill, M.D.
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Orlando, FL
dahmd@gate.net

Previous message: D. Ashley Hill, M.D.: "Re: Post Endometrial Ablation Pain"
In reply to: jamie: "Another Miscarriage"

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