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Dr Sarah Temple
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A family doctor with more than 20 years experience working with children in both General Practice and Mental Health Services. Trained to run Emotion Coaching Parenting Courses. She has a special interest in the link between child and parental wellbeing.
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Antenatal Care

Miscarriage, Recurrent Miscarriage & Ectopic Pregnancy

It can be helpful to understand the symptoms and risks of miscarriage, recurrent miscarriages, and ectopic pregnancies.
Video Tutorial
In Short
Around 1 in 4 pregnancies end in miscarriage.

Recurrent miscarriage means 3 or more miscarriages in a row - a disorder that affects 1-2% of couples.

Around 1 in 80 pregnancies are ectopic - which means the pregnancy occurs outside the womb - usually in the fallopian tubes.

Miscarriage, Recurrent Miscarriage, and Ectopic Pregnancy

Miscarriage is extremely common, perhaps as many as one in four of all pregnancies end in a miscarriage. It is particularly hard to be trying a long time for a pregnancy, find exultantly that you are pregnant and then have it all go away. Our society does not acknowledge most miscarriages very seriously, but for a couple, it can be devastating. Many women who have had miscarriages remember and mourn each year on the date when that loss occurred.

There are many different ways for miscarriages to occur. Some will have pain, either minor or strong. Some will have very heavy bleeding, others may have light bleeding. Others may have no symptoms at all, and the discovery of the miscarriage will only occur at a routine ultrasound scan.

The great majority of miscarriages are completely unexplained and the medical profession probably does not do enough to establish why a miscarriage has happened. Moreover, there is usually very little treatment once a miscarriage is underway , most of them cannot be stopped once the bleeding has started to be anything other than slight. The trauma of a hospital admission for a ‘scrape’ is also deeply unsettling. Moreover, most patients with miscarriages will be onwards with women having abortions or those with serious diseases like uterine cancer and ward and medical staff tends to forget the feelings of women who are undergoing a miscarriage. Miscarriage is so common, it is sometimes unfortunately seen as rather trivial.

Recurrent miscarriage means 3 or more miscarriages in a row and is a prevalent disorder that affects 1-2% of couples. In addition to the physical trauma and psychological stress, miscarriages can also be associated with a variety of complications in a subsequent ongoing pregnancy, including preterm delivery, low birth weight, and physical handicap. Chromosomal errors in the implanting embryo are a common finding, although more often than not, the pregnancy losses remain unexplained. Consequently, many affected patients receive either no treatment or are treated empirically with a variety of drugs, albeit with little or no evidence of clinical efficacy. Moreover, drug intervention in early pregnancy is highly restricted because of concerns regarding the effects on the developing baby.

If you’ve had 3 or more miscarriages in a row, you should seek tests to try to find out the cause. This should happen whether or not you already have children. Testing doesn’t usually happen for fewer early (i.e. less than 14 weeks) miscarriages than 3 since they are so common and often due to chance. You should also be offered tests if your miscarriage is late (second trimester).

Risks of recurrent miscarriage increase if you are over 35 or very overweight or very underweight.

Ectopic pregnancy, a pregnancy that develops outside of the womb – is even more emotionally fraught. Around 1 in 80 pregnancies is ectopic. Most of them are in one of the fallopian tubes. These tubes cannot stretch enough for the embryo to survive, and there is not yet any way to safely transfer the embryo to the womb. Once a woman has had one ectopic pregnancy she is much more likely to have another.

Like miscarriage, doctors don’t always know why someone has an ectopic pregnancy, but risk factors include blocked or narrow fallopian tubes, caused by infection or previous surgery, or a previous ectopic pregnancy. The risks are also higher for women over 35, or women who smoke heavily. But they can occur also in women with none of these risk factors.

Symptoms include bleeding (unlike period bleeding), nausea, dizziness, pain in the stomach, constipation.

If you are concerned you should immediately request a scan or laparoscopy.

If you’ve had an ectopic pregnancy, you can get pregnant again healthily, around 66% of women will get pregnant again naturally, some might need some help with fertility treatment. The overall chance of a subsequent ectopic pregnancy after a first one is around 7-10%.

Please also see our article and video from Professor Robert Winston on miscarriage and ectopic pregnancy in our Conception section.

For further information, please visit Professor Robert Winston’s Genesis Research Trust website, www.genesisresearchtrust.com

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DISCLAIMER
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.