Pregnancy loss | All facts to know

pregnancy loss

Pregnancy loss definition

Miscarriage, also known as spontaneous abortion and pregnancy loss, is the natural death of an embryo or fetus before it is able to survive independently. Some use the cutoff of 20 weeks of gestation, after which fetal death is known as a stillbirth.

Pregnancy loss after 20 weeks

Pregnancy loss in the second trimester can be the result of a very preterm delivery (like a spontaneous miscarriage in the second trimester) or death of the fetus (called a fetal demise).

About 2-3% of pregnancies will be lost in the second trimester, a rate that is much lower than in the first trimester. Once a pregnancy gets to about 20 weeks gestation, less than 0.5% will end in a fetal demise.

A loss at this time in pregnancy is most often a hard and sad experience. Many friends and family already know you are pregnant.

What do you do? What do you say? For most women and their partners, the process of grieving is no different than losing a person who has been in your life for some time.

You often have hopes and dreams about your child before that child is born, and losing the pregnancy in the second or third trimester is certainly a loss for a family.

Pregnancy loss Symptoms of a second trimester loss

  • Bleeding – most commonly, bleeding is a sign of a problem with the placenta and does not indicate a fetal demise.  But, bleeding can be a sign that the cervix is opening without labor (called cervical insufficiency).  With cervical insufficiency, the cervix begins to open early without contractions; as the cervix opens more, contractions then follow.
  • Cramping –pregnancy losses in the second trimester can be due to early labor.
  • Loss of fetal movement can indicate a fetal demise.  Most women can feel the baby moving by the 20th week.  If the baby has been moving and you no longer feel that same movement, it is important to contact the doctor’s office immediately to make sure the baby is fine.  Decreased fetal movement is more commonly a sign that there is a problem with the pregnancy and only rarely does it mean the fetus has died.

Most women less than 20 weeks of pregnancy do not notice any symptoms of a fetal demise.

The test used to check for a fetal demise in the second trimester is an ultrasound examination to see if the baby is moving and growing.  Fetal demise is diagnosed when the ultrasound examination shows no fetal heart activity.

What causes a second trimester loss?

The causes of a pregnancy loss in the second trimester are very different than early pregnancy loss.  There are medical conditions that increase the risk for cervical insufficiency or preterm labor before viability which include:

  • Prior surgery to the cervix
  • Use of illicit drugs, especially cocaine
  • Fetal abnormalities (genetic or structural problems)
  • Uterine infection (this is more common in developing countries and less common in the United States)
  • Physical problems with the uterus, including fibroids or abnormalities in the shape of the uterus

Pregnancy loss causes

There are also some medical conditions that are associated with fetal death in the second trimester which include:

  • Fetal abnormalities (genetic or structural problems)
  • Poorly controlled maternal cnoditions like thyroid disease, diabetes or hypertension
  • Lupus (systemic lupus erythematosus)
  • Autoimmune or genetic conditions that increase a woman’s risk of forming blood clots in her legs or her lungs (like antiphospholipid syndrome)
  • Very early pre-eclampsia or eclampsia of pregnancy
  • Trauma

pregnancy loss symptoms

What Are the Symptoms of a Miscarriage?

Symptoms of a miscarriage include:

  • Bleeding which progresses from light to heavy
  • Severe cramps
  • Abdominal pain
  • Fever
  • Weakness
  • Back pain

If you experience the symptoms listed above, contact your obstetric health care provider right away. He or she will tell you to come in to the office or go to the emergency room.

What Causes Miscarriage?

Most miscarriages happen when the unborn baby has fatal genetic problems. Usually, these problems are unrelated to the mother.

Pregnancy loss support

The other day, I received an email from an online registry, congratulating me on my baby’s impending birth and reminding me to shop for any last-minute items. It’s true, I’m supposed to have a daughter this month — but I won’t, because her heart stopped beating at 16 weeks.

My sweet husband has been, without my knowledge, deleting emails in our joint account each morning before I wake, but this pesky email got through and reached another address.

When we found out I was pregnant this past winter, we told everyone we knew — friends, family, Facebook. We’d done all the genetic tests and passed the first trimester, so we thought we were in the “safe zone.” After the news broke, we received an unbelievable amount of well-wishes and congratulations.

But when I miscarried a month later from an undetected chromosomal condition, though, there was no hiding. None. I felt like a social media cautionary tale. But we opted to take the same route. We told everyone about our loss just as publicly as we announced our joy — and it was the best thing that could have happened.

Less than five minutes after posting about our loss, a former coworker called me. We had talked about her children and pregnancies often over the years, but I never knew about her own miscarriage. She told me that it’s a club no one ever wants to be in — but once you’re in, you realize almost everybody you know was already a member. And with at least one in five pregnancies ending in miscarriage, the odds are that she’s right.

From there, I was inundated with support. Some people called right away, and some waited a month or two to send us a note. Either way, they shared stories of loss, sorrow, and later pregnancies intermingled with hope and terror.

Months later, I still have sad or angry days. And I occasionally hide newsfeed baby photos posted by friends who had similar due dates. I still have a lot of existential questions. I still miss her. But along with leaning on my husband, my family, my faith, and my community, the kind words and stories of a few brave women (and men) have helped me push through.

Here are a few* that I hope can help others:

1. You will be changed, even for the better.

“A year after my own miscarriage, I won’t say it goes away, but the sharpness and the constancy of the grief dulls. And that grief has changed me, in many ways for the better. I’m a more empathetic person now. I listen better. There’s a line from a novel I read over and over again around my due date, ‘You were unsure which pain is worse — the shock of what happened or the ache for what never will.’ I still mark dates and that time in my head (I would have had a 9-month-old now), but it’s less sharp. And as much as the path to get there is one I wouldn’t wish on anyone, there is a lovely silver lining in truly learning your own strength. You’re a badass strong lady. And you’ll keep getting stronger.” — M.F.

2. Distractions are okay.

“We all cope differently. After I learned about my first miscarriage, my husband came home from work and we got in bed and cried together for hours. And then at 6 p.m., I got up, got dressed, and went to go teach. It was my first semester teaching. My husband thought I was nuts, but I wanted to go and I’m still glad I did. It was three hours of being able to put the grief aside, however temporarily, and it was such a relief.” — H.L.

3. Find the positive, however small.

“What got me through both my miscarriages was knowing there are others out there going through the same situation who went on to have a healthy baby. It also helped discussing adoption and knowing if we can’t conceive, we would eventually have a child — just maybe not the way we originally planned. The waiting has been the worst part: for a positive pregnancy test, for the first ultrasound to come back normal, for the miscarriage, and to start trying again. I’ve filled the time with hobbies I’d normally put off — cooking a new recipe, painting, gardening — anything that took me off the Internet and miscarriage blogs.” — K.P.

4. Closure comes gradually.

“I lost a little one 30 years ago. We were in our mid-20s and eight months along. My doctor, whom I loved, told me I should have her naturally, if possible. So, they induced a few days later. I wasn’t sure I wanted to see her, but I’m glad the doctor suggested we do. However, there were two doctors and several nurses standing around the bed, and we always wished that we would have had time with her alone. Later, I remember thinking, What did I do to make this happen? I don’t know if you ever get over it. Even after I got pregnant again four months later, I know it changed me.” — D.C.

5. Go easy on yourself.

“Take your time to grieve. I really beat myself up because I was ‘only’ seven weeks pregnant when we miscarried. But as soon as you find out you are expecting, you begin to dream. Those hopes and dreams need to be grieved, along with the loss of the child.” — J.H.

6. Men grieve too, but differently.

“The hardest thing is that my wife and I know that our next attempt will be fraught with concern. The wonder of the first time, the unmitigated joy, and possibility and optimism are, if not gone, then muted by the knowledge of what could be, and could have been. It’s challenging to be the man. My wife has been amazing and always encouraged me to be open and allow myself to feel what is going on, and I have. At the same time, it is easy to feel at a loss. Men don’t experience the hormonal changes or the physical reality of the pregnancy. We suffer our loss second hand, because we only get to live the experience by proxy. For us the pain is real, and also not real.” — J.M.

7. Ignore the platitudes.

“Parents are treated differently when they lose their babies to miscarriage. But they shouldn’t be. Imagine if people said at funerals what they tell parents who miscarry: ‘It’s probably for the best,’ or ‘Nature has a way of taking care of itself,’ or ‘They just need to have another child.’ What if someone told that to a grieving widow? ‘She will be fine as soon as she has another husband.’ Another husband won’t diminish the love or loss of the previous one. It also helped me so much to humanize my baby by giving him a name. So much better than ‘lost the baby’ or ‘the fetus.’ When a person you love dies, you don’t say the ‘human’ passed away. You use their name.” — L.H.

8. Remember in your own way.

“I lost two babies this summer, one after the other. Even though I’m a therapist and walk with people through grief every day, I couldn’t have prepared myself for the experience of miscarriage. One powerful ritual for me was the memorial that my husband and children created. I didn’t know I needed this — but once the artwork was up in our home, symbolizing the loss off these babies, I found sweet honor of their short lives and my own loss.” — B.M.

9. There are no easy answers.

“We went through seven miscarriages. Six years of heartache, watching other friends get pregnant and have healthy babies, and wondering, hoping, praying that some day it would be our turn. It never got easier to accept. Any time we got a positive test, it was hard to be happy. Many people said it will happen when it’s supposed to. That’s not what you want to hear when you ache for something so much it hurts. We kept to ourselves about it for the most part, but we could’ve used more love and support through it all. Once I stopped thinking about it, it magically happened and we ended up with our rainbow baby. We were excited, but it wasn’t truly real until we held our son in our arms. I hope others that go through this will keep the faith that there is a plan for everyone and everything happens for a reason. That’s hard to accept when you’re personally dealing with it, but in hindsight, that’s just how it works out.”

pregnancy loss meaning

Miscarriage, also known as spontaneous abortion and pregnancy loss, is the natural death of an embryo or fetus before it is able to survive independently. Some use the cutoff of 20 weeks of gestation, after which fetal death is known as a stillbirth.

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