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All to Know about Missed Miscarriage

What

A missed miscarriage is also called a silent miscarriage -- and for good reason: You won't experience the usual red flags of cramping or bleeding, though some symptoms, like tender breasts or nausea, may start easing up. Instead, you'll find out you've had one once you lie down for an ultrasound and there's no fetal heartbeat. Though the embryo has died, your body hasn't expelled it yet.

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The loss can be devastating, but rest assured it's not because of anything you did. A missed miscarriage can happen to anyone. In fact, your pregnancy started off on the right foot when the fertilized egg implanted in your uterus. But some time in the first trimester, usually around 6 to 10 weeks, the embryo quit developing and the heartbeat stopped.

Symptoms

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A missed miscarriage is often known as a silent miscarriage because women generally do not have common miscarriage symptoms, such as vaginal bleeding, heavy cramping, or expulsion of fetal tissue. With a missed miscarriage, the placenta may still release hormones, which can continue the signs of pregnancy for women. However, some women may notice that their pregnancy symptoms, like breast tenderness, nausea, or fatigue, may disappear. Some may also have brownish or red vaginal discharge. Doctors can diagnose missed miscarriages by lack of a fetal heartbeat and an ultrasound that will show an underdeveloped fetus.

Causes

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The exact cause of a missed miscarriage is unknown. However, about half of all early miscarriages occur due to a genetic problem with either the egg or sperm. In addition, other factors such as immune system problems and serious infections can increase the risk of miscarriage. The chance of having a miscarriage also increases with age, because of the natural deterioration of egg quality.

About one percent of all pregnancies end in a missed miscarriage.

When

"Most miscarriages occur before the first 13 weeks of pregnancy," says Dr. Afshar. "Some miscarriages occur before a woman misses a menstrual period or is even aware that she is pregnant."

Diagnosis

In a missed miscarriage, a doctor usually discovers the condition during a routine prenatal checkup. He or she may make the diagnosis based on a few different types of exams. 

One common blood test that a doctor gives a woman during early pregnancy checks her level of human chorionic gonadotropin (hCG), a hormone that is produced by the body during pregnancy. During the first few weeks of pregnancy, a woman's hCG level is expected to double every two to three days. If that number isn't rising quickly during that timeframe, it may or may not be a cause for concern. If that number has stopped rising or is actually dropping during that timespan, that's more concerning. Two consecutive blood tests in early pregnancy that show a decreasing hCG level is most likely a sign of miscarriage. 

Another red flag appears if an ultrasound (also known as a sonogram) reveals that a baby's heartbeat has stopped.

An ultrasound is an exam that uses high-frequency sound waves to project an image of the fetus onto a screen. 

Another clue that a woman is having a missed miscarriage is when the fetus's heartbeat fails to become audible on a fetal heart rate monitor by 12 weeks of gestation.

What Happens After a Missed Miscarriage is Diagnosed?

After a missed miscarriage diagnosis, a woman often faces a choice of whether or not to seek intervention for the miscarriage.

If bleeding has not yet started, a natural miscarriage, (also known as a miscarriage without intervention) might take days or weeks to begin, so look out for symptoms. Many women with this diagnosis opt for a surgical procedure called a dilation and curettage (D&C) in order to have the ordeal over with as quickly as possible. In the first trimester, it's usually called a D&A (dilation and aspiration), because the doctor dilates your cervix and then uses a tool called a suction curette (as opposed to a sharp curette) to gently empty the uterus.

Treatment

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Although the signs of a missed abortion are delayed, your body will eventually miscarry. The main goal of treatment during or after a miscarriage is to prevent uncontrolled bleeding (a hemorrhage) and/or infection to the mother. Earlier miscarriages are more likely to avoid the need for medical or surgical intervention.

Sources

verywell.com, sofeminine.co.uk, womens-health.co.uk, parents.com, fertilityauthority.com


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