A miscarriage can occur when a fetus dies in the womb, and if the body does not initiate the miscarriage process, symptoms may occur. A missed miscarriage may have little to no symptoms, but can be identified through prenatal care. Good prenatal care is important to identify a missed miscarriage, as it carries a higher risk of infection. Women who experience a missed miscarriage may be at risk of developing postpartum depression and require adequate support.
A miscarriage occurs when a fetus has died in the womb or uterus. Most of the time when this occurs, the body naturally initiates the miscarriage process and the fetus is released from the body. In some cases the miscarriage does not start right away and the pregnant woman has little or no indication that anything is wrong. If this state continues, there may be symptoms of miscarriage that can be evaluated.
It is important to note that miscarriage can only refer to the death of an embryo in the uterus in a pregnancy that is not yet 20 weeks advanced. Subsequently, fetal death is often viewed in a different light. However, a pregnant woman who had stillbirth just before 20 weeks with no other signs of miscarriage could still count as a missed miscarriage.
There are some potential symptoms of a missed abortion. Especially in the early stages, things commonly associated with the first trimester like nausea, fatigue, breast tenderness, and dizziness may stop if the fetus is dead. This is not always the case, the pregnancy hormone blood test may remain the same initially, which causes many first trimester symptoms.
However, the longer the fetus stays in the uterus, the more potential symptoms may occur. For example, the pregnancy will not progress. The belly will not grow as if a developing fetus were present. More importantly, the Doppler examination will not show any evidence of a fetal heartbeat and any ultrasound/ultrasound scan would show a completely still and heartbeatless fetus.
In the later parts of the 20 weeks, women may have already felt movement in the uterus. If this movement has been prominent and then stops completely, it could also be a sign of a missed miscarriage. Some women also hemorrhage, especially bright red blood, but do not miscarry completely.
Good prenatal care is helpful in making sure that a miscarriage, whether missed or not, is identified. Doctors will most often want to treat it by performing a dilation and curettage (D&C), if the miscarriage does not start within a few days. The presence of the fetus in the body carries a much higher risk of systemic infection, which could be life-threatening. Indeed, failure to diagnose a missed miscarriage, often due to lack of prenatal care, could lead to a situation where the first symptom is blood infection or sepsis.
In extremely rare circumstances, often an ectopic or abdominal pregnancy, the death of the embryo does not cause infection. Stories collected around the world tell of fetuses that calcified after death and did not infect the mother. These stories must be seen as the extreme exception rather than the rule. Sepsis is typically the result of not having a complete miscarriage, which is why so many doctors recommend D&Cs if the complete miscarriage does not start. Women who are strongly against this procedure could discuss other options with their doctor, such as induction of labor.
One of the tragedies of missed miscarriage is that women can feel very little that something is wrong with a pregnancy. They usually do not bleed initially and do not experience the cramping and pain associated with miscarriage, although they may have a brief episode of this that then subsides quickly without major bleeding. The diagnosis is often made during routine doctor visits and confirmed by ultrasound. The cause is often unidentified, which may be cold comfort.
It is important to note after the end of pregnancy that women are just as at risk of developing postpartum depression as those carrying full term. These feelings may be exacerbated by the loss of a child. Adequate support is needed for the woman experiencing any form of miscarriage.
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