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| |    First Trimester Miscarriage by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. About one of eight known pregnancies is lost in the first trimester. Actually, this number is an underestimate, since some women miscarry before they know they are pregnant, and interpret the miscarriage bleeding as a menstrual period. So the earlier you find out about the pregnancy, the more likely you are to notice if you miscarry. Miscarriage (technically called spontaneous abortion) is defined as the loss of a pregnancy before 20 weeks gestation. The majority of miscarriages occur before 12 weeks. By 12 weeks, if a normal heartbeat is heard or the pregnancy looks normal on ultrasound, the chance of miscarriage goes down to about 1%. What happens in miscarriage? Some miscarriages occur all at once, with heavy bleeding and cramping, passing tissue from the vagina, and then resolution of the symptoms over 6-12 hours. In these cases, women should see their practitioners within a day or two for an examination, to be sure nothing else needs to be done medically. It is helpful to collect any tissue (red, gray or white solid material) that is passed and keep it in a clean jar in the refrigerator to show the doctor. If a woman's blood type is Rh negative, she may need to get RhoGam™. Sometimes a miscarriage is diagnosed by physical examination, ultrasound, or results of blood pregnancy hormone hCG levels. In these cases the miscarriage is often incomplete, and may require a dilation and curettage (D&C) for completion. Could this miscarriage have been prevented? It is human nature to make connections between different events. Many people who have lost a pregnancy search their souls for something that they did that might have caused the loss. Most miscarriages, especially those in the first trimester, could not have been prevented, because the pregnancy wasn't developing normally, often due to a chromosome problem. Some factors like smoking, alcohol and possibly heavy caffeine use can increase the risk of miscarriage, but many people who are involved in these activities have normal pregnancies and we know that people who do not want to be pregnant are not able to guarantee a miscarriage with these activities. The background risk of miscarriage is high enough that the most likely cause of a miscarriage is that your number came up. If you are wondering about the cause of your miscarriage, discuss your concerns with your practitioner. Will I be able to have a normal pregnancy in the future? You may find it hard to believe, but if you have had one first trimester miscarriage, your chance of a successful next pregnancy is the same as it was before you conceived. Once you are pregnant, in most cases you are no more at risk of miscarriage than anyone else. If you have not been pregnant before, the miscarriage proves that the sperm can meet the egg. You just need to try again. If you have had two consecutive losses, or three total losses interspersed with normal pregnancies, discuss with your practitioner whether a work-up for causes of recurrent miscarriage might be helpful.
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