Late Pregnancy Loss

Any miscarriage is a tragedy. Whenever you have experienced an early pregnancy loss or a late pregnancy loss, it is a horrible, heartbreaking tragedy. Both these topics are not the topics discussed enough. But they should be discussed. The doctors say that having a miscarriage is a relatively normal thing. According to the clinical statistics, as many as 75 percent of conceptions in the first trimester will result in miscarriages. You have already learned that even if the digital pregnancy test literally ‘SCREAMS’ that you are pregnant, still there is no absolute guarantee that your embryo will turn into a fetus. Therefore, many couples prefer not to tell that there would be a small bundle to anyone until after the 12–week mark. And after this week, the chances of miscarrying are much lower.

But should you be absolutely sure that after the 12–week mark, the chances to have the pregnancy loss have dramatically decreased? Or are there still the chances to have the late pregnancy loss? 

Late Pregnancy Loss or Late Miscarriage is the most hidden topic. The discussions about it usually are lack of transparency and inclusiveness. But the late pregnancy loss (a miscarriage after the 12–week mark) can be even more emotionally overwhelming. It may result in a nervous break–down with further consequences.

During the first 12 weeks, you will be like a bundle of nerves. Literally a bundle of nerves. The nervous tension will be blended with the content of your thoughts. It will be blended with all your sparkling emotions making them faded. It will make your gorgeous eyes filled with embarrassment. It will make your tone lower and your fingers trembling.

And what is if the worst happens after the 12–week mark? 

First, you are so confused, so embarrassed and so shocked that you cannot utter a single word during several moments. After that, you feel the deep frustration and sorrow because you can do nothing with this situation.

Just whirl of embarrassing thoughts blended with confusing emotions appears in the mind. How did I get there? Why me? Why my baby? Why am I having a miscarriage? Why has it happened? Is something wrong with me? All versions of ‘WHAT IF…’ scenarios will be blended with confusion, shock, and sadness. It is the sadness you had never felt before.

You feel ashamed to say openly how many Google searches you continued to do after months went by. You are scared to show your hurt. You feel utterly guilty reframing in your mind every moment you were holding your small bundle. And re–asking yourself: ‘Was it my fault?’ You still are not sure.

No matter how tiny your bundle of joy was, no matter how much time your tiny dude or lady was with you, he or she was loved. These several weeks changed you completely. Because the love to your small bundle doesn’t need to last forever to make an unforgettable impression. But why has that happened?

1. Statistical data shows that late pregnancy loss is a much rare issue than early pregnancy loss. 

Miscarriage is spontaneous pregnancy loss before 20 weeks of pregnancy. Miscarriages occur most commonly during the early pregnancy (prior to the 12–week mark), and most commonly because of the fetal chromosomal abnormalities. But many miscarriages are not included in the official statistical data, they just occur and that is it. 

Many ladies have their first ultrasound screening at 8 weeks of gestation or more, when many non–viable pregnancies may have already resulted in the miscarriage. That seems, that many tiny embryos and tiny fetuses are living and dying without being even noticed. They just appear and disappear prior to the first ultrasound.

Or the situation may be as the following. You were only about seven weeks pregnant and your embryo–dude or your embryo–lady was so small that was barely visible on the ultrasound, but your tiny bundle was there. They turned the monitor towards you, so you could glance at your tiny bundle for the first time. A tiny little grey tadpole–shaped thing surrounded by a black circle. Your tiny raspberry. So tiny, curled up, maybe has just fallen asleep, but definitely there. One week later you came to the clinic for another ultrasound, but your raspberry has already disappeared somewhere.

But if the small bundle or bundles death occurs after the first ultrasound was done, that is utterly hurtful. And the most hurtful is the late pregnancy loss. It is more than heartbreaking experience. It literally disrupts everything that was so precious for you, including your self–confidence. Even in this situation, you should know that you can cope with this hard experience.

The late pregnancy loss is the miscarriage that occurs after 12 weeks and before 20 weeks of pregnancy. The other late pregnancy loss is called a ‘STILLBIRTH’. The stillbirth is the fetal death that occurs after 20 weeks. According to the clinical statistics, in the second trimester 2–3 percent of all pregnancies result in the late miscarriage. And nearly 1 percent of all pregnancies result in the stillbirth in the last trimester. Miscarriage in later pregnancy usually is associated with autoimmune or thrombotic disorders.

2. Are there any red flags that literally ‘SCREAM’ about the late Miscarriage? 

The most serious red flags are spontaneous cramping and bleeding. Or spontaneous bleeding and cramping. Therefore, you should remember these two flags are really very serious. You shouldn’t wait until you would feel better. Because the situation might be worse than you think.

1. The bleeding is the red flag number one. 
2. The cramping is the red flag number two. 
3. excruciating pain, bleeding and cramping [or cramping and bleeding] that don’t stop ‘SHOUT’ that you may have the miscarriage. And it is of vital importance to call the Ambulance if the bleeding is too heavy and the cramping is too intensive.

In the most cases, the late pregnancy loss starts with bleeding. If you know that you are pregnant, the bleeding is a strong indicator that something is wrong. If the bleeding continues, you should immediately book an appointment with your doctor. And if the bleeding occurs spontaneously and becomes too heavy, you should immediately call the Ambulance.

This story is a real experience of the miscarriage told by my sister–in–law. Surely, it is absolutely embarrassing to tell, but it accurately and vividly describes what had happened.

“That happened at spring–scented midnight. I was nervously tossing and turning on my bed because of painful cramping, trying to fall asleep. My fiancée was sleeping, and I didn’t want to wake him up and frustrate him. I was trying to fall asleep because I believed that in the morning there would be nothing more than just a few faded remembrances in my mind about this spring night. But i was wrong. The pain not only intensified and inspired the negative feelings, it turned my whole reality in a nightmare.

I turned and tossed one more time. Suddenly, the sharp painful cramps began to radiate down my legs. I placed my hand on my belly and hugged it delicately because I didn’t know how to ease the cramping. And I still hoped that it could pass away. I closed my eyes and prayed that the pain would just stop so I could stop worrying about my tiny bundle.

Several moments passed. I glanced at the digital clock on the screen of my iPhone. That seems that this painful cramping continues for more than thirty minutes. And these cramps inside my uterus became more and more intense. The bleeding started.

The pain grew worse, and the bleeding became heavier. I felt that something is wrong with me. I tried to sit on the bed. After that, I tried to go to the hall because I wanted to sit there not to awake my fiancée. But it was too hard to walk. With each step I took, it was extremely painful too much, and I felt like my uterus would detach from my body and fall out. I did my best and sat in the hall for 10 minutes. After that, I decided to go back as it was unbearable to sit on the tuffet.

I came to our second bedroom and accurately sat on the bed. After that, I rolled myself up into the blanket and closed my eyes. I had finally had enough when I woke up in the early morning in agony. I couldn’t hide the pain or torture I had been going through any longer. I burst into tears and screamed. I wailed from my bed, hardly able to move when my fiancée came running in.

“My sweetheart, what has happened?! What is wrong?!”

I couldn’t respond to him, all I could do was scream out in agony. The pain was fierce, and I had dealt with it for too long to control my emotions. My fiancée’s fingers tips unrolled me from my ‘warm blanket–cocoon’ and pulled back the blanket on my bed to reveal the blood licking the inside of my thighs.

He grasped my both wrists and tried to help me to get up. But I couldn’t get up. The hospital was just in 10 minutes’ drive from our apartment. So, he lifted me up and held me to the car.

The emergency room didn’t keep us waiting for long. I was completely lost when I glanced beneath my legs. Nobody had ever told me that there would be so much blood in case if the miscarriage occurs. I think the blood trail that was following my tail end had “urgent” written all over me.

The nurse who was in the emergency room said that she would be in a minute with the medical team. She literally ran to the reception desk to call the doctors and technicians. The medical team entered the emergency room.

“What has happened?! In any case, we should do the ultrasound scans first to find out the problem. So, sweetheart, I’m going to need you to try and hold still. The pain should be excruciating but you should try to hold still. We can’t get an accurate image with you moving around so much. Can you hold still, at least for several moments, please? We need the most accurate images to understand what is going on inside.”

I was laying on the hospital bed, curled up in a ball, writhing in agony. Did they really think I could hold still long enough for them to rub their wand over my belly? The only thing I wanted was to fall asleep without that pain. And after that to wake up absolutely healthy. I wanted them to do anything to get me out of this pain.

Three nurses peered in through the doorway. They were so curious about what was going on. The technician that held the wand nodded to them, and then they proceeded to circle my bed. The pain was indescribable. I thought I would die at any moment if I was forced to endure one more miserable second of this ultrasound.

A few minutes later, I saw a herd of white lab coats running into my room. Before I could utter a single word, a plastic cup was placed over my nose, followed by darkness. I was placed in emergency surgery to have Dilation & Curettage. Next spring morning when I waked up, I tried to utter a single word or to scream, but I couldn’t do that. The more I tried, the more I realized the crisis I was in. I was locked inside my body. The only thing I could control were my thoughts. I was discharged from the hospital after the one week.”

3. What Treatment Options they can offer if you are in this position? 

There are two Treatment Options they can recommend to you except if you have already miscarried naturally. If you have already miscarried naturally, they would closely monitor you.

Staying at hospital, you are having two options. The first one is D&E (Dilation and Evacuation) surgery. And the second one is the labor induction. 

A Dilation and Evacuation abortion is a surgical procedure. An ultrasound scan should be done prior to this surgery to determine the size of the uterus and the gestational age of the fetus. This procedure involves anesthesia. It includes the use of surgical instruments (such as forceps) and a combination of dilation and curettage (D&C) and vacuum aspiration. D&E surgery usually takes 30 minutes.

The other option is the Labor induction. If you choose this option that seems that you would deliver naturally but with the labor–inducing medications. Medical management involves taking one or more medications to cause the cervical dilation and allow the fetus and placenta to be delivered naturally. The medications most often used are misoprostol and mifepristone.

4. Highlighting the risk categories. Do make sure that you don’t have these health–episodes.

Identifying women at high risk of late miscarriage could help diagnose potentially treatable causes of miscarriage such as infection, thrombosis or immunological disease.

If you glanced through these risk categories and found yourself, do not hesitate to contact your doctor and to ask for the constant monitoring. The clinical management is of vital importance in all these cases.

If you are incidentally diagnosed with septate uterus during your pregnancy, you have an extremely high risk of miscarriage, either in the first or even in the second trimester.

Abnormal placental development is observed in two–thirds of miscarriages. Do ask your doctor to monitor the development of your placenta via ultrasound scans.

Small for gestational age fetuses are at increased risk of late fetal death regardless of the underlying determinants. If your fetus is termed as “the small for gestational age fetus”, do not hesitate to ask your doctor for the constant monitoring. Do not neglect the blood tests, the ultrasound appointments, and the other procedures.

Take into consideration that the late fetal death rates are increased in smokers. Wondering why? Smoking during pregnancy has been considered a cause of fetal growth restriction, fetal death, low–birth weight, stillbirth and reduced lung function. If you smoke the cigarettes during your pregnancy, it is high time that you must stop doing that. Smoking is also closely associated with the late fetal death.

If you are having twins or triplets (the multiple pregnancy) and your fetuses are extremely small for the gestational age, do ask your doctor to be always “on call” with you.

You are also at increased risk of the miscarriage if you have the hypertensive disorders if you are diagnosed with a severe preeclampsia, infection, thrombosis or immunological disease.

CONCLUSIVE REMARKS:

Every pregnancy is the absolutely unique phenomenon. It should be the utmost accurately monitored by the experienced doctor. If you have at least one symptom like these: bleeding, painful cramps, stabbing pain in your lower abdomen, swollen abdomen, flu symptoms, fever, or severe shoulder pain, you must call your doctor and Ambulance. The time is everything. And the life–threatening situation may occur if you lost the time. It is the mystery of life – some things can give you such beauty for such a short period of time, feeling like they would last forever but also were terminated before they really had a chance to shine.