Pregnancy Loss Medical Procedures, Tests, & Conditions

An ectopic pregnancy happens when a fertilized egg implants itself outside of the uterus, and usually happens in the fallopian tube (in which eggs travel from the ovaries to the uterus). This is also known as a tubal pregnancy. Ectopic pregnancies can also occur in other areas such as the cervix, ovary, or abdominal cavity. This type of pregnancy is potentially life-threatening and requires immediate medical attention.

An ectopic pregnancy is a serious condition because, as the fertilized egg grows, it can lead to rupture of the fallopian tube or other structures where it has implanted. This can result in severe bleeding and critical complications for the mother if left untreated. Additionally, the embryo cannot survive outside of the uterus, which means it cannot develop into a viable pregnancy. To protect the health and safety of the mother, an ectopic pregnancy must be diagnosed and treated as soon as possible.

Symptoms of ectopic pregnancy

Initial symptoms may include such as abdominal pain, vaginal bleeding or spotting. In some cases, blood may leak from the fallopian tube where the embryo is implanted and cause shoulder pain or the urge to defecate.

Dangerous symptoms of ectopic pregnancy include fainting, acute lightheadedness and shock. This may occur if the fertilized egg causes a rupture of the fallopian tube, which can cause bleeding into the abdomen. If any of these symptoms are experienced, it is crucial to seek medical attention, and for severe symptoms, it’s necessary to do so immediately. 

Confirming an ectopic pregnancy

An ectopic pregnancy can be diagnosed through blood tests and ultrasounds. Once diagnosed, treatment options will depend on the size and location of the ectopic pregnancy, as well as individual health factors. Treatment may involve medication to stop the growth of the embryo or surgery to remove it.

Sources

“Ectopic pregnancy”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/diagnosis-treatment/drc-20372093 

A molar pregnancy is a rare pregnancy complication that results from the abnormal fertilization of an egg. It is sometimes referred to as a hydatidiform mole or gestational trophoblastic disease (GTD) and is estimated to occur in less than 1% of pregnancies or 1 out of every 1,000 pregnancies. Molar pregnancies may be complete or partial, but placenta abnormalities occur in both types.

When a complete molar pregnancy occurs, abnormal placental tissue grows and contains tumors or cysts. An embryo is not present in a complete molar pregnancy. However, abnormal placental tissue produces a hormone called hCG, which normal placental tissue also produces during pregnancy. This hormone ultimately causes the symptoms associated with pregnancy and can result in a positive pregnancy test even though the person is not pregnant. 

If abnormal placental tissue grows with an embryo and the egg has been fertilized by two sperm, it is considered a partial molar pregnancy. An embryo in a partial molar pregnancy has a chromosomal abnormality since it contains both the mother’s chromosomes and two sets of chromosomes from the father, resulting in 69 chromosomes rather than 46. Although the embryo may continue to develop, it typically does not survive.

While molar pregnancies are rare, it is important to understand that anyone can experience one. Some individuals are at higher risk of having a molar pregnancy, such as those who have had two or more miscarriages or those with a previous history of molar pregnancies. Molar pregnancies are characterized by several symptoms, including: 

• Nausea and vomiting 
• Vaginal bleeding during the first three months of pregnancy 
• High HCG levels 
• Anemia 
• Abdominal swelling 
• High blood pressure (preeclampsia) 
• Small grape-like cysts discharged from the vagina 

Most individuals who have molar pregnancies experience full recovery and can have viable pregnancies in the future with appropriate treatment. Although molar pregnancies cannot result in a live birth, they can pose a serious health risk due to complications if they are untreated. Early diagnosis and treatment are necessary, and even after treatment, hCG levels must be monitored to prevent further issues. Taking this into consideration, those who suspect they may be experiencing a molar pregnancy are encouraged to contact a healthcare provider and seek immediate medical attention.

Sources

“Molar pregnancy.” Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17889-molar-pregnancy 

“Molar pregnancy.” Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/symptoms-causes/syc-20375175 

“Molar pregnancy: Symptoms, risks, and treatment.” American Pregnancy Association. https://americanpregnancy.org/healthy-pregnancy/birth-defects/molar-pregnancy/ 

Physical complications can occur following a stillbirth or miscarriage, but the severity can vary depending on the circumstances. When someone has a miscarriage and tissue remains in the uterus, it can result in a uterine infection known as a septic miscarriage within a matter of a few days. Common symptoms can include: 

• Chills
• Fever
• Vaginal bleeding
• Foul-smelling vaginal discharge
• Pain in the lower abdomen 

This type of infection can become life-threatening and requires immediate medical attention. Another common complication that may occur after a miscarriage is heavy bleeding, which is called a hemorrhage. Sometimes a hemorrhage may be accompanied by other symptoms including: 

• Dizziness due to low blood pressure 
• Fatigue or weakness due to anemia 
• Fast heartbeat

Complications after a stillbirth are generally similar to those that are experienced after a miscarriage. However, in some instances when a fetus dies near term or during late pregnancy yet remains in the uterus, it may result in the development of a clotting disorder known as disseminated intravascular coagulation (DIC). DIC is a potentially life-threatening condition that can lead to uncontrolled bleeding, organ failure and death. 

Individuals should also be aware that symptoms associated with complications can vary since everyone’s body is unique and may respond to trauma differently. If a miscarriage or stillbirth is suspected, it is crucial to seek medical attention as soon as possible and follow the recommended post-loss care instructions provided by a healthcare practitioner. Even if there is any doubt regarding whether someone is experiencing symptoms of a complication, the best course of action is to seek medical guidance to prevent, diagnose, and treat the symptoms to reduce the risk of any potential health threats. 

Sources

“Miscarriage”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298 

“Disseminated Intravascular Coagulation (DIC)”. MedScape. https://emedicine.medscape.com/article/199627-overview?form=fpf#a8 

In the event of a suspected pregnancy loss, medical tests such as an ultrasound and/or bloodwork are typically used to determine miscarriage or stillbirth. It’s possible these tests may not provide instant confirmation, and depending on the test, may need to be repeated the next day or week. 

To confirm or diagnose miscarriage or stillbirth, tests may include:

• Ultrasound — Most often performed with a probe inserted vaginally, this allows doctors to determine if there is still a fetal heartbeat and if the pregnancy is developing normally. If there is no heartbeat or the fetus appears to have stopped growing, this may be an indication of pregnancy loss. If the results of an initial ultrasound aren’t clear, you will likely be asked to have another in about a week.
• Blood test — This measures the level of the pregnancy hormone hCG, or human chorionic gonadotropin. The levels of hCG in the blood can indicate whether a pregnancy is progressing normally. If the levels are abnormally low or decreasing, it may be a sign of an impending miscarriage.
• Pelvic exam — Doctors may also perform a pelvic exam to check if your cervix has started opening, which can indicate a miscarriage.
• Tissue testing — If you’ve passed clots or tissue, it may be sent to the pathology lab to confirm pregnancy loss and/or determine if there was a different cause.

Sources

“Miscarriage: Diagnosis”. NHS. https://www.nhs.uk/conditions/miscarriage/diagnosis/ 

“Miscarriage”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/diagnosis-treatment/drc-20354304 

If you suspect a pregnancy loss has occurred, it is important to seek medical attention as soon as possible. While it is advisable to contact your healthcare provider to inform them of your concerns, seeking emergency care is crucial to ensure there aren’t any imminent threats to your health. A healthcare provider will be able to provide guidance regarding the next steps to confirm whether a pregnancy loss is in process or has occurred. In any instance, emergency services should be contacted immediately.

When pregnancy loss results from a miscarriage, it may happen very suddenly or gradually, sometimes over several weeks. It is often characterized by symptoms such as stomach pain, vaginal bleeding, and cramps. Some types of miscarriage can cause tissue to remain in the uterus and may even result in a life-threatening infection known as sepsis, so it is important to get evaluated by a medical professional immediately. Your healthcare provider will ensure that you are stabilized and can also conduct tests that may provide more insight into the cause of the pregnancy loss. 

After receiving medical care, it is important to connect with your support network. This may be a family member, a close friend, or a mental health professional such as a counselor or therapist. These individuals will be able to help you navigate through the grief process and can provide you with additional support during moments that are especially difficult. Some individuals also find it helpful to attend a support group to connect with other individuals who have experienced a recent pregnancy loss. 

Ultimately, if you suspect that you are experiencing a pregnancy loss or one has previously occurred, it is important to prioritize your physical health and seek medical attention immediately, followed by taking necessary steps to attend to your mental and emotional well-being. Remember that your experience with pregnancy loss is unique, and allow yourself to grieve and experience your emotions in the manner that feels the most authentic to you. Self-care and being sensitive to your needs will be essential in the overall process of your recovery.

Sources

“Miscarriage”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/diagnosis-treatment/drc-20354304 

“How do I know if I’m having a miscarriage?” Planned Parenthood. https://www.plannedparenthood.org/learn/pregnancy/miscarriage/how-do-i-know-if-im-having-miscarriage 

A pregnancy loss that occurs before 20 weeks gestation is known as a miscarriage or, medically, a spontaneous abortion. This most often happens in the first trimester (up to week 13). After 20 weeks, pregnancy loss is known as stillbirth. There are various signs and symptoms that may indicate pregnancy loss, both early- and late-term.

Signs of Potential Miscarriage (Before 20 weeks)

According to Cleveland Clinic, signs of a miscarriage may include:

• Vaginal bleeding — This can range from light spotting to heavy bleeding, and may or may not be accompanied by cramping and pain.
• Passing tissue from the vagina — This may look like large blood clots or grayish tissue (if possible, save tissue that you pass for examination by a healthcare provider).
• Abdominal pain — This may feel like menstrual cramps, though is often more severe.
• Lower back pain — Mild to severe.
• Fast heartbeat
• Absence of pregnancy symptoms — If you’d been experiencing symptoms like nausea, breast tenderness, food cravings/aversions that suddenly disappear, it could be a sign of miscarriage.

Signs of Potential Stillbirth (After 20 weeks)

• Decreased fetal movement — If you notice that your baby is moving less than usual or not moving at all, it can be a sign of stillbirth. This is often the only noticeable sign. If your baby is vigorously moving much more than usual, this could be an indication something is amiss, though fluctuations in fetal activity are normal.
• Abdominal cramps and vaginal bleeding — This is experienced by some but not all.

Please note that experiencing any or all of these signs and symptoms does not necessarily mean a miscarriage or stillbirth has occurred and could be related to other pregnancy issues. It’s always best to consult with a healthcare provider if you experience any of these signs or have concerns about your pregnancy.

Sources

“Stillbirth”. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9685-stillbirth 

“What Causes a Loss of Pregnancy Symptoms?”. Parents. https://www.parents.com/is-loss-of-pregnancy-symptoms-a-sign-of-miscarriage-2371242 

“Miscarriage”. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9688-miscarriage 

“Miscarriage”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298 

While there are some tests available that can help identify potential causes of pregnancy loss, it is important to acknowledge that not all pregnancy losses can be fully explained. Medical tests can be helpful in identifying underlying factors that may contribute to or increase the risk of pregnancy loss and can provide valuable insights. Specific tests that are recommended by a healthcare provider will vary based on each individual’s circumstances and medical history.

Prior to any testing, your healthcare provider should spend time gathering a detailed history that focuses on medical, family, surgical, and genetic background. An ultrasound is usually the most common test that is conducted first, since it allows the physician to evaluate the uterus and uterine cavity. Other tests that might be conducted for additional insight include a saline ultrasound, hysterosalpingogram, X-ray, MRI, and hysteroscopy. Saline ultrasounds are used to identify abnormalities within the uterus, such as the presence of fibroids or polyps and differ from a conventional ultrasound due to the injection of saline during the test. If fibroids or other abnormalities are suspected, an MRI may be used to locate them for further evaluation. A hysterosalpingogram X-ray provides imaging of the uterus and inside of the fallopian tubes to determine whether they are open or closed. Your healthcare provider may also choose to conduct a hysteroscopy to look more directly into the uterus. However, hysteroscopy is typically considered to be a minor surgical procedure since it can also be used for fibroid and polyp removal or resection of scar tissue. 

Blood tests are another common approach to gaining insight into the cause of pregnancy loss. Labs may be drawn for antiphospholipid antibodies, thyroid function, thyroid antibodies, follicle-stimulating hormone, and prolactin measurement. Healthcare providers are frequently interested in potential hormone imbalances since inappropriate levels of progesterone may sometimes result in pregnancy loss and can usually be treated. Some healthcare providers may also order an ovarian reserve test to determine if one or both ovaries are functioning properly. Depending on the outcome, a referral to a fertility specialist may be necessary.

Finally, chromosomal analysis or karyotype test may be performed to determine if the chromosomes of the fetus indicate the presence of a genetic disorder or abnormalities. Sometimes this testing is only performed when all other abnormalities have been ruled out. While these types of abnormalities are rare, they can significantly reduce the likelihood of embryo survival if certain chromosomes have an extra or missing copy. 

Sources

“Recurrent pregnancy loss”. UCLA Health. https://www.uclahealth.org/medical-services/obgyn/conditions-treated/recurrent-pregnancy-loss 

“Diagnosing Recurrent Miscarriage”. NYU Langone Health. https://nyulangone.org/conditions/recurrent-miscarriage/diagnosis#:~:text=Hysterogram,that%20can%20lead%20to%20miscarriage

“Can genetic testing explain the cause of recurrent miscarriages?”. UT Southwestern Medical Center. https://utswmed.org/medblog/miscarriage-genetics/

When your healthcare provider conducts tests to diagnose a miscarriage, they may use specific terms to describe the type of miscarriage that has occurred. What has happened to the tissue during the miscarriage and the potential complications that may result after a miscarriage often determine how it will be categorized. Some common types of miscarriage include incomplete, septic, and missed miscarriages.

Sometimes you may not realize that you have had a miscarriage. This often happens with a missed miscarriage that occurs when the fetus or embryo ceases to develop very early but the body hasn’t stopped producing pregnancy hormones. A missed miscarriage may be diagnosed during an ultrasound, which often reveals an empty amniotic sac, no sac, or a significantly smaller fetus or embryo within the sac. In instances where the sac is empty or is not present, your body may have reabsorbed the embryo. 

When tissue from the pregnancy remains in the uterus, it is typically considered an incomplete miscarriage. Like other miscarriages, you will likely experience bleeding and dilation of the cervix. However, your body might have difficulty fully passing the tissue. It is not uncommon to pass the remaining tissue after diagnosis, which usually means you will not need further treatment or monitoring from your healthcare provider. However, if you are unable to pass the tissue, it can lead to complications such as heavy, prolonged bleeding or infection.

Infections that occur following a miscarriage should be treated promptly since they can rapidly progress from the uterus into the bloodstream and cause septic shock. When sepsis develops due to an infection from the tissue that remains in the uterus after a miscarriage, it is called a septic miscarriage. Sepsis is a life-threatening condition that requires immediate medical attention. If you experience any of these symptoms after having a miscarriage, you should seek emergency care immediately for further evaluation:

• A fever of 100.4 or higher 
• Chills
• Unusual drowsiness 
• Pelvic pain 
• Tenderness in the uterus 
• Bleeding and cramping for over two weeks  
• Foul-smelling vaginal discharge 

It is important to understand that regardless of the terms used to describe the miscarriage, these circumstances are often deeply emotional and can be traumatic. While prioritizing medical care following a miscarriage, it is equally important to emphasize the value of emotional support. Those who have experienced a miscarriage are encouraged to connect with their healthcare provider to explore additional resources to support their emotional and mental well-being. 

Sources 

“Missed Miscarriage: Causes, Symptoms, Diagnosis, and Treatment”. Very Well Health. https://www.verywellhealth.com/missed-miscarriage-symptoms-treatment-and-coping-5189858 

“What to Know About Incomplete Miscarriage”. Parents. https://www.parents.com/incomplete-miscarriage-symptoms-causes-treatment-8645920