Today we are talking about a complex topic, one that I get asked many questions about and one that can be very challenging both emotionally and physically for a patient. As defined by The American College of Obstetrics and Gynecologists (ACOG), “The loss of a pregnancy during the first 13 weeks of pregnancy (the first trimester) is called early pregnancy loss, miscarriage, or spontaneous abortion.” Approximately 80% of all cases of pregnancy loss occur within the first trimester. ACOG has an excellent resource on early pregnancy loss, and you can find it here.
Early pregnancy loss occurs in about 10% of known pregnancies, and is clinically recognized as “common”. However, that does not mean it is unimportant or insignificant. Though it is common in the larger population of all pregnancies, it is not necessarily common to the individual who experiences it. It is still a loss.
As someone who has experienced early pregnancy loss, I know first-hand how devastating it can be. No matter if it is a miscarriage, stillbirth, or ectopic pregnancy, there are support groups available to help you. If you have experienced a pregnancy loss, this article in Very Well Family is a tremendous resource in which to find support.
We cover the many reasons early pregnancy loss can occur. We also discuss whether each loss is considered in a recurrent pregnancy loss workup or not. Physicians do not always include all pregnancy losses in recurrent pregnancy loss workup, but they will still keep it noted in your medical history. Although a full workup may not be done, know that as a patient and parent it is absolutely OK and normal to grieve the loss. If you are concerned about pregnancy loss, have experienced it, or are wanting to understand more about it, this discussion will be very helpful.
4:42- Chemical Pregnancy Loss
A chemical pregnancy is when you have a positive pregnancy test right after you miss a period, but the next test is negative or you have a period shortly after. It occurs at less than 5 weeks and is thought to be caused by chromosomal abnormalities. A biochemical or chemical pregnancy is not considered in a recurrent pregnancy loss workup. This is because it was super early before there was ever a viable fetus in the uterus or anything showing up on an ultrasound. However, if there are multiple chemical pregnancies back-to-back, a fertility doctor may do a work-up to see what might be the underlying cause.
9:12- Anembryonic Demise/Pregnancy or Blighted Ovum
It’s thought that these types of pregnancy losses make up about half of all pregnancy losses. These losses are included in a recurrent pregnancy loss workup because there was a sac in the uterus that showed up on an ultrasound at some point.
10:44- Ectopic Pregnancy
When a pregnancy implants anywhere other than the uterine cavity, an ectopic pregnancy has occurred. These losses are not considered in a recurrent pregnancy loss workup. Some factors that can increase the risk for ectopic pregnancy are STD’s like Chlamydia, smoking, tubal ligation or sterilization, age, and IVF.
13:28- Molar Pregnancy
This is a genetically abnormal pregnancy. A patient may present with a larger than normal uterus, possibly with bleeding or pain because there can be cysts on the ovaries. This is not included in a recurrent pregnancy loss workup
16:40- How Common is Early Pregnancy Loss.
We want patients to understand that early pregnancy loss is not caused by one’s own fault in any way. Although early pregnancy loss is common, it can still be devastating.
18:18- Chromosomal Abnormalities
30:00- When will a patient have D&C versus medical management of an early pregnancy loss
32:24- D&C (Dilation and curettage)
34:40- The option to pursue genetic testing on products of conception (to check for chromosomal analysis) after an early pregnancy loss
35:40- How long a patient should wait to get pregnant again after experiencing an early pregnancy loss
40:00- Progesterone supplementation (if, and, or when it is used)
42:06- Recurrent Pregnancy Loss
This is when a patient has 2 or more clinical pregnancy losses (something is seen on an ultrasound) before 20 weeks of pregnancy, back-to-back.
I know this topic can be very difficult if you are in the midst of it. The hopeful news is that 60-80% of those who experience early pregnancy loss will eventually hold a pregnancy full-term.
As always, I hope that this information helps you feel empowered in your journey.
Shannon M. Clark, MD, MMS is a double board certified ObGyn and Maternal-Fetal Medicine Specialist, and founder of Babies After 35. In her roles as a clinician, educator and researcher at UTMB-Galveston, she focuses on the care of people with maternal and/or fetal complications of pregnancy. Dr. Clark has taken a special interest in pregnancy after the age of 35, which according to age alone, is considered a high-risk pregnancy.
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