When pregnancy goes wrong

 

 
Sadly, some women may have to face an ectopic pregnancy, a miscarriage or the death of the baby.  If this sadly happens to you, talk to the people close to you about how you feel, and to your doctor about what's happened and why. Sometimes it is easier to talk to someone outside your family and friends.
 
Ectopic pregnancy
 
This is when a fertilised egg implants outside the womb, usually in a fallopian tube. The fertilised egg can’t develop properly and your health may be at serious risk if the pregnancy continues. The egg has to be removed – this can be through an operation or medicines. The warning signs of an ectopic pregnancy can start soon after a missed period.
 
Miscarriage

A miscarriage is when a pregnancy is lost before 24 weeks, and it’s thought that around one in five confirmed pregnancies ends this way. Many early miscarriages (before 14 weeks) happen because there is something wrong with the baby. They can start like a period, with spotting or bleeding. A later miscarriage may be due to an infection, problems in the placenta, or the cervix being weak and opening too early in the pregnancy.

 

Losing a baby

In some pregnancies the baby dies before it's born (known as stillbirth) or soon after (neonatal death). Although rare, it does still happen. It is shocking to lose a baby this way.

 
Eptopic Pregnancy

Having an ectopic pregnancy

 

After fertilisation, the egg should move down into the womb to develop. Sometimes it gets stuck in the fallopian tube and begins to grow there. This is called an ectopic or tubal pregnancy.

 

Rarely, the egg can become stuck elsewhere, such as the ovary or the cervix (neck of the womb). The fertilised egg can’t develop properly and your health may be at serious risk if the pregnancy continues. The egg has to be removed – this can be through an operation or medicines.

 
A common cause of an ectopic pregnancy is damage in the fallopian tube, possibly as a result of an infection. The risk can also be increased if you have had a previous ectopic pregnancy, or previous abdominal surgery. The warning signs of ectopic pregnancy start soon after a missed period, and are: 

 

  • severe pain on one side, low down in the abdomen
  • vaginal bleeding or a brown watery discharge
  • pain in your shoulders
  • feeling dizzy or faint
  • pain when you have a bowel movement 
If you have any of these symptoms and you might be pregnant – even if you have not had a positive pregnancy test – you should see your doctor immediately. 

 

Some women have no obvious signs or symptoms at all, and an ectopic pregnancy may sometimes be mistaken for irritable bowel syndrome, food poisoning or appendicitis. 
 
Afterwards

You may feel a strong sense of loss, and you should give yourself time to grieve. An ectopic pregnancy involves abdominal surgery or treatment with powerful medicines and it may affect your chances of becoming pregnant again.

Talk to your doctor to discuss the possible causes and whether your chances of conceiving a baby have been affected.
 
Coping with a miscarriage

If a pregnancy ends before the 24th week, it is known as a miscarriage. Miscarriages are quite common in the first three months of pregnancy and around one in five confirmed pregnancies ends this way. Many early miscarriages (before 14 weeks) happen because there is something wrong with the baby. There can be other causes of miscarriage, such as hormone or blood-clotting problems.

A later miscarriage may be due to an infection, problems in the placenta, or the cervix being weak and opening too early in the pregnancy.

Symptoms

A miscarriage in the first few weeks can start like a period, with spotting or bleeding and mild cramps or backache. The pain and bleeding may get worse and there can be heavy bleeding with blood clots and quite severe cramping pains. With a later miscarriage, you may go through an early labour.

 

 

If you bleed or begin to have pains at any stage of pregnancy, contact your doctor.

 
If you are more than six or seven weeks pregnant, you may be referred for an ultrasound scan to see if your baby has a heartbeat and is developing normally. Sometimes the bleeding stops by itself and your pregnancy will carry on quite normally.
 
 Some women find out that their baby has died only when they have a routine scan. If they have had no pain or bleeding, this can come as a terrible shock, especially if the scan shows that the baby died days or weeks before. This is sometimes called a missed or silent miscarriage.
 

 
Some women find out at a routine scan that they have a molar pregnancy, which means the pregnancy has not been successful and a baby will not develop. This is not the same as a miscarriage, and surgery is needed to remove the molar pregnancy.
 
Treatment for a miscarriage
 
Sometimes it is preferable to wait and let the miscarriage happen naturally, but there are three ways of actively managing a miscarriage:

 

  • Medicine. You may be offered tablets or pessaries to start the process of miscarriage.
  • An operation. If you have been pregnant for less than 14 weeks, your doctor may advise an operation called an ERPC (evacuation of retained products of conception). This will empty your womb (uterus). It is done under anaesthetic. The cervix is gently widened and the contents of your womb are removed by suction.
  • Induced labour. If your baby dies after about 14 weeks, you may go into labour. If this doesn't happen, you will be offered tablets that start labour. Although some women would prefer not to go through labour, this is safer for you than an operation to remove the baby. You will be cared for and supported throughout your labour and the birth of your baby.
After a miscarriage

One early miscarriage is unlikely to affect your chances of having a baby in the future. If you have three or more early miscarriages in a row, you should be referred to a specialist for further investigations. However, sometimes no clear cause can be found.

 

Both women and men can find it difficult to come to terms with a miscarriage at any stage. You will almost certainly feel a sense of loss. You'll need time to grieve over the lost baby just as you would over the death of anyone close to you, especially if the miscarriage has happened later in your pregnancy.

 

You may feel shocked, distressed, angry or just numb. You may feel guilty, wondering whether your miscarriage was caused by anything you did or did not do. It is important to know that, whatever the cause, miscarriage is never anyone's fault. If a miscarriage is going to happen, there is very little that anyone can do to stop it.

 

Some people find it helps to have something to remember their baby by. In early pregnancy you might be able to have a picture of a scan. If you have a late miscarriage you may be able to see and hold your baby if you wish. You might also be able to take photographs, footprints and handprints as a keepsake.

 

Talk about your feelings with your partner and those close to you.
 
Coping with stillbirth

 

A stillbirth is when the pregnancy has lasted 24 weeks or more but the baby is already dead when it's born. About the same number die soon after birth (known as neonatal death). The causes of these deaths are often unknown.

 

Sometimes, a baby dies in the womb (called an intra-uterine death) and labour doesn't start. If this happens, you'll be given medicines to induce (start) the labour. This is the safest way of delivering the baby. It also means that you and your partner can see and hold the baby if you would like to.
 
Coping with your loss

It is shocking to lose a baby like this. You and your partner are likely to experience a range of emotions that come and go unpredictably. These can include disbelief, anger, guilt and grief. Some women think they can hear their baby crying, and it's not uncommon for mothers to think they can still feel their baby kicking inside. The grief is usually most intense in the few months after the loss. 

 

Some parents find it helpful to create memories of their baby, for example, seeing and holding the baby and giving him or her a name. You may also like to have a photograph of your baby and to keep mementos such as a lock of hair, hand and footprints or the baby's shawl. All this can help you and your family to remember your baby as a real person and can, in time, help you come to terms with your loss.

 

You may also find it helpful to talk to your doctor or to other parents who have lost a baby. 
 
A post-mortem examination

One of the first questions you're likely to ask is why your baby died. Sometimes, a post-mortem examination can provide some answers, but often no clear cause is found. A post-mortem may provide other information that could be helpful for future pregnancies and may rule out certain causes. If it's felt that a post-mortem could be helpful, a senior doctor or midwife will discuss this with you. If you decide on a post-mortem, you'll be asked to sign a consent form.
 

When the post-mortem report is available, you'll be offered an appointment with a consultant who can explain the results to you and what they might mean for a future pregnancy.
 
Multiple births

The loss of one baby from a multiple pregnancy (twins, triplets or more) is very difficult for any parent. Grieving for the baby who has died while caring for and celebrating the life of the surviving baby brings very mixed and complex emotions. Often, the surviving baby is premature and receiving special care in a neonatal unit, which causes additional concern.