* [Stillbirth](https://nabtahealth.com/glossary/stillbirth/) is the loss of a baby in the womb after 24 weeks of pregnancy. * Every year there are an estimated 2.6 million stillbirths worldwide. * One third of stillbirths are unexplained. Around a quarter are caused by birth defects. Other risk factors include higher age, drug use and multiples. * Early warning signs of [stillbirth](https://nabtahealth.com/glossary/stillbirth/) include change the baby’s movements, bleeding, itching, fever and headaches. One [stillbirth](https://nabtahealth.com/glossary/stillbirth/) tragically occurs every 16 seconds according to the [World Health Organisation (WHO)](https://www.who.int/health-topics/stillbirth#tab=tab_3). The [National Institutes of Health (NIH)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139804/) acknowledges that there is no universally accepted definition for when a fetal death is called a [stillbirth](https://nabtahealth.com/glossary/stillbirth/). Rather than a [miscarriage](https://nabtahealth.com/glossary/miscarriage/) and the interpretation of gestational age differs by country. What causes [stillbirth](https://nabtahealth.com/glossary/stillbirth/)? ----------------------------------------------------------------------- [Around one third of stillbirths are unexplained](https://my.clevelandclinic.org/health/diseases/9685-stillbirth). According to the Centers for Disease Control and Prevention (CDC) [](https://www.cdc.gov/ncbddd/stillbirth/facts.html)[stillbirth](https://nabtahealth.com/glossary/stillbirth/) can happen to women of any age, background or ethnicity. The CDC goes on to say that the loss of a baby due to [stillbirth](https://nabtahealth.com/glossary/stillbirth/) occurs more commonly among: * Women with a higher maternal age; * Women who smoke or use recreational drugs during pregnancy; * Black women; * Women of a low [socioeconomic](https://nabtahealth.com/glossary/socioeconomic/) status; * Women who are pregnant with multiples (twins, triplets and quadruplets); and, * Women who have had a previous pregnancy loss. Blood-clotting disorders and chronic diseases (diabetes, heart disease, [lupus](https://nabtahealth.com/glossary/lupus/), obesity and thyroid disease) are also linked with increased risk of [stillbirth](https://nabtahealth.com/glossary/stillbirth/). As are complications with the [placenta](https://nabtahealth.com/glossary/placenta/) and [umbilical cord](https://nabtahealth.com/glossary/umbilical-cord/), maternal infections (group B streptococcus, [malaria](https://nabtahealth.com/glossary/malaria/), [HIV](https://nabtahealth.com/glossary/hiv/) and some STDs) and physical trauma. ##### Research says; [The Cleveland Clinic](https://my.clevelandclinic.org/health/diseases/9685-stillbirth) says birth defects are the cause of around 25% of stillbirths. While Tommy’s says that [failure of the](https://www.tommys.org/baby-loss-support/stillbirth-information-and-support/causes-stillbirth) [placenta](https://nabtahealth.com/glossary/placenta/) is the most common known reason for a baby to be stillborn. Half of all stillbirths linked to complications with the [placenta](https://nabtahealth.com/glossary/placenta/). The risk of the [placenta](https://nabtahealth.com/glossary/placenta/) calcifying increases when the baby reaches [full term](https://nabtahealth.com/glossary/full-term/). Over half of all placentas will experience some degree of calcification at [full term](https://nabtahealth.com/glossary/full-term/). Placental calcification preterm ranges wildly – from 3.8 to 23.7 percent – based on the risk factors listed above. What are the warning signs of [stillbirth](https://nabtahealth.com/glossary/stillbirth/)? ----------------------------------------------------------------------------------------- [Stillbirth](https://nabtahealth.com/glossary/stillbirth/) can occur without any obvious indicators but there are some signs to look for. If you experience any of the below symptoms during your pregnancy you should contact your medical team immediately. * **Change in baby’s movements**: Most women will start to feel the flutterings of their baby moving anywhere from 16 weeks onwards. By around 24 weeks the baby’s movements will be becoming more regular. [UK charity Tommy’s](https://www.tommys.org/baby-loss-support/stillbirth-information-and-support/stillbirth-symptoms-and-risks) recommends that you learn to recognise your baby’s pattern of movements in the womb. Some women notice that their baby seems more active in the evenings. This is when they sit down and put their feet up or in response to the music beat during an exercise class. Others find their baby’s kicks increase when they eat spicy foods or drink a large glass of cold juice. The important point here is that if you notice any change in your baby’s movements – if the kicks suddenly seem less frequent or not as strong as usual – you should contact your doctor immediately. As this may be a sign that your baby is not getting enough oxygen or nutrients. * **Vaginal spotting or bleeding and cramping:** This could be the sign of placental abruption, [a serious condition in which the](https://www.marchofdimes.org/complications/placental-abruption.aspx) [placenta](https://nabtahealth.com/glossary/placenta/) separates from the wall of the [uterus](https://nabtahealth.com/glossary/uterus/) before birth. * **Vaginal discharge or fluid leaking from the [vagina](https://nabtahealth.com/glossary/vagina/)**: Discharge could be linked with an intrauterine infection or infection in the womb. Leaking fluid could be your waters breaking early. * **Feeling something in your [vagina](https://nabtahealth.com/glossary/vagina/) during pregnancy:** This might be the sign of an [umbilical cord](https://nabtahealth.com/glossary/umbilical-cord/) prolapse which would mean your baby isn’t getting enough oxygen. * **Itching:** Severe itching on your palms and soles of your feet may be a sign of Intrahepatic Cholestasis of Pregnancy (IHP). It is a pregnancy-related liver condition that can [lead](https://nabtahealth.com/glossary/lead/) to [stillbirth](https://nabtahealth.com/glossary/stillbirth/). Also called obstetric cholestasis you should report any itching to your physician. * **Fever:** Some infections during pregnancy can be dangerous for an unborn baby. * **Headaches, blurred vision or swelling:** These can be [symptoms of](https://nabtahealth.com/articles/what-is-preeclampsia/) [preeclampsia](https://nabtahealth.com/glossary/preeclampsia/) which can [lead](https://nabtahealth.com/glossary/lead/) to loss of pregnancy in the womb. Your medical team will monitor your symptoms including carrying out an ultrasound to check your baby and using a [doppler ultrasound](https://nabtahealth.com/glossary/doppler-ultrasound/) to measure the fetal heart rate. It is important that you attend all your routine antenatal tests and scans and report any concerns or unusual symptoms you have. However slight you feel they may be, as soon as you notice them. Getting the support you need after [stillbirth](https://nabtahealth.com/glossary/stillbirth/) --------------------------------------------------------------------------------------------- Losing a baby at any stage is devastating and it is important that you, your partner and family get the physical and emotional support you need. Your [healthcare team](https://nabtahealth.com/team/) will be able to advise on the local support networks and dedicated charities there to support you. — Nabta is reshaping [women’s healthcare](https://nabtahealth.com/). We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [](https://nabtahealth.com/glossary)[menopause](https://nabtahealth.com/glossary/menopause/). You can track your symptoms and get [personalised support by using the Nabta app.](https://nabtahealth.com/our-platform/nabta-app/) Get in [touch](/cdn-cgi/l/email-protection#740d15181815341a151600151c111518001c5a171b19) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources** “[Stillbirth](https://nabtahealth.com/glossary/stillbirth/)” The Cleveland Clinic https://my.clevelandclinic.org/health/diseases/9685-[stillbirth](https://nabtahealth.com/glossary/stillbirth/) “[Stillbirth](https://nabtahealth.com/glossary/stillbirth/)” WHO, [https://www.who.int/health-topics/](https://www.who.int/health-topics/stillbirth#tab=tab_3)[stillbirth](https://nabtahealth.com/glossary/stillbirth/)#tab=tab\_3 Tavares da Silva, F, “[Stillbirth](https://nabtahealth.com/glossary/stillbirth/): Case definition and guidelines for data collection, analysis, and presentation of maternal immunization safety data” Dec 2016, Vaccine, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139804/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139804/) “What is [Stillbirth](https://nabtahealth.com/glossary/stillbirth/)” CDC https://www.cdc.gov/ncbddd/[stillbirth](https://nabtahealth.com/glossary/stillbirth/)/facts.html “Causes of [Stillbirth](https://nabtahealth.com/glossary/stillbirth/)” Tommy’s, https://www.tommys.org/baby-loss-support/[stillbirth](https://nabtahealth.com/glossary/stillbirth/)\-information-and-support/causes-[stillbirth](https://nabtahealth.com/glossary/stillbirth/)
Polycystic ovary syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)) is a common hormonal disorder that can affect a woman’s ability to get pregnant. While having [PCOS](https://nabtahealth.com/glossary/pcos/) does not necessarily increase a woman’s chance of [miscarriage](https://nabtahealth.com/glossary/miscarriage/), it can make it more difficult for her to conceive and can also increase her risk of other pregnancy complications. [PCOS](https://nabtahealth.com/glossary/pcos/) is a condition in which the [ovaries](https://nabtahealth.com/glossary/ovaries/) produce an excess of male hormones, which can interfere with the development of eggs and make it more difficult for the eggs to be released from the [ovaries](https://nabtahealth.com/glossary/ovaries/). This can make it more difficult for a woman with [PCOS](https://nabtahealth.com/glossary/pcos/) to get pregnant. * There is a known link between [PCOS](https://nabtahealth.com/glossary/pcos/) and [miscarriage](https://nabtahealth.com/glossary/miscarriage/), but there is not enough data on this topic. * There is no solid evidence that any drugs can mitigate the risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/). * Choosing a healthy lifestyle is one of the key ways you can increase your chances of staying pregnant and preventing [miscarriage](https://nabtahealth.com/glossary/miscarriage/). A link between [PCOS](https://nabtahealth.com/glossary/pcos/) and [miscarriage](https://nabtahealth.com/glossary/miscarriage/) was first described in the late 1980s and yet, despite this, in the past 30 years very little progress has been made. We are still not sure why women with [PCOS](https://nabtahealth.com/glossary/pcos/) are at greater risk of miscarrying and, perhaps more importantly for those affected, we are no closer to finding a solution. It almost goes without saying that this is an area of research that desperately needs more attention and resources. Here we explore the limited data available, discuss why the need for answers is getting greater, and suggest what you can do to maximise your chances of falling pregnant and staying pregnant. You can track your pregnancy free of charge [using the Nabta App](https://nabtahealth.com/our-platform/nabta-app/). **What does the data suggest about [PCOS](https://nabtahealth.com/glossary/pcos/) and [Miscarriage](https://nabtahealth.com/glossary/miscarriage/)?** ----------------------------------------------------------------------------------------------------------------------------------------------------- Women with [PCOS](https://nabtahealth.com/glossary/pcos/) often struggle to conceive; in fact, the condition is considered to be one of the [leading causes of](https://nabtahealth.com/causes-of-female-infertility-failure-to-ovulate/) [infertility](https://nabtahealth.com/glossary/infertility/) in females. The problem is that once pregnant, those women with [PCOS](https://nabtahealth.com/glossary/pcos/) are also at increased risk of going through the trauma of one, or even multiple, [miscarriages](https://nabtahealth.com/miscarriage-101/). Women with [PCOS](https://nabtahealth.com/glossary/pcos/) are three times more likely to miscarry than those without [PCOS](https://nabtahealth.com/glossary/pcos/). There is some evidence that women who suffer recurrent miscarriages are more likely to have [polycystic](https://nabtahealth.com/do-polycystic-ovaries-equal-pcos/) [ovaries](https://nabtahealth.com/glossary/ovaries/), but no proof that this abnormal ovarian morphology is causing pregnancy loss. There is also very little data to support the idea that increased levels of luteinising hormone or [testosterone](https://nabtahealth.com/glossary/testosterone/) are implicated in [miscarriage](https://nabtahealth.com/glossary/miscarriage/). One of the biggest issues with the work that has been completed to date is that many of the studies rely on retrospective evidence. The accuracy and reproducibility of the results is dependent on participant recollection. As a result, many of the large scale reviews have deemed the evidence that is currently available to be of low quality and inconclusive. Also, the variation in the criteria used to define [PCOS](https://nabtahealth.com/glossary/pcos/) before the Rotterdam criteria became the [gold](https://nabtahealth.com/glossary/gold/) standard in 2003, led to some inconsistencies in the association between [PCOS](https://nabtahealth.com/glossary/pcos/) and miscarriages. **Why does the association between [PCOS](https://nabtahealth.com/glossary/pcos/) and [miscarriage](https://nabtahealth.com/glossary/miscarriage/) urgently require further work?** ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- [](https://nabtahealth.com/what-is-pcos/)[PCOS](https://nabtahealth.com/glossary/pcos/) is a medical condition that is not going to disappear any time soon. In fact, the percentage of women affected by it is likely to increase over the coming years. [PCOS](https://nabtahealth.com/glossary/pcos/) is [strongly associated with obesity and](https://nabtahealth.com/treating-the-associated-symptoms-of-pcos/) [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/); and, whilst these two conditions are increasing in prevalence across the developed world, an unfortunate consequence of this will be that more women will find themselves facing the realities of a [](https://nabtahealth.com/problems-with-traditional-diagnosis-of-pcos/)[PCOS](https://nabtahealth.com/glossary/pcos/) diagnosis. We know that women with [PCOS](https://nabtahealth.com/glossary/pcos/) who do conceive are at risk of further pregnancy complications, including [](https://nabtahealth.com/gestational-diabetes-8-things-you-should-know/)[gestational diabetes](https://nabtahealth.com/glossary/gestational-diabetes/), [](https://nabtahealth.com/what-is-preeclampsia/)[preeclampsia](https://nabtahealth.com/glossary/preeclampsia/) and premature delivery. This is financially costly, placing an increasing burden on healthcare systems across the world; but it is also emotionally draining for those couples who have to go through it. Experiencing a [miscarriage](https://nabtahealth.com/glossary/miscarriage/) can be a devastating experience. There can never be a right or wrong way of coping with and managing your loss. However, for many women, closure, or acceptance, is possible once they understand why something has happened. We need to improve our knowledge on [](https://nabtahealth.com/pcos-and-pregnancy/)[PCOS](https://nabtahealth.com/glossary/pcos/) and pregnancy; we need to better understand why [PCOS](https://nabtahealth.com/glossary/pcos/) increases the risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/); and, perhaps above all, we need to give those women who have experienced a loss, answers. **What can you do to manage your risk of miscarrying and increase your chances of a healthy pregnancy?** -------------------------------------------------------------------------------------------------------- As already discussed, there is significant work to be done to support the risk of [PCOS](https://nabtahealth.com/glossary/pcos/) and [miscarriage](https://nabtahealth.com/glossary/miscarriage/). Some reports have suggested that [ovulation](https://nabtahealth.com/glossary/ovulation/) induction agents, such as clomiphene citrate and [metformin](https://nabtahealth.com/i-have-pcos-should-i-take-metformin/), might improve live birth rates. In fact, metformin is not strictly an [ovulation](https://nabtahealth.com/glossary/ovulation/) inducer, it is used to treat [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/), and has, therefore, been used ‘off-label’ to manage some of the symptoms of [PCOS](https://nabtahealth.com/glossary/pcos/). There is limited evidence that it improves [ovulation](https://nabtahealth.com/glossary/ovulation/) rates. There is no solid evidence that either of these drugs reduce the risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/) and the data across different studies remains conflicting. Whilst this may all be sounding a little depressing, there is one key thing that should be remembered; [many of the symptoms of](https://nabtahealth.com/is-it-possible-to-reverse-pcos/) [PCOS](https://nabtahealth.com/glossary/pcos/) can be alleviated by making healthy lifestyle decisions. Losing weight, exercising more, making considered choices with regards to your [diet](https://nabtahealth.com/eating-to-conceive/), these are all things that can help to improve menstrual cycle regularity. This in turn, increases your chances of getting, and staying, pregnant. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#354c54595954755b545741545d505459415d1b565a58) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Cocksedge Karen, et al., “How common is polycystic ovary syndrome in recurrent [miscarriage](https://nabtahealth.com/glossary/miscarriage/)?” _Reproductive Biomedicine Online_, 2009 Oct;19(4):572-6. doi: 10.1016/j.rbmo.2009.06.003. PMID: 19909600. * “Does [PCOS](https://nabtahealth.com/glossary/pcos/) Affect Pregnancy?” _Eunice Kennedy Shriver National Institute of Child Health and Human Development_, U.S. Department of Health and Human Services, [www.nichd.nih.gov/health/topics/](http://www.nichd.nih.gov/health/topics/pcos/more_information/FAQs/pregnancy)[pcos](https://nabtahealth.com/glossary/pcos/)/more\_information/FAQs/pregnancy. * Kaur, R and Gupta, K. “Endocrine Dysfunction and Recurrent Spontaneous Abortion: An Overview.” _International Journal of Applied and Basic Medical Research_, vol. 6, no. 2, 2016, pp. 79–83., doi:10.4103/2229-516x.179024. * Legro, Richard S., et al. “Clomiphene, Metformin, or Both for [Infertility](https://nabtahealth.com/glossary/infertility/) in the Polycystic Ovary Syndrome.” _New England Journal of Medicine_, vol. 356, no. 6, 8 Feb. 2007, pp. 551–566., doi:10.1056/nejmoa063971. * Mills, Ginevra, et al. “Associations between Polycystic Ovary Syndrome and Adverse Obstetric and [Neonatal](https://nabtahealth.com/glossary/neonatal/) Outcomes: a Population Study of 9.1 Million Births.” _Human Reproduction_, vol. 35, no. 8, 9 July 2020, pp. 1914–1921., doi:10.1093/humrep/deaa144. * Rai, Raj, et al. “Polycystic [Ovaries](https://nabtahealth.com/glossary/ovaries/) and Recurrent [Miscarriage](https://nabtahealth.com/glossary/miscarriage/)—a Reappraisal.” _Human Reproduction_, vol. 15, no. 3, 1 Mar. 2000, pp. 612–615., doi:10.1093/humrep/15.3.612. * Sagle, M., et al. “Recurrent Early [Miscarriage](https://nabtahealth.com/glossary/miscarriage/) and Polycystic [Ovaries](https://nabtahealth.com/glossary/ovaries/).” _Bmj_, vol. 297, no. 6655, 22 Oct. 1988, pp. 1027–1028., doi:10.1136/bmj.297.6655.1027. * Sharpe, Abigail, et al. “Metformin for [Ovulation](https://nabtahealth.com/glossary/ovulation/) Induction (Excluding Gonadotrophins) in Women with Polycystic Ovary Syndrome.” _Cochrane Database of Systematic Reviews_, 17 Dec. 2019, doi:10.1002/14651858.cd013505.
Pregnancy can be a time of excitement and eager anticipation as you look forward to your new arrival. However, for some women, particularly those who have previously experienced a [miscarriage](https://nabtahealth.com/glossary/miscarriage/), the excitement is tempered by feelings of worry, stress and anxiety. This heightened anxiety is exacerbated further in women who have experienced multiple miscarriages. #### The inefficiency of reproduction A [miscarriage](https://nabtahealth.com/glossary/miscarriage/) is defined as the spontaneous loss of a pregnancy before 20 weeks gestation. Fertilisation occurs when a [](https://nabtahealth.com/articles/my-husband-has-a-low-sperm-count-when-is-the-best-time-to-have-intercourse/)[sperm](https://nabtahealth.com/glossary/sperm/) from the male fertilizes a female’s egg. The process of human reproduction is so inefficient that only about one third of successful fertilisations will result in a live birth. Many potential pregnancies fail prior to [implantation](https://nabtahealth.com/glossary/implantation/) and before the female even realises that she is pregnant. Approximately 15% of clinical pregnancies (meaning an ultrasound has been used to confirm successful [implantation](https://nabtahealth.com/glossary/implantation/) of the fertilised egg into the wall of the [uterus](https://nabtahealth.com/glossary/uterus/)) end in [miscarriage](https://nabtahealth.com/glossary/miscarriage/), usually as a result of embryo chromosomal abnormalities. It is significantly less common for a [miscarriage](https://nabtahealth.com/glossary/miscarriage/) to occur between weeks 12 and 20, so much so that many women are confident to share their news after their 12 week scan. Losses after week 12 are termed late miscarriages and occur in approximately 4% of cases. #### If I have had one [miscarriage](https://nabtahealth.com/glossary/miscarriage/), how likely am I to have another? Having one [miscarriage](https://nabtahealth.com/glossary/miscarriage/) does not usually place a woman at increased risk of having another [miscarriage](https://nabtahealth.com/glossary/miscarriage/). However, having two or more consecutive miscarriages does increase her risk. The European Society of Human Reproduction and Embryology ([ESHRE](https://www.eshre.eu/)) defines **recurrent [miscarriage](https://nabtahealth.com/glossary/miscarriage/)** (RM) as three or more consecutive losses occurring before 20 weeks gestation. Women who experience RM have a 43% chance of experiencing further miscarriages. Approximately 1% of couples who are attempting to conceive experience RM and there is no doubt that repeated miscarriages will cause extensive emotional turmoil. #### What causes recurrent [miscarriage](https://nabtahealth.com/glossary/miscarriage/)? Various factors have been associated with RM including parental chromosome abnormalities (10 times more prevalent in couples who have experienced RM, than in the general population), immune dysfunction, endocrine disorders (thyroid conditions and [](https://nabtahealth.com/pcos-and-pregnancy/)[PCOS](https://nabtahealth.com/glossary/pcos/)), damage to the DNA in the male’s [](https://nabtahealth.com/everything-you-need-to-know-about-sperm/)[sperm](https://nabtahealth.com/glossary/sperm/) and uterine structural abnormalities (endometrisis). However, in approximately 50% of cases of RM, the exact cause is unknown. #### How long should I wait after a [miscarriage](https://nabtahealth.com/glossary/miscarriage/) before attempting to conceive again? In the last set of guidelines published by the [World Health Organisation](http://www.who.int/maternal_child_adolescent/documents/birth_spacing.pdf) in 2005, it was recommended that couples wait 6 months after [miscarriage](https://nabtahealth.com/glossary/miscarriage/) before attempting to conceive again. However, more recent work has disputed this and even found that couples who fell pregnant within three months of miscarrying got pregnant faster, had a higher live birth rate and were no more likely to experience complications, when compared to those who waited for longer than 3 months to start trying to conceive. What is absolutely essential to consider before trying to conceive after a [miscarriage](https://nabtahealth.com/glossary/miscarriage/) is whether you are ready emotionally. Whilst your body may be physically fit, it is important to remember that you have experienced a loss and, as such, may still be grieving. Giving yourself time to heal mentally is just as important as allowing your body to recover. If you have experienced RM, your doctor will likely have screened both you and your partner for chromosomal abnormalities. If any of these screens came back positive, it is important to consider what the implications are for future pregnancies, prior to attempting to conceive again. The type of abnormality will determine whether you are capable of carrying a pregnancy to term and how likely it is that children you give birth to will have genetic disorders. Your doctor will be able to counsel and advise you accordingly. #### Pregnancy after [miscarriage](https://nabtahealth.com/glossary/miscarriage/) In the majority of cases it is difficult to advise on how to have a successful pregnancy after [miscarriage](https://nabtahealth.com/glossary/miscarriage/). The reasons for [miscarriage](https://nabtahealth.com/glossary/miscarriage/) are varied and, in many cases, poorly understood. Doctors do agree, however, that it is worth adopting a healthy lifestyle; increasing your folic acid intake, [eating healthily](https://nabtahealth.com/eating-to-conceive/), stopping smoking and reducing your alcohol intake. In combination these factors maximise your chances of both conceiving and experiencing a problem-free pregnancy. _Pregnancy after [miscarriage](https://nabtahealth.com/glossary/miscarriage/)_ can be a scary thing. Women who have previously miscarried are often hesitant to get excited about their next pregnancy, fearing the same outcome. The main thing is to take it a day at a time, focusing on getting to each recognised milestone; for example, the 12 week scan, the 20 week scan, the age at which the foetus becomes viable if born (approximately 23 weeks). Hopefully as you draw closer to your delivery date you will be able to start relaxing and making plans for your new arrival. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#cfb6aea3a3ae8fa1aeadbbaea7aaaea3bba7e1aca0a2) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Branch, D. Ware, et al. “Recurrent [Miscarriage](https://nabtahealth.com/glossary/miscarriage/).” _New England Journal of Medicine_, vol. 363, no. 18, 28 Oct. 2010, pp. 1740–1747., doi:10.1056/nejmcp1005330. * Jauniaux, E, et al. “Evidence-Based Guidelines for the Investigation and Medical Treatment of Recurrent [Miscarriage](https://nabtahealth.com/glossary/miscarriage/).” _Human Reproduction_, vol. 21, no. 9, Sept. 2006, pp. 2216–2222., doi:10.1093/humrep/del150. * Larsen, E C, et al. “New Insights into Mechanisms behind [Miscarriage](https://nabtahealth.com/glossary/miscarriage/).” _BMC Medicine_, vol. 11, no. 154, 26 June 2013, doi:10.1186/1741-7015-11-154. * Moreuil, Claire, et al. “Hydroxychloroquine May Be Beneficial in [Preeclampsia](https://nabtahealth.com/glossary/preeclampsia/) and Recurrent [Miscarriage](https://nabtahealth.com/glossary/miscarriage/).” _British Journal of Clinical Pharmacology_, vol. 86, no. 1, 21 Oct. 2019, pp. 39–49., doi:10.1111/bcp.14131. * “Pregnancy after [Miscarriage](https://nabtahealth.com/glossary/miscarriage/): What You Need to Know.” _Mayo Clinic_, 12 Mar. 2019, [www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/pregnancy-after-](http://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/pregnancy-after-miscarriage/art-20044134)[miscarriage](https://nabtahealth.com/glossary/miscarriage/)/[art](https://nabtahealth.com/glossary/art/)\-20044134. * Schliep, K C, et al. “Trying to Conceive After an Early Pregnancy Loss: An Assessment on How Long Couples Should Wait.” _Obstetrics and Gynecology_, vol. 127, no. 2, Feb. 2016, pp. 204–212., doi:10.1097/AOG.0000000000001159. * World Health Organization Report of a WHO technical consultation on birth spacing, Geneva Switzerland 13-15 June 2005. Available at: [http://www.who.int/maternal\_child\_adolescent/documents/birth\_spacing.pdf](http://www.who.int/maternal_child_adolescent/documents/birth_spacing.pdf). Accessed 06/05/2019.
\***_According to Patient Feedback_** “Who are the best gynaecologists in Dubai? Can anyone recommend an OBGYN?” You asked us and we turned the question back to you. We have compiled the top 10 gynaecologists in Dubai, based only on real patient recommendations, experience and feedback. No healthcare professionals were questioned. Gathered from exemplary recommendations across Dubai social media forums, these top 10 gynaecologists in Dubai not only have a wealth of clinical expertise in their field, they also stand out for the overwhelmingly positive comments from their patients. #### **Dr Salma Ballal, Consultant Obstetrics and Gynaecology, [Genesis Healthcare Center](https://www.genesis-dubai.com/our_doctors/dr-salma-ballal/)** Having delivered well over 1000 babies, Dr Salma Ballal has extensive experience in managing normal and complex pregnancies and deliveries. Dr Salma trained in obstetrics and gynaecology with the UK’s NHS where she developed a strong interest in maternal medicine, high-risk pregnancies, and labour care. She completed advanced maternal medicine and labour ward practice training with the Royal College of Obstetrics and Gynaecology (RCOG) before moving to Dubai in 2014. Dr Salma was most recently at Mediclinic Parkview hospital before joining the Genesis Healthcare Center team. Dr Salma believes in open communication with her patients and that “women should be kept informed through every step of what is the most amazing experience in any woman’s life.” She also offers pre-pregnancy counselling to patients with complicated or traumatic pregnancy history. Patients describe Dr Salma as “refreshingly honest”, and “very safe hands”, saying she “totally respected my wishes”. #### **Dr Esra Majid, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Kings’ College Hospital Dubai**](https://kingscollegehospitaldubai.com/dr/esra-mejid/) Based in Dubai since 2016, Dr Esra has built a reputation for her management of high-risk pregnancies and gynaecological conditions. She worked at Al Zahra Hospital Dubai, where she regularly received excellent feedback from her patients, before moving to King’s College Hospital Dubai. At Kings’ College Hospital Dubai Dr Esra “performs major surgical procedures, follow up of high-risk pregnancies and deliveries, along with natural and water births.” Dr Esra qualified in Baghdad and went on to complete her Board Certificate in Obstetrics and Gynaecology in Sweden. She worked at the teaching hospital Sundsvall County Hospital and as a specialist at Sodra Alv Bord Hospital in Gothenburg before moving to Dubai. Patients have praised Dr Esra for her expertise and skill, describing her as “straight to the point, warm and approachable.” #### **Dr Vibha Sharma, Specialist [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Prime Medical Center**](https://www.primehealth.ae/prime-medical-centers/medical-centers/prime-medical-center-sheikh-zayed-road/dr-vibha-sharma) Working in Dubai since 2004, Dr Vibha is known for her commitment to supporting women with a range of gynaecological and women’s health problems. In the UAE she worked at Ministry of Health and Tertiary Care hospitals prior to joining Prime Medical Center. Dr Vibha specialises in areas of women’s health requiring specialist gynaecological expertise. Qualified in India at Jammu Medical College, Dr Vibha went on to do her post-graduate at King George’s Medical College in Lucknow. She worked at Queen Mary’s Hospital Lucknow and Willingdon and Batra Hospitals and Research Centre in New Delhi before moving to the Middle East. Patients have described Dr Vibha as “consistent”, “approachable”, and “professional”. **Dr Aisha Alzouebi, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Mediclinic Parkview Hospital**](https://www.mediclinic.ae/en/corporate/doctors/1/aisha-alzouebi-dr.html) Dr Aisha Alzouebi has more than 15 years of experience in obstetrics and gynaecology in the UK and the UAE, with specialist expertise in “early pregnancy, management of complications in early pregnancy, family planning and sexual health, [benign](https://nabtahealth.com/glossary/benign/) open and laparoscopic surgery and hysteroscopy.” A member of the UK’s Royal College of Obstetricians and Gynaecologists (RCOG), Dr Aisha attended medical school at Sheffield University and completed her Masters in Surgical Education at Imperial College London. Patient social media feedback on Dr Aisha said, “she was brilliant”, “I would highly recommend her”, “Dr Aisha is great”. #### **Dr Reeja Mary Abraham, Specialist in Obstetrics and Gynaecology,** [**Medcare Women and Children Hospital**](https://www.medcare.ae/en/physician/view/reeja-mary-abraham.html) A specialist in high-risk pregnancies, Dr Reeja takes an “evidence-based” approach to complex and low risk gynaecological issues. Dr Reeja is based at Medcare Women and Children Hospital, where she also “performs and assists in major and minor gynaecological procedures”. A member of the Indian Medical Association (IMA) and the Kerala Federation of Obstetricians and Gynaecologists (KFOG), Dr Reeja began her medical career at Christian Fellowship Hospital in Oddanchatram, Tamil Nadu and worked in hospitals in Kerala and Tamil Nadu before moving to Dubai to work at Medcare Women and Children Hospital. Patients recommending Dr Reeja describe her as “kind and attentive”, “highly professional”, and “detail-oriented”. #### **Dr Nashwa Abulhassan, Head of Obstetrics and Gynaecology, Dr** [**Sulaiman Al Habib Hospital Healthcare City**](https://www.hmguae.com/doctor/dr-nashwa-abul-hassan/) Dr Nashwa is a specialist in normal and complex pregnancies and deliveries, as well as “acute gynaecology and early pregnancy complications management” based at Dr Sulaiman Al Habib Hospital Healthcare City. A member of the Royal College of Obstetricians and Gynaecologists (RCOG) and an accredited member of the British society of colposcopists and cervical pathologists, Dr Nashwa has more than 15 years of experience in the UK and the UAE. Dr Nashwa has been featured in the UAE media discussing pregnancy complications and was most recently in [Gulf News](https://gulfnews.com/uae/health/step-by-step-guide-to-dealing-with-covid-19-during-pregnancy-1.80112211), offering advice for pregnant women who have tested positive for Covid-19. Dr Nashwa’s patients describe her as “kind and caring”. #### **Dr Samina Dornan, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/) and sub specialist in Maternal Fetal Medicine, [Al Zahra Hospital](https://azhd.ae/doctors/dr-samina-dornan/#:~:text=Consultant%20Maternal%20and%20Fetal%20Medicine,London%20to%20come%20to%20Dubai.)** An established international voice on maternal and fetal health issues, Dr Samina Dornan has extensive experience in fetal medicine. At Al Zahra Hospital she works as a consultant [obstetrician](https://nabtahealth.com/glossary/obstetrician/) and gynecologist with a sub-specialty in Maternal Fetal Medicine. Dr Samina qualified at Queen’s University Belfast. She received a fellowship from the Royal College of Obstetricians and Gynaecologists (RCOG) in 2017 and is the “first female Maternal Fetal Medicine sub-specialist \[at RCOG\]” to work with patients in Dubai. Frequently quoted in the media, Dr Samina is “extensively published in complex twin pregnancies”. Patient feedback on Dr Samina is overwhelmingly positive, describing her as “wonderful”, “absolutely fantastic”, “caring” and “amazing”. #### **Dr Sarah Francis, Consultant Obstetrics and Gynaecology,** [**American Hospital Dubai and American Hospital Al Khawaneej Clinic**](https://www.ahdubai.com/doctors-profile/sarah-francis) With clinical expertise in general and [benign](https://nabtahealth.com/glossary/benign/) gynaecology, adolescent gynaecological issues, polycystic ovarian syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)), and low and high-risk pregnancies, Dr Sarah supports patients at American Hospital Dubai and American Hospital Al Khawaneej Clinic. A member of the Royal College of Obstetricians and Gynaecologists (RCOG), Dr Sarah qualified in Sierra Leone and practised in NHS hospitals and trusts across the UK before moving to the UAE. She worked with patients at Drs Nicholas and Asp clinics before joining the team at American Hospital. Patients say that Dr Sarah is “wonderful” and “exceptionally supportive”. #### **Dr Dragana Pavlovic-Acimovic, Specialist Obstetrics and Gynaecology,** [**Mediclinic Meadows**](https://www.mediclinic.ae/en/corporate/doctors/8/dragana-pavlovic-acimovic.html) Dr Dragana has “a special interest in obstetrics” and consults on “adolescent gynaecology, [menopause](https://nabtahealth.com/glossary/menopause/), family planning” and various gynaecological conditions. Dr Dragana qualified in Serbia and started her career at University Hospital Narodni Front in Belgrade, “the largest specialised obstetrics and gynaecology centre in South-East Europe”. She moved to Dubai in 2015 and worked at Drs Nicholas and Asp before joining Mediclinic. Patients’ experience with Dr Dragana is “great”. #### **Dr Alessandra Pipan, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Mediclinic City Hospital**](https://www.mediclinic.ae/en/corporate/doctors/1/alessandra-pipan.html) With more than 30 years’ experience in gynaecology and obstetrics Dr Alessandra treats a range of gynaecological conditions, is a specialist in [infertility](https://nabtahealth.com/glossary/infertility/) and oncology, and works with high-risk pregnancies at Mediclinic City Hospital. A member of the Royal College of Obstetrics and Gynaecology (RCOG), the European Society of Reproduction and Embryology, and the European Society of Gynaecological Endoscopy, Dr Alessandra qualified at Cattolica University of Rome, Italy and has developed extensive sector experience in positions across the Italian and UAE healthcare institutions. Patients of Dr Alessandra have described her as “great” and “amazing”. \_\_\_ Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [](https://nabtahealth.com/glossary)[menopause](https://nabtahealth.com/glossary/menopause/). You can track your menstrual cycle and get [personalised support by using the Nabta app.](https://nabtahealth.com/our-platform/nabta-app/) Get in [touch](/cdn-cgi/l/email-protection#fc859d90909dbc929d9e889d94999d908894d29f9391) if you have any questions about this article or any aspect of women’s health. We’re here for you.
Ectopic literally means ‘abnormal place or position’. An [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) is when the fertilised egg implants outside the [uterus](https://nabtahealth.com/glossary/uterus/) and the embryo begins to develop in that site. The most common location is the fallopian tube, but ectopic pregnancies can also happen in the ovary, abdomen and sometimes in the [cervix](https://nabtahealth.com/glossary/cervix/) or a [c-section scar](https://www.parents.com/pregnancy/complications/testing-for-ectopic-pregnancy-what-to-expect/). Unfortunately, the fetus can’t develop or survive in sites outside the [uterus](https://nabtahealth.com/glossary/uterus/), which are unable to hold a growing embryo. And there is serious risk to the mother’s health if the [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) is not diagnosed. #### _How can I detect an [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/)?_ Ectopic [pregnancy symptoms](https://nabtahealth.com/articles/pregnancy-symptoms/) usually develop [from the 4th week of pregnancy](https://www.nhs.uk/conditions/ectopic-pregnancy/). Signs to look for include: – Intermittent vaginal bleeding, watery and brownish in colour – Persistent sharp abdominal cramps and pain low on one side – Nausea and vomiting – Shoulder tip pain – Urge to go to the toilet, discomfort when doing a pee or a poo, and sometimes [diarrhoea](https://nabtahealth.com/glossary/diarrhoea/). Sometimes an [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) is only detected during a routine pregnancy ultrasound scan. If you have experienced one [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/), there is a [10% risk](https://www.tommys.org/baby-loss-support/ectopic-pregnancy-information-support) of it happening again. _Does an [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) show up on a home pregnancy test?_ Ectopic pregnancies produce [human chorionic gonadotropin (hCG) hormone](https://www.ncbi.nlm.nih.gov/books/NBK532950/) so register as a positive on a home pregnancy test. #### _How do doctors diagnose an [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/)?_ An [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) is tricky to diagnose because the [symptoms](https://nabtahealth.com/articles/pregnancy-symptoms/) can be confused with a healthy pregnancy, with all the typical early signs of pregnancy, including missed periods, tender breasts, and fatigue. And not every woman has symptoms. Or even realises she is pregnant. Doctors usually diagnose an [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) with a test to [measure hCG in the blood](https://www.parents.com/pregnancy/complications/testing-for-ectopic-pregnancy-what-to-expect/). In an [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) levels of the hormone rise at a slower rate than in a normal pregnancy. A pelvic exam with a [transvaginal ultrasound](https://nabtahealth.com/glossary/transvaginal-ultrasound/) scan then confirms the size and position of the pregnancy. #### _What happens if an [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) is not detected?_ It’s crucial to diagnose ectopic [pregnancy early](https://nabtahealth.com/articles/am-i-pregnant-13-early-signs-of-pregnancy/). Unfortunately, the embryo can’t be saved and could mean ruptured [fallopian tubes](https://nabtahealth.com/glossary/fallopian-tube/), internal bleeding, or even maternal death if left untreated. [Signs of a fallopian tube rupture include](https://www.tommys.org/baby-loss-support/ectopic-pregnancy-information-support) – Sudden intense abdominal pain – Dizziness and weakness or fainting – Feeling nauseous – Looking very pale and unwell. If you notice any symptoms of a ruptured fallopian tube, you must call emergency services at once and go directly to your closest hospital for urgent medical attention. #### _Treatment for [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/)_ If a doctor confirms [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) in its early stages, they will probably prescribe a [methotrexate](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191676/) injection. Methotrexate stops the cells dividing and halts embryo growth. But if the [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) is advanced or ruptured, surgery may be necessary to remove it under general anaesthetic with a [laparoscopy](https://nabtahealth.com/glossary/laparoscopy/) (keyhole surgery). The surgeon will remove the pregnancy, and may remove the fallopian tube if they decide that is the best approach for the mother’s safety. An [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) is a distressing and potentially life-threatening event for any woman. If something doesn’t feel right, or if you notice signs or symptoms of a potential [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) go to your nearest healthcare centre at once.
 #### What is maternal health and why is it so important? Pregnancy and childbirth are exciting, scary, life-changing events. They can be joyful experiences, and they can be fraught with anxiety, and physical and emotional challenges. Maternal health is about the wellbeing of women and their babies during pregnancy, childbirth, and the postnatal period. Women should feel comfortable and confident in the medical care and attention they receive each stage of their pregnancy journey. Lack of awareness about the potential complications associated with pregnancy and childbirth can [lead](https://nabtahealth.com/glossary/lead/) to devastating outcomes. Most maternal complications are preventable with prompt support by trained maternal health professionals. The goal for maternal health is always positive outcomes for both mother and baby. #### What are maternal health services? A pregnant woman will usually meet some or all the following skilled healthcare practitioners during and after her pregnancy: * Doctor or General Practitioner (GP): Provides basic pregnancy care. Doctors with added expertise may share pregnancy care with a hospital. * [Obstetrician](https://nabtahealth.com/glossary/obstetrician/): A doctor qualified in specialist antenatal and postnatal care for women and their babies. Obstetricians deliver babies and manage high-risk pregnancies and births. * Midwife: Medically trained to care for women during pregnancy, labour and after childbirth. Often a pregnant woman will be cared for by a team of midwives. * Doula: Some women choose a Doula as a companion for support during pregnancy and labour. A Doula is not a medically trained professional. * [Lactation](https://nabtahealth.com/glossary/lactation/) consultant: Helps mother and baby establish breastfeeding and overcome difficulties with latching, low milk supply, and sore nipples. * Maternal and child health nurses: Monitor the child’s development and growth from newborn until around 3.5 years old. #### Antenatal checks, tests, and screenings Routine antenatal checks and tests are an important part of a woman’s pregnancy care. As the pregnancy progresses, blood tests, urine samples and ultrasound scans are accompanied by scheduled check-ups to assess the mother’s health and wellbeing, and the baby’s development. Screening and scans during pregnancy typically include a full blood count, infectious disease screen, urine culture, dating scan, screens for genetic abnormalities, [gestational diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) screening, and Group B strep screen. It’s a personal choice to have all the antenatal tests. A mother’s healthcare team will recommend that she has all tests and scans as scheduled for a complete picture of her health and her baby’s development. The tests are also designed to pick up any medical problems and identify possible genetic conditions affecting the baby. This will enable the mother and her doctors to make informed decisions about further testing or actions. #### What are maternal health concerns during pregnancy? Major maternal health problems can [lead](https://nabtahealth.com/glossary/lead/) to serious illness or death for both mother and baby. Complications can include excessive blood loss during labour, infections, [anaemia](https://nabtahealth.com/glossary/anaemia/), high blood pressure ([hypertension](https://nabtahealth.com/glossary/hypertension/)), obstructed labour, and heart disease. Maternal mental health is also an important consideration. Pregnancy and childbirth are different for every woman. Access to the right healthcare before, during and after pregnancy will reduce the risk of complications. #### – Before pregnancy Medical history and pre-existing conditions: The healthcare team should be made aware of any medical conditions, medications, or family history that may affect the mother’s health, or the unborn baby’s health during pregnancy. #### – During pregnancy The mother should attend all recommended check-ups and screenings. The maternal health team will monitor and treat pregnancy-related health issues including [anaemia](https://nabtahealth.com/glossary/anaemia/), urinary tract infections, [hypertension](https://nabtahealth.com/glossary/hypertension/), [gestational diabetes](https://nabtahealth.com/glossary/gestational-diabetes/), mental health conditions, excess weight gain, infections, [hyperemesis gravidarum](https://nabtahealth.com/glossary/hyperemesis-gravidarum/) (severe and persistent vomiting). #### – After pregnancy The postpartum period usually refers to the first six weeks after childbirth. While there’s (understandably) lots of focus on the new arrival, postpartum health is just as important: * Physical recovery: Allow time for physical recovery from a vaginal birth or C-section. Mothers should prepare for perineal pain, vaginal bleeding (lochia) and uterine [contractions](https://nabtahealth.com/glossary/contraction/). * Postpartum or postnatal depression: Take care of emotional health. It’s normal to experience the ‘baby blues’ when hormones dip a few days after giving birth. Prolonged low moods and feelings of helplessness should be raised with the healthcare team. * Rest is best: Try to sleep or rest when the baby sleeps. Rest will help with recovery. * Eat regularly: Eat regular, healthy meals. What a mother eats, her baby eats. * Hydrate: Drink water, lots of it. Hydration will aid milk supply. * Feeding routines: Get support establishing feeding routines, whether breast-feeding or bottle-feeding. * Physical exertion: Avoid heavy lifting for the first 4 to 6 weeks after delivery and especially after a C-section. Exercise should be gentle walks with the baby. Try not to do any physically demanding activities (no running up and down the stairs and definitely no gym sessions!). * Vitamins: Continue taking antenatal vitamins #### What are postpartum complications? Postpartum complications to be aware of include mastitis, postnatal depression, excessive bleeding (hemorrhage) after giving birth, infection or sepsis, [hypertension](https://nabtahealth.com/glossary/hypertension/), pulmonary [embolism](https://nabtahealth.com/glossary/embolism/), cardiomyopathy, and cardiovascular disease. Postpartum mothers should be counselled to recognise the signs and symptoms of a problem. Contact a doctor at once at any sign of high fever, flu-like symptoms, a red and swollen breast, a headache that doesn’t improve with medication, chest pain, shortness of breath, seizures, bleeding through one maternity pad in an hour, and a red or swollen leg painful to touch. #### What happens at a postpartum check-up? Postpartum maternal checks are about the mother’s health. At your postpartum check-ups your doctor will check your abdomen, [vagina](https://nabtahealth.com/glossary/vagina/), [cervix](https://nabtahealth.com/glossary/cervix/), and [uterus](https://nabtahealth.com/glossary/uterus/) to make sure you are healing well. They will talk to you about when it is safe to have sex again and birth control (remember that even if you don’t have your periods while you breastfeed you can still become pregnant). And your doctor will also talk to you about your emotional health, whether you are getting enough rest, eating well and how you are bonding with your baby. Use these check-ups to raise any concerns you might have with your recovery and emotional wellbeing. #### Getting started with Nabta Health Nabta’s marketplace and resources are designed to support mothers at every stage of their maternal health journey. From at-home tests to prenatal courses; on-demand Doulas to hypnobirthing courses; maternity pads to nursing bras; prenatal yoga to postpartum care packages… Nabta’s team of healthcare and wellness experts has carefully selected products to meet a woman’s maternal health needs.
By definition, recurrent miscarriages (also known as recurrent pregnancy loss) is the loss of two or more pregnancies. A single [miscarriage](https://nabtahealth.com/glossary/miscarriage/) may be devastating for hopeful parents-to-be, and this emotional toll usually increases as more losses occur. After a woman experiences a [miscarriage](https://nabtahealth.com/glossary/miscarriage/), many questions tend to swim through her mind. “Why did this happen to me? Will it happen again? Am I to blame?” Despite trying to stay logical and level-headed, many women are left feeling a combination of sad, guilty, angry, and hopeless. The most common cause of miscarriages is genetics; that is, something went awry during development when the egg or [sperm](https://nabtahealth.com/glossary/sperm/) were formed, or when fertilization occurred. Usually, this is because the incorrect number of [chromosomes](https://nabtahealth.com/glossary/chromosomes/) were present at the time of development. This actually accounts for about 60 percent of miscarriages but becomes more common as a woman (and her eggs) get older. For the most part, the chance that a woman who has had a [miscarriage](https://nabtahealth.com/glossary/miscarriage/) will have another is about 1 percent. That number increases, however, if the reason for the [miscarriage](https://nabtahealth.com/glossary/miscarriage/) was a different type of genetic problem called a translocation. This is when a woman’s eggs or a man’s [sperm](https://nabtahealth.com/glossary/sperm/) have an extra or a missing piece on a certain chromosome. This can be detected by testing the [chromosomes](https://nabtahealth.com/glossary/chromosomes/) of the parents. Not all miscarriages are related to these genetic problems, however. Others may be caused by medical conditions such as immune disorders that make a woman prone to blood clots, such as antiphospholipid syndrome. Problems with diabetes and thyroid disorders can also cause pregnancy loss. Unfortunately, most of the time (up to 75 percent) a reason for repeated miscarriages cannot be discovered. Things that are often done to try to find a diagnosis include going through a thorough medical history, physical exam, blood tests, and genetic testing (both for the parents and the pregnancy tissue). An ultrasound or other imaging may also be done to see if the shape of the [uterus](https://nabtahealth.com/glossary/uterus/) may be part of the problem as well. Treatment for recurrent pregnancy loss depends on what may be causing it. Some women may need surgery to correct the shape of their [uterus](https://nabtahealth.com/glossary/uterus/), while others may be placed on blood thinners if the antiphospholipid syndrome is present. Fertility treatments, such as in-vitro fertilization, or the use of donor eggs, [sperm](https://nabtahealth.com/glossary/sperm/), or a gestational carrier may also be part of the treatment plan. Overall, about 65 percent of women go on to have healthy babies after experiencing recurrent pregnancy loss. It is important that throughout this process women (and their partners) get the support they need, since so many times they blame themselves or have to deal with well-meaning but unhelpful advice from families and friends. **Sources:** * The American Congress of Obstetricians and Gynecologists * FAQ 100: Repeated miscarriages * May 2016. Powered by Bundoo®
* An [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) occurs when an egg implants outside the womb, for example in the fallopian tube. * 1% of women can experience an [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/). * There are various risk factors including medical conditions, age and lifestyle but often the cause is unknown. * Early detection can sometimes save the fallopian tube from permanent damage. * Whilst risk of another [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) can increase, most woman are able to have a healthy pregnancy after an ectopic. #### What is are ectopic pregnancies? An [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) is a distressing and potentially life-threatening experience in which a fertilised egg implants outside the womb, sometimes attaching to an ovary but more often developing in a fallopian tube. Early detection can prevent permanent damage to the [fallopian tubes](https://nabtahealth.com/glossary/fallopian-tube/) and the risk of serious health complications for the mother. Sadly, an [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) isn’t viable for mother or baby and fetal survival is very rare. #### What causes an [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/)? Are there any obvious risk factors to be aware of? An [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) affects [1 in 100 women and can happen to any woman](https://www.tommys.org/baby-loss-support/ectopic-pregnancy-information-support). According to [UK charity Tommy’s](https://www.tommys.org/baby-loss-support/ectopic-pregnancy-information-support) around a third of women who have an [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) have no known risk factors. That said, your risk may be increased by any of the following: * A previous [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) * Damaged [fallopian tubes](https://nabtahealth.com/glossary/fallopian-tube/) or previous surgery on your [fallopian tubes](https://nabtahealth.com/glossary/fallopian-tube/) * Scarring in your pelvic region from a ruptured appendix or surgery * Pelvic inflammatory disease * [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) * [IVF](https://nabtahealth.com/glossary/ivf/) or other fertility treatment * Becoming pregnant while using an intrauterine device ([IUD](https://nabtahealth.com/glossary/iud/)) * A maternal age above 35 * Being a smoker #### Are there obvious signs a pregnancy is ectopic? What should you look out for? An [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) will feel like a healthy pregnancy at the start with a missed period, sore and swollen breasts, positive pregnancy test and morning sickness. While it doesn’t always cause symptoms, the [UK’s National Health Service (NHS)](https://www.nhs.uk/conditions/ectopic-pregnancy/symptoms/) recommends contacting your doctor as soon as possible if you notice any of the following signs during your first trimester (up to 12 weeks’ gestation): * Vaginal bleeding * Intermittent or persistent abdominal cramps or pelvic pain, possibly down one side * Shoulder tip pain, where the shoulder meets the arm (this could be a sign of internal bleeding) * Discomfort going to the toilet (urinating or passing stools) [In around 15% of ectopic pregnancies the fallopian tube ruptures](https://www.betterhealth.vic.gov.au/health/healthyliving/ectopic-pregnancy#symptoms-of-ectopic-pregnancy). This is a medical emergency and if you experience sudden and intense pain in your stomach, sharp shoulder pain, or feel faint or nauseous you should call emergency or go to your closest emergency department immediately. #### Can I conceive again after an [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/)? An [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) can be an extremely painful and upsetting experience and it’s natural to wonder whether you’ll be able to get pregnant safely again. According to [Mayo Clinic](https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/diagnosis-treatment/drc-20372093) most women who have had an [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) are able to have a future, healthy pregnancy. Your risk does [increase by around 10%](https://www.nhs.uk/conditions/ectopic-pregnancy/) if you have had a previous [ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/), so it is important to seek your healthcare team’s advice and attend any scans and blood tests they recommend. Find out more [here.](https://nabtahealth.com/what-is-an-ectopic-pregnancy) \_\_\_ Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). You can track your menstrual cycle and get [personalised support by using the Nabta app.](https://nabtahealth.com/our-platform/nabta-app/) Get in [touch](/cdn-cgi/l/email-protection#8bf2eae7e7eacbe5eae9ffeae3eeeae7ffe3a5e8e4e6) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources** Better Health “[Ectopic Pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/)” [https://www.betterhealth.vic.gov.au/health/healthyliving/ectopic-pregnancy#symptoms-of-ectopic-pregnancy](https://www.betterhealth.vic.gov.au/health/healthyliving/ectopic-pregnancy#symptoms-of-ectopic-pregnancy) Mayo Clinic “[Ectopic Pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/)” https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/diagnosis-treatment/drc-20372093 NHS “[Ectopic Pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/)” [https://www.nhs.uk/conditions/ectopic-pregnancy/](https://www.nhs.uk/conditions/ectopic-pregnancy/) Tommy’s “[Ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) information and support” [https://www.tommys.org/baby-loss-support/ectopic-pregnancy-information-support](https://www.tommys.org/baby-loss-support/ectopic-pregnancy-information-support)
* Molar pregnancies are very rare cases when a growth forms in the [uterus](https://nabtahealth.com/glossary/uterus/) as a result of an abnormal pregnancy. * Due to chromosome complications, the baby does not develop. * Molar pregnancies can be detected by a scan or a hCG blood test. * The molar mass is removed by surgical procedure known as D&C, performed under general anesthetic. #### What is a Molar Pregnancy? A molar pregnancy is an abnormal pregnancy in which a growth forms on the wall of the [uterus](https://nabtahealth.com/glossary/uterus/) and a baby doesn’t develop. The non-cancerous mass, or tumour, is formed when a [sperm](https://nabtahealth.com/glossary/sperm/) fertilises an egg, but due to a chromosomal complication, abnormal trophoblast cells form a growth in the [uterus](https://nabtahealth.com/glossary/uterus/). Trophoblast cells would normally connect the fertilised egg to the wall of the [uterus](https://nabtahealth.com/glossary/uterus/) and create part of the [placenta](https://nabtahealth.com/glossary/placenta/). There are two types of molar pregnancy: * In a **complete molar pregnancy**, the [sperm](https://nabtahealth.com/glossary/sperm/) with the father’s DNA fertilises an egg that doesn’t contain the mother’s DNA. Fetal tissue doesn’t form and the [placenta](https://nabtahealth.com/glossary/placenta/) grows abnormally, forming fluid-filled cysts sometimes described as looking like grapes on an ultrasound. * A **partial molar pregnancy** is when there is some fetal tissue and an abnormal [placenta](https://nabtahealth.com/glossary/placenta/). In this case a [sperm](https://nabtahealth.com/glossary/sperm/) or sperms fertilise a healthy egg but there are two sets of the father’s DNA in the fertilised egg. A molar pregnancy is also known as a hydatidiform mole and is a gestational trophoblastic disease (GTD). #### What is the cause of a molar pregnancy? Molar pregnancies are rare and affect [fewer than 1% of all pregnancies](https://my.clevelandclinic.org/health/diseases/17889-molar-pregnancy). Most women go on to have a healthy pregnancy after a molar pregnancy. While the exact causes are unknown, [UK charity Tommy’s](https://www.tommys.org/baby-loss-support/molar-pregnancy-information-support) says your risk is higher if you are under 20 or over 40 and they are twice as common in women of Asian origin. A previous molar pregnancy increases your chance of having another molar pregnancy to around 1 in 80 from 1 in 600. This increases to 1 in 5 after two molar pregnancies. #### Are there any signs or symptoms of a molar pregnancy? Most molar pregnancies seem like healthy pregnancies at the start and in many cases women will only discover their pregnancy is hydatidiform mole during their 12-week tests and scan. That said, some women do experience [](https://nabtahealth.com/causes-of-miscarriage/)[miscarriage](https://nabtahealth.com/glossary/miscarriage/) symptoms during the first trimester and you should call your doctor if you experience any of the following: * Vaginal bleeding; * Severe nausea and vomiting; * An unusually swollen abdomen for the time of pregnancy; * Pelvic pain or pressure; * High blood pressure or signs of [preeclampsia](https://nabtahealth.com/glossary/preeclampsia/) such as swollen feet or hands. In rare cases a molar pregnancy can [lead](https://nabtahealth.com/glossary/lead/) to a malignant [gestational trophoblastic neoplasia (GTN)](https://www.cancer.gov/types/gestational-trophoblastic/patient/gtd-treatment-pdq). #### How is a molar pregnancy diagnosed? A blood test will measure the amount of [hCG (human chorionic gonadotrophin (hCG)](https://www.ncbi.nlm.nih.gov/books/NBK532950/), a hormone made by the body during pregnancy. High levels of hCG are often linked with a molar pregnancy. The medical team will monitor for a fetal heartbeat and carry out an ultrasound and [pelvic examination](https://nabtahealth.com/glossary/pelvic-examination/). #### Molar Pregnancy Treatment and follow-up The molar tissue is removed with [dilation](https://nabtahealth.com/glossary/dilation/) and curettage (D&C), a surgical procedure to remove tissue from the [uterus](https://nabtahealth.com/glossary/uterus/) and the same procedure carried out following a [miscarriage](https://nabtahealth.com/glossary/miscarriage/). Your healthcare team will monitor your recovery. A molar pregnancy is a distressing experience. Women who have had one molar pregnancy will understandably be concerned about having the same experience if they conceive again. Medical and counselling support is available and if you have any concerns about your pregnancy and the health of your developing baby you should contact your healthcare team immediately. [Molar pregnancies or](https://nabtahealth.com/glossary) [miscarriage](https://nabtahealth.com/glossary/miscarriage/), though rare, can happen to anyone. Learn about your body and take a [women’s health test](https://nabtahealth.com/product/womens-health-test/). Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#720b131e1e13321c131006131a17131e061a5c111d1f) if you have any questions about this article or any aspect of women’s health. We’re here for you.
A [miscarriage](https://nabtahealth.com/glossary/miscarriage/) is the spontaneous loss of a pregnancy during the first 23 weeks. The physical signs of a [miscarriage](https://nabtahealth.com/glossary/miscarriage/) are usually cramping and bleeding. Whilst it might provide little comfort to those experiencing a pregnancy loss, the reality is that miscarriages often happen for no obvious reason and can rarely be prevented. #### **How common are miscarriages?** The topic of miscarriages remains fairly taboo, with many women reluctant or unable to talk about their experience. However, they are common, affecting approximately one in eight known pregnancies, with many more likely to have occurred before a woman knows that she is pregnant. Approximately 1% of women will experience recurrent miscarriages, meaning they have three or more in a row. The risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/) reduces as a pregnancy progresses. About 80% of miscarriages happen during the first trimester, with fewer than 1% occurring after week 20 of pregnancy. This is why many women wait until they have reached 12 weeks before telling others they are pregnant. #### **What causes [miscarriage](https://nabtahealth.com/glossary/miscarriage/)?** Approximately 50% of miscarriages that happen during the first trimester are due to a **chromosomal problem** with the developing foetus. Usually there will be the wrong number of [chromosomes](https://nabtahealth.com/glossary/chromosomes/) – too many, or too few – which means the foetus is unable to survive. The risk of chromosomal abnormalities is higher in older women, which is one of the reasons why **older mothers** are more likely to experience miscarriages than younger women. In women over 45, more than 50% of pregnancies end in [miscarriage](https://nabtahealth.com/glossary/miscarriage/). Other things that can result in early pregnancy loss are **improper [implantation](https://nabtahealth.com/glossary/implantation/)** of the fertilised egg, issues with the development of the **[placenta](https://nabtahealth.com/glossary/placenta/)** and a problem with the **male’s [sperm](https://nabtahealth.com/glossary/sperm/)**. **Lifestyle factors** can also increase the risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/), for example: * Obesity ([Body Mass Index](https://nabtahealth.com/what-is-body-mass-index-bmi/) > 25kg/m²). * Smoking * Drug taking * Alcohol * Excessive caffeine consumption (try to limit consumption to below 200mg per day). * Environmental toxins/workplace hazards, e.g. working with radiation. You should check with your healthcare provider before taking any **medication** during pregnancy as not all medicines are appropriate to take at this time. Specific examples of drugs that are best avoided include, retinoids (anti-acne), methotrexate (relief of rheumatoid arthritis) and non-steroidal anti-inflammatories (pain relief). Some women have **long-term (chronic) health conditions**, which increase their risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/), particularly if the condition is not well managed. Examples include: * Diabetes * [Hypertension](https://nabtahealth.com/glossary/hypertension/) * Auto-immune diseases ([lupus](https://nabtahealth.com/glossary/lupus/)) * Kidney disease * Thyroid issues * [Polycystic Ovary Syndrome](https://nabtahealth.com/what-is-pcos/) ([PCOS](https://nabtahealth.com/glossary/pcos/)). The connection between [](https://nabtahealth.com/pcos-and-pregnancy/)[infertility](https://nabtahealth.com/glossary/infertility/) and [PCOS](https://nabtahealth.com/glossary/pcos/) is well established. However, emerging evidence suggests that even if conception is successful, women with the condition are 2.5 times more likely to miscarry than their healthy counterparts. It is not yet clear whether [ovulation](https://nabtahealth.com/glossary/ovulation/) induction therapy, using clomiphene citrate for example, increases a female’s risk of miscarrying; the available data to date is low quality and conflicting. However, women in this category usually have an underlying medical condition that has prompted their use of [ovulation](https://nabtahealth.com/glossary/ovulation/) induction and may, therefore, already be at higher risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/). **Infections** and severe **food poisoning** can both increase the risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/). This is one reason why women are advised to consider their diet during pregnancy and avoid those food types that are associated with a higher risk of food poisoning, for example unpasteurised dairy, undercooked meats, raw eggs and raw shellfish. Pregnant women should also limit the amount of tuna and oily fish that they eat. #### **Causes of late [miscarriage](https://nabtahealth.com/glossary/miscarriage/)** Experiencing a [miscarriage](https://nabtahealth.com/glossary/miscarriage/) during the second trimester can be particularly difficult to cope with. By now, you will have made it through the period that is typically considered to be most high-risk (the first 12 weeks) and are likely to have started telling more people and forming plans. Some of the risks for late miscarriages are the same and women are encouraged to continue to consume a healthy diet and avoid smoking, drinking alcohol and taking recreational drugs. It is also important to ensure that chronic health conditions are under control and any medication is approved as safe for use during pregnancy by your doctor. Unfortunately, as with early miscarriages, a lot of late miscarriages are unavoidable. Sometimes the **[uterus](https://nabtahealth.com/glossary/uterus/) is an abnormal shape**, or has unusual growths, such as [](https://nabtahealth.com/a-simple-guide-to-fibroids/)**[fibroids](https://nabtahealth.com/glossary/fibroids/)** that increase the risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/). In some cases, a female will have a **weakened/incompetent [cervix](https://nabtahealth.com/glossary/cervix/)**, which widens and opens during pregnancy. The [cervix](https://nabtahealth.com/glossary/cervix/) should remain closed until just before delivery. This muscular weakness can be due to previous injury, or surgery to the [cervix](https://nabtahealth.com/glossary/cervix/). One treatment option for this is to undergo a [cervical cerclage](https://nabtahealth.com/what-is-a-cervical-cerclage/). #### **What does not increase the risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/)?** Despite concerns to the contrary, the following are not likely to cause a [miscarriage](https://nabtahealth.com/glossary/miscarriage/): * The mother’s emotional state (although remaining happy and calm throughout your pregnancy is definitely recommended and you should seek professional help if you do start to feel overwhelmed, anxious or depressed). * Experiencing a shock or fright. * Sexual intercourse. For most couples, continuing to have an intimate relationship during pregnancy is perfectly safe, provided of course, both parties want to. If your pregnancy is high risk, or you have had significant bleeding, your doctor might advise you to abstain. * Exercise. Although you should always check with a professional before commencing any physical activity. * Flying. * Spicy food. #### **Conclusion** Experiencing a [miscarriage](https://nabtahealth.com/glossary/miscarriage/) can put both a physical and emotional strain on the body. Whilst some women may take comfort in knowing there was nothing they could have done to avoid it; for others, the lack of control over the situation can be difficult. Not knowing whether your pregnancy loss was an unfortunate one-off, or something you will experience again with [subsequent pregnancies](https://nabtahealth.com/pregnancy-after-miscarriage/) makes the healing process challenging. Take time to recover and talk through your emotions with friends and family. [Miscarriage](https://nabtahealth.com/glossary/miscarriage/) can happen to anyone, try get a [women’s health test](https://nabtahealth.com/product/womens-health-test/) and learn more about your body. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#1b627a77777a5b757a796f7a737e7a776f7335787476) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “Early Pregnancy Loss.” _ACOG_, [www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/11/early-pregnancy-loss](http://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/11/early-pregnancy-loss). * Legro, Richard S., et al. “Clomiphene, Metformin, or Both for [Infertility](https://nabtahealth.com/glossary/infertility/) in the Polycystic Ovary Syndrome.” _New England Journal of Medicine_, vol. 356, no. 6, 8 Feb. 2007, pp. 551–566., doi:10.1056/nejmoa063971. * “[Miscarriage](https://nabtahealth.com/glossary/miscarriage/) – Causes.” _NHS Choices_, NHS, [www.nhs.uk/conditions/](http://www.nhs.uk/conditions/miscarriage/causes/)[miscarriage](https://nabtahealth.com/glossary/miscarriage/)/causes/. * “[Miscarriage](https://nabtahealth.com/glossary/miscarriage/): Risks, Symptoms, Causes & Treatments.” _Cleveland Clinic_, [my.clevelandclinic.org/health/diseases/9688-](https://my.clevelandclinic.org/health/diseases/9688-miscarriage)[miscarriage](https://nabtahealth.com/glossary/miscarriage/). * “What Are the Causes of and Risks for Pregnancy Loss (Before 20 Weeks of Pregnancy)?” _Eunice Kennedy Shriver National Institute of Child Health and Human Development_, U.S. Department of Health and Human Services, [www.nichd.nih.gov/health/topics/pregnancyloss/conditioninfo/causes](http://www.nichd.nih.gov/health/topics/pregnancyloss/conditioninfo/causes). * Yu, Hai-Feng, et al. “Association between Polycystic Ovary Syndrome and the Risk of Pregnancy Complications.” _Medicine_, vol. 95, no. 51, 23 Dec. 2016, doi:10.1097/md.0000000000004863.
In the weeks after losing Olivia the gaping emptiness left within me stayed brutally apparent. Time and time again, Jonathan would ask how I was doing, and all I had to say was “I just want my baby back.” And I did. I do, I suppose, although I’m acutely aware that having her back would mean not having this baby growing away within, and I don’t want that either. I love this baby just as much as I love Olivia, neither is comparable to one another. Every life is as precious as the next. We had decided to try again as soon as I was physically able to do so. Following the medical management, though Olivia passed from me that same day, the [miscarriage](https://nabtahealth.com/glossary/miscarriage/) itself lasted for a little over three weeks. A week later and I got my first menstrual cycle and, annoying as it was to have had only about five days without a bleed, I was grateful to my body for beginning to return to normal so soon. I have known friends who have miscarried and still been without a regular cycle six months later, only compounding their pain, denying them the chance to try again. Though regular in length my first cycle wasn’t entirely ‘normal’ lets say, so we held little hope for a positive test, but were at least once again grateful when twenty-eight days later the next cycle began. Three weeks later and I knew it was silly, it was too soon to know, but when I first woke up I took one of the many, many cheap tests I had stockpiled ready for my impatience then brushed my teeth, certain I’d be dropping a negative in the bin in three minutes time. I finished up and looked at the test. There they were, two lines, one significantly fainter than the other, but still visible. Still clear. Pregnant again. This time though I am experiencing pregnancy through a different lens. I am excited, I am grateful to have fallen so quickly, I am madly in love with the life growing inside me, but this isn’t the same as Harry or Olivia’s pregnancies; this is pregnancy after a loss. I don’t for one second assume I am alone in the feelings, the fears, the anxieties I am experiencing in this third pregnancy. After all, when one in four pregnancies ends in [miscarriage](https://nabtahealth.com/glossary/miscarriage/) there are plenty of other women out there in my position, and that is exactly why I want to talk about it, to write about it, to normalise the rollercoaster of emotions that comes with being pregnant again following the loss of a baby. Pregnancy after loss, for me at least, is scary. My anxiety rolls and crashes like waves. I can be calm and confident for days or weeks and then, as quick as the turning of the tide, it’s gone and I am terrified. For me this fear manifests in obsessive behaviours. After my early pregnancy test I continued to take tests daily until I reached the point I would have missed my period. I watched the line get darker, more solid, and with it I relaxed a little. A week or so later I took a clearblue digital just to make sure that it had gone from saying 1-2 weeks to 2-3. A week later I did the same again, making sure it had gone to 3+ weeks. I knew each week this was not ‘normal’ behaviour, but it gave me some reassurance, kept my anxiety at bay a little longer. But that’s it, beyond that point it just says 3+ weeks and there’s no way of checking your hormones are increasing. There’s no need, in reality, but that’s easier said than believed when you’ve lost your much loved baby. I took cheap pregnancy tests too, maybe once a week, all the way through to about nine weeks. I know deep down this was a fairly pointless exercise. When I lost Olivia and then developed the infection in my womb I was told to take a pregnancy test to see if all signs of the pregnancy had gone. A week and a half after the medical management of my [miscarriage](https://nabtahealth.com/glossary/miscarriage/) – a suspected three or four weeks after she had died – and I got the strongest line on a test that I had until that point in my life ever had. So in reality my continuing to take pregnancy tests was utterly pointless, but nevertheless eased my worried mind a few days. Pregnancy after loss in my case is not rational. We booked a scan privately so that Jonathan could come with me. The idea of lying on my own whilst being scanned gave me palpitations; last time I’d been alone for a scan I watched my baby lying still upon the screen and was told what I already knew; the baby I’d seen alive, heart beating, a few weeks earlier was now dead. I could not shake the image every time I thought of my scan; despite my sickness, my tender breasts, my rapidly growing bump, I felt so sure it would happen again, and I couldn’t bare to be on my own when it did. The scan went well, as you all know. There it was, baby number three, heart beating away happily, bigger than we had predicted. The sonographer was happy, we were happy, I was relieved. This relief lasted a week or so, as the anxious part of my brain reminded me we’d had a scan with Olivia, she was fine too. And then she was not. Maybe the baby’s heartbeat was too slow this time and the sonographer chose not to tell me? Something I recognise as highly insulting to the professionalism of the sonographer who I am sure wouldn’t do this, but then intrusive thoughts are rarely sensitive to anyone. I don’t believe for a second any one type of [miscarriage](https://nabtahealth.com/glossary/miscarriage/) is more painful than the next. They are devastating, cruel and I feel like unless you have had one it’s hard to comprehend the magnitude of the loss. People who haven’t had one I think often judge their severity by how far along the pregnancy was which, I think, once you get into the realms of a [stillbirth](https://nabtahealth.com/glossary/stillbirth/) I would agree is likely ‘worse’ given the necessity for a full labour and the fact your baby should live at this point, regardless of what happens; there is absolutely no expectation of death like in the early weeks and it’s a pain I only hope I never know first hand, no parent should have to. But in terms of [miscarriage](https://nabtahealth.com/glossary/miscarriage/) I don’t really see it that way; pain shouldn’t be compared. Why would someone who lost their baby at six weeks not have their pain recognised in the same way mine was? My pain is not ‘worth more’ than theirs, just because I’d had scans, just because I got to hold my baby when she came out. In fact sometimes I think I would have struggled more _not_ being able to hold my baby. I got closure from the hour I spent with her in my palm, stroking her tiny body, telling her my thoughts. The be all and end all for every [miscarriage](https://nabtahealth.com/glossary/miscarriage/) is a mother, a father, a family, has lost a much loved child. Not a six week, or twelve week, or fifteen week old fetus; they’ve lost the lifetime they planned for their child, the future they envisioned, and that’s the same for them all. This being said, I do wonder sometimes, had I had a ‘conventional’ [miscarriage](https://nabtahealth.com/glossary/miscarriage/), rather than a missed or silent one, would my anxiety be more manageable this time around? If I had miscarried Olivia through spontaneous bleeding then I would no doubt be worried this pregnancy, I would be checking my tissue for blood every time I went to the toilet just like I do now, but would I get comfort from the lack of blood that eased my mind? Would I get comfort from my strong symptoms, the sickness and tender breasts? Because these do not help. The lack of blood does not tell me my baby has not died. The sickness does not tell me my baby has not died. My aching breasts do not tell me my baby has not died. Because I had all these things last time. They remained, as my baby passed and beyond, and now it seems my anxious mind is adamant I will not trust my body to complete the task at hand. Pregnancy after loss is exciting. Pregnancy after loss is a blessing. Pregnancy after loss is terrifying. Pregnancy after loss is taking too many pregnancy tests. Pregnancy after loss is irrational thoughts. Pregnancy after loss is constant photos of my stomach to compare with previous ones, desperately trying to make sure it isn’t shrinking. Pregnancy after loss is inspecting the tissue for blood every time I wipe. Pregnancy after loss is what feels like agonisingly long waits between scans. Pregnancy after loss is, importantly, not a replacement for the lost baby. Our new baby is loved and wanted on its own. Our new baby does not negate our grief for Olivia, nor does it replace her. A person is not replaceable. But that does not mean we are not overjoyed at the impending arrival of baby number three. It is a conflicting feeling, as I said previously, knowing without the grief for Olivia this baby would not exist. But we know she is not coming back, and so at this point I do not wish for her back anymore, but wish instead for her to always be remembered. She will always be part of our family, and a new baby does not change that fact. I can only wish, and hope, that this baby remains safe in my womb and then, when it’s fully grown, I can deliver it safely into my arms. Our third baby will always be our third baby. Not our second. Harry will always have at least two younger siblings. Olivia, and baby number three, are as real as Harry, regardless of how long they live. As the Skin Horse in the Velveteen Rabbit so aptly put it, “once you are real, you can’t become unreal again. It lasts for always.” \*\*\* This article was originally published on Rosie’s personal blog, [Words for Olivia](https://wordsforolivia.wordpress.com/blog-2/). #### **About the Author** Rosie is 28 and lives in Oxford with her husband, son Harry and their dog, Nigel. She is mother to three children, Harry who is now three, Olivia who they sadly lost in March of this year and their third baby who she is busy growing. Rosie has a degree in English Literature and Creative Writing and has always enjoyed writing. Since losing Olivia, Rosie has found it incredibly therapeutic to write and talk about the reality of [miscarriage](https://nabtahealth.com/glossary/miscarriage/) in the hope of supporting other women who have experienced the same thing.
#### **What is a [miscarriage](https://nabtahealth.com/glossary/miscarriage/)?** [Miscarriage](https://nabtahealth.com/glossary/miscarriage/) is the spontaneous loss of a pregnancy before the 23rd week. About 10 percent of known pregnancies end in [miscarriage](https://nabtahealth.com/glossary/miscarriage/). The actual percentage of miscarriages may be higher because many miscarriages occur so early in pregnancy that a woman doesn’t realize she’s pregnant. #### **What are the symptoms of [miscarriage](https://nabtahealth.com/glossary/miscarriage/)?** The physical signs of a [miscarriage](https://nabtahealth.com/glossary/miscarriage/) are usually cramping and bleeding. Whilst it might provide little comfort to those experiencing a pregnancy loss, the reality is that miscarriages often happen for no obvious reason and can rarely be prevented. #### **How common is [miscarriage](https://nabtahealth.com/glossary/miscarriage/)?** The topic of miscarriages remains fairly taboo, with many women reluctant or unable to talk about their experience. This is despite the fact that miscarriages are common, affecting approximately 1 in 8 known pregnancies, with many more likely to have occurred before a woman knows that she is pregnant. Approximately 1% of women will experience recurrent miscarriages, meaning they have three or more miscarriages in a row. The risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/) reduces as a pregnancy progresses. About 80% of miscarriages happen during the first trimester, with fewer than 1% occurring after week 20 of pregnancy. This is why many women wait until they have reached 12 weeks before telling others they are pregnant. #### **What percentage of pregnancies end in [miscarriage](https://nabtahealth.com/glossary/miscarriage/)?** Fertilisation occurs when a [sperm](https://nabtahealth.com/glossary/sperm/) from the male fertilises a female’s egg. Approximately 1 in 3 successful fertilisations will result in a live birth. Many potential pregnancies fail prior to [implantation](https://nabtahealth.com/glossary/implantation/) and before a woman even realises that she is pregnant. Approximately 15% of clinical pregnancies (meaning an ultrasound has been used to confirm the successful [implantation](https://nabtahealth.com/glossary/implantation/) of the fertilised egg into the wall of the [uterus](https://nabtahealth.com/glossary/uterus/)) end in [miscarriage](https://nabtahealth.com/glossary/miscarriage/), usually as a result of chromosomal abnormalities in the embryo. It is significantly less common for a [miscarriage](https://nabtahealth.com/glossary/miscarriage/) to occur between weeks 12 and 20, so much so that many women are confident to share their news after their 12 week scan. Losses after week 12 are termed late miscarriages and occur in approximately 4% of cases. #### **What causes [miscarriage](https://nabtahealth.com/glossary/miscarriage/)?** Approximately 50% of miscarriages that happen during the first trimester are due to a **chromosomal problem** with the developing foetus. Usually there will be the wrong number of [chromosomes](https://nabtahealth.com/glossary/chromosomes/) – too many, or too few – which means the foetus is unable to survive. The risk of chromosomal abnormalities is higher in older women, which is one of the reasons why **older mothers** are more likely to experience miscarriages than younger women. In women over 45, the risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/) can be as high as 50%. Other factors that can result in early pregnancy loss include **improper [implantation](https://nabtahealth.com/glossary/implantation/)** of the fertilised egg, issues with the development of the **[placenta](https://nabtahealth.com/glossary/placenta/), structural problems** in the female reproductive system, **chronic conditions** (eg. diabetes, kidney disease, thyroid disease), and a problem with the **male’s [sperm](https://nabtahealth.com/glossary/sperm/)**. **Infections** and severe **food poisoning** can both increase the risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/). This is one reason why women are advised to consider their diet during pregnancy and avoid food types that are associated with a higher risk of food poisoning, such as unpasteurised dairy, undercooked meats, raw eggs, and raw shellfish. Pregnant women should also limit the amount of tuna and other large fish due to potential [mercury](https://nabtahealth.com/glossary/mercury/) content which may affect the healthy development of the child’s nervous system. #### **Could lifestyle choices affect my chances of miscarrying?** Yes, lifestyle factors can increase the risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/). For example: * Chronic conditions such as obesity, diabetes and cardiovascular disease. * Smoking * Drug taking * Alcohol * Excessive caffeine consumption (try to limit consumption to below 200mg per day). * Environmental toxins/workplace hazards, e.g. working with radiation. You should check with your healthcare provider before taking any **medication** during pregnancy as not all medicines are appropriate to take at this time. Specific examples of drugs that are best avoided include, retinoids (used for improving skin conditions), methotrexate (used for cancer and other autoimmune disorders such as arthritis) and non-steroidal anti-inflammatories (used for pain relief). #### **Why do late miscarriages occur?** Experiencing a [miscarriage](https://nabtahealth.com/glossary/miscarriage/) during the second trimester can be particularly difficult to cope with. By that point, you will have made it through the period that is typically considered to be most high-risk (the first 12 weeks) and are likely to have started announcing your pregnancy others and forming plans. Throughout pregnancy, women are encouraged to continue to consume a healthy diet and avoid smoking, drinking alcohol and taking recreational drugs. It is also important to ensure that chronic health conditions are under control and any medication is approved as safe for use during pregnancy by your doctor. Unfortunately, as with early miscarriages, some late miscarriages are unavoidable. Sometimes the **[uterus](https://nabtahealth.com/glossary/uterus/) is an abnormal shape**, or has obstructions, such as the growth of [](https://nabtahealth.com/a-simple-guide-to-fibroids/)**[fibroids](https://nabtahealth.com/glossary/fibroids/)** which can increase the risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/). In some cases, a woman will have a **weakened/incompetent [cervix](https://nabtahealth.com/glossary/cervix/)**, which widens and opens prematurely during pregnancy. The [cervix](https://nabtahealth.com/glossary/cervix/) should remain closed until just before delivery. This muscular weakness can be due to previous injury, or surgery to the [cervix](https://nabtahealth.com/glossary/cervix/). One treatment option for this is to undergo a [cervical cerclage](https://nabtahealth.com/what-is-a-cervical-cerclage/). #### **I have an underlying health condition: does that make me more likely to miscarry?** Some women have **long-term (chronic) health conditions**, which increase their risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/), particularly if the condition is not well managed. Examples include: * Diabetes * [Hypertension](https://nabtahealth.com/glossary/hypertension/) * Auto-immune diseases ([lupus](https://nabtahealth.com/glossary/lupus/)) * Kidney disease * Thyroid issues * [Polycystic Ovary Syndrome](https://nabtahealth.com/what-is-pcos/) ([PCOS](https://nabtahealth.com/glossary/pcos/)). #### **Does [PCOS](https://nabtahealth.com/glossary/pcos/) increase my risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/)?** The connection between [](https://nabtahealth.com/pcos-and-pregnancy/)[infertility](https://nabtahealth.com/glossary/infertility/) and [PCOS](https://nabtahealth.com/glossary/pcos/) is well established. Emerging evidence suggests that even if conception is successful, women with the condition are 2.5 times more likely to miscarry than their healthy counterparts. It is not yet clear whether [ovulation](https://nabtahealth.com/glossary/ovulation/) induction therapy, using clomiphene citrate for example, increases a woman’s risk of miscarrying; the available data to date is low quality and conflicting. However, women in this category usually have an underlying medical condition, such as diabetes or obesity, that has prompted their use of [ovulation](https://nabtahealth.com/glossary/ovulation/) induction and may, therefore, already be at higher risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/). #### **What factors do NOT increase the risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/)?** Despite concerns to the contrary, the following are not likely to cause a [miscarriage](https://nabtahealth.com/glossary/miscarriage/): * The mother’s emotional state (although remaining happy and calm throughout your pregnancy is definitely recommended and you should seek professional help if you do start to feel overwhelmed, anxious or depressed). * Experiencing a shock or fright. * Sexual intercourse. For most couples, continuing to have an intimate relationship during pregnancy is perfectly safe, provided of course, both parties want to. If your pregnancy is high risk, or you have had significant bleeding, your doctor might advise you to abstain. * Moderate exercise.You should always check with a professional before commencing any physical activity. * Flying. * Spicy food. #### **If I have already had one [miscarriage](https://nabtahealth.com/glossary/miscarriage/), how likely am I to have another?** Having one [miscarriage](https://nabtahealth.com/glossary/miscarriage/) does not usually place a woman at increased risk of having another [miscarriage](https://nabtahealth.com/glossary/miscarriage/). However, having two or more consecutive miscarriages does increase her risk. The European Society of Human Reproduction and Embryology (ESHRE) defines recurrent [miscarriage](https://nabtahealth.com/glossary/miscarriage/) (RM) as three or more consecutive losses occurring before 20 weeks gestation. Women who experience RM have a 43% chance of experiencing further miscarriages. Approximately 1% of couples who are attempting to conceive experience RM. #### **What causes recurrent [miscarriage](https://nabtahealth.com/glossary/miscarriage/)?** Various factors have been associated with RM including parental chromosome abnormalities (10 times more prevalent in couples who have experienced RM, than in the general population). These include: * Immune dysfunction * Endocrine disorders (thyroid conditions and [PCOS](https://nabtahealth.com/glossary/pcos/)) * Damage to the DNA in the male’s [sperm](https://nabtahealth.com/glossary/sperm/) * Uterine structural abnormalities ([endometriosis](https://nabtahealth.com/glossary/endometriosis/)). However, in approximately 50% of cases of RM, the exact cause is unknown. #### **How are miscarriages diagnosed?** To diagnose a [miscarriage](https://nabtahealth.com/glossary/miscarriage/), your healthcare provider will conduct one or more of the following tests: * **Pelvic exam**. Your health care provider might check to see if your [cervix](https://nabtahealth.com/glossary/cervix/) has begun to dilate. * **Ultrasound.** During an ultrasound, your health care provider will check for a fetal heartbeat and determine if the embryo is developing normally. If a diagnosis can’t be made, you might need to have another ultrasound in about a week. * **Blood tests.** Your health care provider might check the level of the pregnancy hormone, human chorionic gonadotropin (HCG), in your blood and compare it to previous measurements. If the pattern of changes in your HCG level is abnormal, it could indicate a problem. Your health care provider might check to see if you’re anemic — which could happen if you’ve experienced significant bleeding — and may also check your blood type. * **Tissue tests.** If you have passed tissue, it can be sent to a lab to confirm that a [miscarriage](https://nabtahealth.com/glossary/miscarriage/) has occurred — and that your symptoms aren’t related to another cause. * **Chromosomal tests.** If you’ve had two or more previous miscarriages, your health care provider may order blood tests for both you and your partner to determine if your [chromosomes](https://nabtahealth.com/glossary/chromosomes/) are a factor. (Source: Mayo Clinic) #### **What is a “missed [miscarriage](https://nabtahealth.com/glossary/miscarriage/)”?** A missed [miscarriage](https://nabtahealth.com/glossary/miscarriage/), also known as a silent [miscarriage](https://nabtahealth.com/glossary/miscarriage/) or missed abortion, occurs when a fetus is no longer alive, but this fact is not recognised by the body and the pregnancy tissue is not expelled. Because of this, the [placenta](https://nabtahealth.com/glossary/placenta/) may continue to release hormones, and you may continue to experience signs of pregnancy. (Source: NHS England) #### **What should I do if I miscarry?** If a [miscarriage](https://nabtahealth.com/glossary/miscarriage/) is diagnosed, there are a few management options. The first is to allow your body to complete the [miscarriage](https://nabtahealth.com/glossary/miscarriage/) on its own without intervention. This is only an option if you are early in pregnancy and you are medically stable (for example, your bleeding is not dangerously heavy). Another option is to take medication to help your [uterus](https://nabtahealth.com/glossary/uterus/) contract and complete the [miscarriage](https://nabtahealth.com/glossary/miscarriage/). While this is often successful in earlier miscarriages, sometimes surgery is needed if the medication doesn’t work or you start to bleed too much. Lastly, a [dilation](https://nabtahealth.com/glossary/dilation/) and curettage (or D&C) is a surgical option to treat a [miscarriage](https://nabtahealth.com/glossary/miscarriage/). This can be chosen as a first line treatment, or if waiting or taking medicine does not work. Since every case needs to be tailored to the individual, it is important to make an informed decision with your doctor to select the option that is right for you. #### **How long should I wait after a [miscarriage](https://nabtahealth.com/glossary/miscarriage/) before attempting to conceive again?** In the last set of guidelines published by the World Health Organisation in 2005, it was recommended that couples wait 6 months after [miscarriage](https://nabtahealth.com/glossary/miscarriage/) before attempting to conceive again. However, more recent work has disputed this and even found that couples who fell pregnant within three months of miscarrying got pregnant faster had a higher live birth rate and were no more likely to experience complications, when compared to those who waited for longer than 3 months to start trying to conceive. What is absolutely essential to consider before trying to conceive after a [miscarriage](https://nabtahealth.com/glossary/miscarriage/) is whether you are ready emotionally. Always consult your healthcare professional who may advise you to wait more or less dependent on the stage of your [miscarriage](https://nabtahealth.com/glossary/miscarriage/), your physiological and emotional condition. Whilst your body may be physically fit, it is important to remember that you have experienced a loss and, as such, may still be grieving. Giving yourself time to heal mentally is just as important as allowing your body to recover. #### **Should I wait longer after a [miscarriage](https://nabtahealth.com/glossary/miscarriage/) before attempting to conceive again if I have miscarried more than once?** If you have experienced recurrent [miscarriage](https://nabtahealth.com/glossary/miscarriage/), your doctor will likely have screened both you and your partner for chromosomal potential abnormalities. If any of these screens came back positive, it is important to consider what the implications are for future pregnancies, prior to attempting to conceive again. The type of abnormality will determine whether you are capable of carrying a pregnancy to term and how likely it is that children you give birth to will have genetic disorders. Your doctor, along with a genetics counsellor, will be able to counsel and advise you accordingly.
