Typically, miscarriages are associated with bleeding, abdominal cramping and lower back pain. However, in a missed abortion (also called missed miscarriage or silent miscarriage) there may be little to no bleeding and no indication that the fetus is no longer alive. In this case, the body does not recognize that the fetus has died so the placenta may continue to release hormones. There are no warning signs of miscarriage.
For me, I was in New York City at the time. I had my 8-week OB appointment that went well. I had my ultrasound that showed us a fetal heartbeat. I had morning sickness and was eating plain crackers at work to make it through my shifts. My husband and I told only our closest family members and friends about our pregnancy.
A couple weeks later, I told my sister that my morning sickness had completely subsided. It was as though a miracle had occurred and the cloak of illness had passed. We thought that heralded the end of the first trimester of pregnancy.
At my 12-week OB appointment, my husband accompanied me and I had some routine blood tests and then my OB came in and did an ultrasound. Given my husband and I are both ER physicians, we immediately knew what we were seeing on the ultrasound monitor. There was no heartbeat. Immediately, my OB said, “I’m so sorry, Debbie.” Even though I fully knew what had occurred, I asked, “What’s going on?”
At that point, I was given 2 options: a medical abortion or a surgical abortion. Medical abortion consists of either taking *misoprostol orally or having it placed vaginally and allowing expulsion of fetal contents to occur on its own. The clear benefit to a medical abortion is not having surgery. The possible complications of a medical abortion include bleeding, infection, that the medication may not work at all or that it may only expel a portion of the uterine contents (leaving some behind can be dangerous).
The surgical option is a suction D&C (dilation and curettage). The risks of suction D&C include bleeding, infection, perforation of the uterus and a rare complication called Asherman syndrome in which scar tissue forms in the uterus after the procedure. My OB recommended surgery. In her opinion, given how far along I was in pregnancy, she was worried about the amount of bleeding I would incur. So that afternoon, I called out sick from work (my first time doing this during residency), and I headed to the hospital I work at everyday, checked myself into the hospital and waited in the surgical waiting room as an add-on case. Needless to say, I cried the entire way out of the doctor’s office, in the hospital, and in the surgical waiting room, all the way into the operating room.
The hardest part about the process for us was the helplessness and disappointment. We had done nothing wrong. Thousands of women have miscarriages on a daily basis but when it happens to you, that is when you actually understand the deep sadness that these women (and men) feel.
My OB told me that my next pregnancy would be hard on me because I would be paranoid at every turn. Despite my medical knowledge and overall calm demeanor towards even the most dramatic medical emergencies, she was completely correct. When I became pregnant again, I didn’t want anyone to know. I wanted an ultrasound at every OB visit (something that is not indicated in a routine pregnancy). Lack of fetal movement (normal early in pregnancy) made it difficult for me to sleep at night. We didn’t share the news with close friends until I was 25 weeks pregnant and with coworkers when I was 30 weeks pregnant. Only my immediate family knew up until then.
When it was time to decorate our baby’s nursery, I was hesitant. Then my husband provided some perspective. Something terrible can happen at any point of our child’s life but living our lives in fear is not an option. Now, I am 39 weeks pregnant, cautiously optimistic… thankful that we have a baby on the way and just praying for a healthy child.
*misoprostol: a prostaglandin E1, a.k.a. a medication that causes uterine contractions.