Miscarriage occurs when a baby dies in the womb or uterus during pregnancy. The average time or cut off for miscarriage is defined differently around the world based on how early the baby can survive outside the womb (viability), but the WHO generally states that a baby who dies before 28 weeks of pregnancy is referred to as a miscarriage, and babies who die at or after 28 weeks are stillbirths. The NHS uses a cut off of 23 weeks to define a miscarriage while the National Library of Medicine defines a miscarriage as pregnancy loss before 20 weeks. Estimates of the miscarriage rate vary, estimates it is the most common form of pregnancy loss. It is estimated that as many as 26% of all pregnancies end in miscarriage and up to 10% of clinically recognized pregnancies also end in miscarriage. This translates to about 1 in 4 pregnancies. But even though miscarriage is common, it can be emotionally difficult. Feelings of grief and loss are normal after losing a pregnancy. The medical term for miscarriage is spontaneous abortion and about 80% of early pregnancy loss occurs in the first trimester (first 3 months).
What are the causes of a miscarriage?
It can be difficult to know exactly why a miscarriage happened. There are however, some situations which are more commonly associated with miscarriage. They are:
Abnormalities in the chromosomes(genes) of the child. If a baby has too many or not enough chromosomes, it will not develop properly and a miscarriage will occur. This is the major cause of most miscarriages and usually happens early, within the first 3 months. Certain illnesses, like severe diabetes
Severe infections (sepsis) or major injuries
Abnormalities in the uterus.
Having more than 2 miscarriages in a row
A miscarriage is almost never caused by something the pregnant person did. Normal activities like sex, exercise, working, and taking most medicines do NOT cause a miscarriage. Minor injuries, like falling, do not generally cause a miscarriage either.
Types of miscarriage
A miscarriage can be complete or incomplete based on whether all the products of conception (the dead baby or fetus, supporting tissues, or placenta) are expelled completely out of the woman’s body, through the vagina.
It can be threatened or inevitable based on whether the miscarriage eventually happens and the child dies and is expelled or whether the signs of miscarriage stop, and the child survives with the continuation of the pregnancy.
It can also be a missed abortion if the child dies but is not expelled out of the body.
An abortion can also be described as septic if the lining of the womb and any of the products of conception becomes infected.
What are the signs of miscarriage?
The signs of miscarriage are
Vaginal bleeding that ranges from light to heavy.
Fluid, blood or tissue passing, or sometimes gushing from the vagina
Severe stomach cramps and pain.
Worsening or severe lower back pain
Pain in the pelvic area
Weakness and extreme fatigue
There may also be nausea and vomiting
Can you have a miscarriage at 5 months of pregnancy?
A miscarriage is also described based on the time it occurs in pregnancy.
Early miscarriage occurs before 24 weeks (0 to 3 months), while late miscarriages happen between 12 and 24 weeks (3 to 6 months).
So the answer is yes, miscarriage can happen at 5 months, even though this is a late miscarriage and not common. A late miscarriage is also sometimes called a second-trimester or mid-trimester loss. Late miscarriages are not very common and happen in 1-2% of pregnancies. This rate is significantly lower than in the first trimester. Pregnancy loss in the second trimester can be the result of a very preterm delivery (like a spontaneous miscarriage in the second trimester) or death of the fetus (called a fetal demise). Once a pregnancy gets to about 20 weeks (about 5 months) less than 0.5% will end in a fetal death.
The risk factors for late miscarriages are slightly different from early miscarriages. In addition to chromosomal defects, and other causes of early miscarriage; factors like increased maternal age, blood disorders, weak cervix, uterine abnormalities, and fetal developmental issues also contribute to late miscarriages.
What to do in case of a miscarriage?
Unfortunately, nothing can prevent a miscarriage from happening once it has begun. The treatment is aimed at preserving the health of the mother and her chances of getting pregnant again.
Once the symptoms are noticed, it is advised for the woman to see the doctor as soon as possible. The doctor would examine the woman to confirm, and do tests including an ultrasound to confirm that the fetus or child is dead and exclude a threatened miscarriage where the child is still alive and the miscarriage has not yet occurred.
In cases of a confirmed miscarriage, the options are the natural or ‘watch and wait ‘management where the woman is sent home and waits for the pregnancy tissue to pass naturally.
The second option is the medical option where drugs are given to the woman to hasten the expulsion of the pregnancy tissue.
The surgical option is the third option where the pregnancy tissues are removed in a form of minor surgery called a ‘dilatation and curettage’ (also called a D&C or a curette). This procedure is often recommended if there is attendant heavy bleeding, significant pain or signs of infection.
The first option is often for early miscarriages while the second option is used for late miscarriages more. Each option has its risks and benefits and the choice is usually made after careful consideration of the individual case with the doctor.
If you have had a miscarriage, regardless of the month of pregnancy it occurred and are feeling sad or having problems coping with the grief, ask for help by joining a support group or speaking to your mental health doctor to help you go through this tough period. Chances are that the next pregnancy will not result in loss and you will have a pregnancy carried to full term.