Missed Miscarriage: Trauma and Treatment

A missed miscarriage can be a devastating diagnosis for an expectant parent. Many couples who experience a missed miscarriage develop increased fears and anxiety during subsequent pregnancies. We will be discussing the diagnosis of missed miscarriage, its psychological effects and its treatment.

What Is a Missed Miscarriage?

A missed miscarriage occurs when the fetus has died but has not been physically miscarried. For women with a missed miscarriage, they do not have symptoms, such as bleeding or pain. Other names for a missed miscarriage are missed abortion or silent miscarriage. A missed miscarriage occurs in 1 to 5% of pregnancies.

How Is a Missed Miscarriage Diagnosed?

Clinicians diagnose a missed miscarriage via ultrasound. Additionally, your physician will likely order serial hCG testing in order to determine fetal viability. In a normal pregnancy, the hCG level will increase over time. If hCG testing reveals stagnant or decreasing levels, it may further point to a nonviable pregnancy.

What Causes a Missed Miscarriage?

It is not always possible to determine the reason for a missed miscarriage. However, most often, a chromosomal issue makes the fetus incompatible with life.

How Is a Missed Miscarriage Treated?

There are three main ways in which a missed miscarriage is treated:

The body is allowed to miscarry naturally. In this setting, patients elect to not undergo treatment. Clinicians will often allow the patient to remain pregnant until the body recognizes the nonviable pregnancy and miscarries. In terms of pros, this allows a woman to avoid the trauma of surgery and possible scarring. However, allowing the body to miscarry naturally can be a psychologically difficult process. Women are left with unknowns in terms of how or when the loss will occur. Some women find carrying a nonviable pregnancy to be devastating and seek more immediate treatment.

The second main treatment for missed miscarriage is medication. In this setting, your provider will prescribe medications which will help the uterus to contract and expel the tissue. Some women choose this route since it allows some control over the process. Additionally, women can plan for pain medication if needed. This method of treatment allows women to avoid the risks that come with surgery.

The third main treatment for missed miscarriage is a dilation and curettage (D&C). For pregnancies that are further along, it may be difficult to pass the tissue on your own. Your physician may recommend a D&C in this setting.

What Are the Psychological Effects of Missed Miscarriage?

Pregnancy loss can be a traumatic event for a family. Couples tend to experience significant distress in the immediate timeframe following this loss. Although this pain tends to improve over time, the sadness of a miscarriage can leave a permanent mark. Some women experience feelings of guilt following miscarriage, even though there is nothing that a women could have done to prevent the occurrence.

A recent study revealed that nearly 20% of women who experience a miscarriage become symptomatic for depression or anxiety. In most of these women, symptoms persist for one to three years. Women who are at higher risk of these significant psychological effects include women with a history of infertility or prior miscarriage. The uncertainties of miscarriage often create additional anxiety in women during subsequent pregnancies. The same study revealed that 64% of women who experienced a miscarriage reported that this affected decisions about subsequent pregnancies.

Unfortunately, follow-up psychological care is often lacking. While most clinicians recognize the prevalence of depression and anxiety following pregnancy loss, many patients do not get the follow-up care needed in terms of mental health screening and treatment.

Closing Message:

A missed miscarriage can be a psychologically devastating event for a family. The three main treatment options are miscarrying naturally, medications and surgery. Women who experience pregnancy loss are at a greater risk of depression and anxiety. These symptoms sometimes remain for years following loss. It is important that women discuss their concerns with their provider and seek counseling if needed.

Have you experienced pregnancy loss? What helped you as you went through this difficult process? Please share in the comment below.