Dr.SSA Giada Frontino

Dr. Giada Frontino

Dr.SSA Giada Frontino

Dr. Giada Frontino
Consultant Gynaecologist

English (UK)
English (UK)

Dr. Giada Frontino
Consultant Gynaecologist

Dr.ssa Giada Frontino
ginecologa italiana a londra

English (UK)
English (UK)

Early Pregnancy Loss (Miscarriage or Spontaneous Abortion)

What is an early pregnancy loss?

This is the loss of a pregnancy during the first trimester (the first 13 weeks). Miscarriage or Spontaneous abortion are also terms used to signify this.


Does an early pregnancy loss always show with heavy bleeding?

It actually often does not show any symptoms at all, neither bleeding nor pain. These silent cases are diagnosed through an ultrasound scan. In other cases, an early pregnancy loss causes mild or heavy bleeding and or crampy pelvic pain or low back pain. In some cases this bleeding will not cause the loss of the pregnancy, which will continue normally even despite these symptoms. If you are experiencing bleeding and/or pain, please contact your Early Pregnancy Unit (EPU) or your Gynaecologist. If you haven’t had an ultrasound scan showing the fetus yet, please access the A&E or your EPU in order to rule out an ectopic pregnancy.


Are early pregnancy losses very rare events?

These are actually extremely frequent, and occur in 1 out of 5 pregnancies.


How can I know what has caused my early pregnancy loss?

About half of the cases of early pregnancy losses is due to random errors during the development of the egg cells and/or of the sperm cells, therefore causing chromosome anomalies in the resulting embryo.


Can I have done something that has caused my early pregnancy loss?

Neither working, physical exercise, sexual activity, nor having taken the contraceptive pill can cause an early pregnancy loss. Laughing hard nor coughing can cause an early pregnancy loss. Nausea is not a cause of early pregnancy loss.

Severe blows directly to the abdomen may cause a pregnancy loss. Cigarette smoking/vaping, alcoholic drinks, caffeine (contained in coffee and green tea/matcha), marijuana and all recreational drugs can cause early pregnancy losses.


Can some women have a higher chance of having an early pregnancy loss?

The chance of having an early pregnancy loss increases the age of the woman and of the man increase. An early pregnancy loss occurs in 1 out of 3 pregnancies in women older than 40 years old.


Which are the signs and symptoms of an early pregnancy loss?

The most common symptoms are bleeding and pelvic crampy pain. Light bleeding that then disappears, and mild transient cramps can be common in the first months. However, bleeding and pain should always be reported to the EPU or to your Gynaecologist, as these can be a sign of more serious problems in pregnancy, such as an infection or an ectopic pregnancy.


How is an early pregnancy loss diagnosed?

If you have symptoms of early pregnancy loss, you will likely have a physical exam. Your Gynaecologist will ask you questions regarding when the bleeding started and how much you are bleeding, and whether you have pain. An ultrasound exam will be done to check whether the embryo is still growing in the uterus and to detect the presence of a heartbeat. You might need to have a blood test to measure the level of human chorionic gonadotropin (hCG), which is a substance made by the placenta. If the hCG levels are low or decreasing, this can mean the pregnancy is not viable. You might need to undergo several ultrasound scans and hCG tests in order to understand if a pregnancy loss has occurred.


Do I require treatment if I have an early pregnancy loss?

In some cases of pregnancy loss, residues of the pregnancy are retained in the uterus and need to be removed, either through specific medication or through a surgical procedure. You will be able to discuss the options. The available options have similar risks, which include infection and heavy bleeding. The risk of having serious complications is very small, regardless of the type of treatment.

Following an early pregnancy loss and if your blood type is Rh negative. Problems that can occur in a future pregnancy when the mother is Rh negative and the fetus is Rh positive can be prevented by giving Rh immunoglobulin after a pregnancy loss.


Which nonsurgical options do I have following an early pregnancy loss?

One option is to wait and let the tissue pass naturally, which can require 2 weeks or longer in some cases. This option is possible only if you do not have any signs of an infection.

Another option is to take medication that helps release the tissue.


What can I expect if I choose the nonsurgical option?

Bleeding is usually heavier than a menstrual period and lasts for longer. Crampy pain, diarrhoea, and nausea may also occur. Pain medication can be taken to reduce the pain during the process. You may notice clots in addition to bleeding. An ultrasound scan or blood tests for hCG are done afterward to confirm that all of the tissue has been expelled. If it has not, you may need to have surgical treatment.


Which are the surgical options to treat an early pregnancy loss?

Surgery is recommended if you have signs of an infection, heavy bleeding, or other medical conditions. One surgical option is called vacuum aspiration. In this procedure, a thin tube attached to a suction device is inserted into the uterus to remove the pregnancy residues. Local anesthesia and medication to help you relax will be used. Another option is called dilation and curettage (D&C), during which the cervix is dilated and an instrument is used to remove the pregnancy residue. General anesthesia or regional anesthesia may be used.


What should I expect while I recover from an early pregnancy loss?

You will be advised to avoid sexual intercourse and to avoid introducing anything into the vaginal canal for 1-2 weeks , in order to avoid infections. Contact your EPU or your Gynaecologist if you have any of the following:

  • Heavy bleeding that requires changing a sanitary pad every half an hour or

  • Unexplained fever

  • Shivering

  • Severe pain


What can we do to cope after a pregnancy loss?

If you or your partner feel that you are finding it difficult to cope, please talk to your Gynaecologist, the staff at the EPU or your GP. Speaking to a Psychologist/Counselor can be very helpful, especially through a post-traumatic approach. Online or in person support

groups can also be very helpful.


Can I have another baby after a pregnancy loss?

An early pregnancy loss normally occurs only once. Most women then have successful pregnancies. Investigations (for example, a cervicovaginal swab, blood tests and hormonal tests) can be done even after one early pregnancy loss, although these tests are normally done after several pregnancy losses.


When can I start seeking another pregnancy after an early pregnancy loss?

Ovulation occurs after about 2 weeks from the early pregnancy loss. If you wish, you can start seeking a pregnancy immediately or after your first menstrual period, so that you will be able to more easily calculate the due date of your next pregnancy more.

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