1. Was the miscarriage a ‘chemical pregnancy’; meaning that you had a positive pregnancy test but your period was only a few days late and there was not any products of conception or ‘tissue’ seen, only menstrual flow? What this usually represents is a low Progesterone (P4) level that was so low that it did not make a rich enough secretory lining for a healthy fetus to properly implant and it would not properly establish a healthy implantation for a healthy placenta to form. A healthy placenta is the ‘filter’ through which maternal bloodflow, nutrition and oxygen will exchange with the returning blood and waste from the fetus for the mother to exchange out, allowing for a healthy pregnancy. Patients who are prone to recurrent multiple ‘chemical pregnancies’ need to have their Progesterone (P4) levels checked and bio-identical P4 replaced to help maintain that pregnancy until the placenta is big enough to make enough P4 on its own at around 14weeks pregnant.
2. Was the miscarriage associated with a fetus? As crazy as this sounds, some pregnancies will have a placenta and an amniotic sac filled with fluid but the cells destined to make the fetus never develop into a fetus; this is called a blighted ovum and has no real cause as to why it happens; those cells destined to become the fetus simply do not start growing. Once the body figures out that it is doing all of this work to have a healthy pregnancy but there is no fetus there to support, then the body will ‘figure it out’ and will initiate the miscarriage process on its own. Although sometimes the body doesn’t figure it out and you may wish to have your doctor set up a scheduled D&C to end the process and allow your body to ‘reset’.
3. Was the miscarriage associated with a fetus that had a heartbeat? At the time of miscarriage or perhaps spotting that prompted you to see your doctor, did an ultrasound demonstrate a fetus that measured to be as far along as you thought you were pregnant? Sometimes, a fetus will have a chromosomal problem that the body knows will not survive if it develops to term and delivers. Sometimes a fetus will have a heartbeat that will then lose its heartbeat before 12wks pregnant. This can represent the low P4 level as in #1 above; it can also be associated with multiple small blood clots to the placental blood vessels that compromise bloodflow in the placenta and cut off blood and nutrition to the fetus.
4. Was the miscarriage with a fetus not the first miscarriage but was it the 2nd or 3rd recurrent miscarriage of a pregnancy with a fetus? In this case it may represent autoimmune disease and a recurrent miscarriage to rule out autoimmune disease is needed. This work-up includes a clotting work-up to rule-out multiple blood clots in the placenta and includes: antiphospholipid antibodies, anticardiolipin antibodies, lupus anticoagulant, MTHFR deficiency, Factor VIII, platelet antibodies. Unfortunately, recurrent miscarriage may be the first sign of autoimmune disease and deserves a work-up.
5. Was the miscarriage after the first trimester ended (post 12weeks)? This timing would be much more dangerous to the mother as it may mean a maternal medical issue that is causing the miscarriage or it may not occur until the middle to end of the 2nd trimester which may not be at a timing when the fetus could survive outside of the womb.
Usually, a miscarriage at any stage in the pregnancy is a very physically and emotionally traumatic incident. Emotionally, you have given this child a name and a place in your heart and in your family; and now you’ve suffered a death that is NOT OF YOUR MAKING!!! Too many times, the woman is ‘blamed’ by her partner for ‘doing something wrong’ or ‘doing something that caused the miscarriage’ or ‘eating or drinking something’ that caused the miscarriage; these are hurtful and non-productive statements that can cause depression in the mom, feeling that she in deed is ‘at fault’ or ‘did something’ when indeed it was not within her control.
From a physically traumatic aspect, too many women are told that it is best to go through a miscarriage ‘the natural way’ by allowing the body to spontaneously miscarry. The natural process may occur and may completely evacuate the contents of the pregnancy and placenta but sometimes it doesn’t; this may result in retained placental pieces that may trigger an intrauterine infection which can be serious and even fatal if not recognized early in the process. Or it may result in significant blood loss and hemorrhage which can take weeks to months for the patient to recover from.
Regardless of which of the above have been the actual situation that you may have had happen to you, the uterus actually needs to recover, to get back to its normal size and be healthy enough to accept another pregnancy and not reject a healthy pregnancy because a patient got pregnant too soon before the uterus was prepared to properly handle the rigors of a healthy pregnancy. I usually tell my patients to allow the body and the mind/heart to heal over the next 2 cycles, then it’s okay and you are psychologically ready to try again; usually this timing will allow a proper reset of your body and you will have no increased risk of miscarriage simply because you got pregnant too soon.
Remember, chromosomal abnormalities are usually NOT going to cause a 2nd or 3rd trimester miscarriage; so doing a chorionic villous sampling of placental cells by 10wks pregnant or an amniocentesis sampling of sloughed fetal cells in the amniotic fluid between 14-17 wks pregnant can determine the exact genetics of the fetus. These tools are most commonly employed when the mom is ‘advanced maternal age’ or AMA with conception occurring after age 35years old.
Hope this helps answer a very simple question but it doesn’t have anything but a complicated answer.
Well, it depends what you mean by "right after." Typically, it is usually a month or two depending on a couple of factors: How far along you were when you miscarried, when you passed everything from the uterus, etc. Typically, once the uterus is empty, then it will take awhile for your hCG (pregnancy hormone) to reach 0. Once it reaches 0, then after a few weeks, you will ovulate and you can become pregnant.
I hope that this helps.
Joseph A. Adashek, MD FACOG