Complications of Pregnancy and Help for Infant and Pregnancy Loss
Pregnancy can be a blessing in so many ways. It can also be a scary time, or a time of pain and grief, especially if the pregnancy does not proceed as planned. There are several possible complications to pregnancy that may lead to pregnancy loss. But there are also many women who have had similar experiences who can support you in difficult times.
Miscarriage is an umbrella term encompassing any loss of pregnancy before the baby reaches 20 weeks. About 80% of miscarriages happen in the first 12 weeks. Most early miscarriages occur because the embryo is not viable, and cannot survive, and anywhere from 50 to 70% of early miscarriages are due to chromosomal abnormalities. Fortunately, serial miscarriages are uncommon, meaning you are likely to have a healthy pregnancy following a miscarriage.
Stillbirth refers to any pregnancy loss occurring at 20 weeks or later. A baby is stillborn in about 1 in 200 pregnancies. This can be very painful for parents because many of them occur in what appeared to be otherwise normal pregnancies. It can also be difficult to accept this loss because in about half of the cases, the cause is unknown. Another difficult aspect to stillbirth is that the mother must give birth to her deceased baby to preserve her own health. The good news is that 90% of women who experience stillbirth go on to have a healthy pregnancy in the future.
Perhaps the most devastating of all, sometimes babies die during birth or shortly thereafter. It’s possible your child was born with a condition or defect that did not allow her to live for more than a few hours. Perhaps you had to make the impossible decision to discontinue life support for a critically ill infant. Or maybe there were complications during birth that led to the loss of your child and your own endangerment. Whatever the case, losing an infant is one of the most painful events a parent can experience. It is traumatic, and it will take time and support to heal. See the list of resources below for places you can go to talk with other people who have experienced the tragedy of infant loss.
Some women may test positive for pregnancy, then get their period a few days to a week late. One explanation could be that she had a biochemical pregnancy in which the egg is fertilized, but hCG remains low. The pregnancy miscarries on its own, often due to chromosomal issues. Essentially, in a chemical pregnancy, you do get pregnant, but it is not viable, and it will miscarry. Only if you test at the right time will you even know about this type of miscarriage.
What is ectopic pregnancy?
A healthy pregnancy begins when a fertilized egg implants in the uterus. An ectopic pregnancy starts with that egg implanting somewhere outside the uterus, most commonly (in 97% of cases) in the fallopian tube. This is why some people refer to it as a “tubal pregnancy.” Only intrauterine pregnancies are viable, making all extrauterine pregnancies a danger to the mother’s health.
What are the symptoms of ectopic pregnancy?
1 in 50 pregnancies is ectopic, and cannot result in a healthy baby. The early symptoms include spotting or mild cramping, though many women feel nothing at all. These symptoms often occur in healthy pregnancies as well, making early detection difficult. After 7 weeks, if you are experiencing an ectopic pregnancy you may feel shoulder pain on the side of the implantation. If the improperly implanted embryo causes the fallopian tube or other tissues to burst, you will have heavy bleeding and severe pain, and possibly lightheadedness and fainting. This is an emergency situation. Get to an emergency room or call 911 immediately, as you can go into shock or even die if this condition is left untreated.
What are the risk factors of ectopic pregnancy?
Risk factors include:
Previous ectopic pregnancy
Prior fallopian tube surgery
Previous pelvic or abdominal surgery
Pelvic inflammatory disease
Endometriosis, a condition in which uterine lining is found outside the uterus
Age (increased risk over 40)
Having an IUD
Previous miscarriage or abortion
Progestin-only birth control pills
What are the treatments for ectopic pregnancy?
Although any pregnancy loss is medically referred to as an “abortion,” please understand that in the case of ectopic pregnancy, having a baby is not an option. An embryo cannot survive outside the uterus, and it cannot be transferred and reattached into the uterus. Removing an ectopic pregnancy is a vital, life-saving procedure, and is not an elective abortion.
If the embryo is discovered before rupture, methotrexate may be an option. Methotrexate causes cells to stop growing and is sometimes used to treat cancer. This ends the pregnancy, and the cells are reabsorbed into the body. This is an alternative to surgery and may not always be an option.
If the pregnancy has progressed too far or if any tissues have ruptured, surgery will likely be required. Ectopic pregnancy is often discovered during emergency surgery for internal bleeding. Surgeons may use laparoscopic surgery or traditional surgery. They will remove the embryo, and may need to remove part of the fallopian tube as well.
How will I feel after an ectopic pregnancy?
Your feelings after an ectopic pregnancy may be complicated. You might be mourning for your loss as well as traumatized by your own near-death experience. Your partner has lost a baby and may have almost lost you as well, depending on the circumstances. After the ectopic pregnancy is removed, you may still feel pregnant. It may take several weeks for all the hCG to leave your system, and several cycles for your period to return. It will take time for your body and your heart to recover. Having an ectopic pregnancy gives you about a 10% chance that it will happen again. This means the odds are overwhelmingly in favor of your having a healthy pregnancy after an ectopic one. But be sure to discuss your risks with your doctor if you eventually become pregnant again, because any future pregnancies will be high-risk.
What is heterotopic pregnancy?
Heterotopic pregnancy goes by many names. It is also called coincident pregnancy, multiple-sited pregnancy, and combined ectopic pregnancy. The word “heterotopic” means “other place.” In the case of pregnancy, it refers to both a healthy and an ectopic pregnancy taking place at the same time. As with ectopic pregnancy, the most common extrauterine location for the embryo to implant is in the fallopian tube. In rare cases, the embryo may implant on the cervix or the ovary. The healthy pregnancy, meanwhile, carries on inside the uterus.
How common is heterotopic pregnancy?
Estimates of the number of heterotopic pregnancies in spontaneous (natural) pregnancies vary from 1 in 7,000 to 1 in 30,000. It is much more common in assisted pregnancies. 1 in 100 assisted pregnancies will be a multiple-sited pregnancy.
What are the symptoms of heterotopic pregnancy?
Symptoms of heterotopic pregnancy are similar to those of ectopic pregnancy, and can include: intermittent stabs of pain, pain that can be dull and throbbing or sharp and startling, intensifying abdominal pain, pain on one side, dizziness, fainting, abnormal bleeding, bloating, nausea and vomiting. Also like ectopic pregnancy, heterotopic pregnancy can be deadly if untreated. Unfortunately, it is difficult to detect and diagnose. Over half of all cases of heterotopic pregnancies are not discovered until emergency surgery is performed to seek the cause of bleeding or pain.
Why is heterotopic pregnancy hard to diagnose?
Heterotopic pregnancy often goes undiagnosed because the ectopic pregnancy occurs alongside a healthy pregnancy, and many of the symptoms are also symptoms of a healthy pregnancy, such as spotting and cramping. It is not until the appearance of more extreme symptoms, such as intense pain or heavy bleeding, that it becomes apparent that something is wrong. Because this condition is most common in women who have had an assisted pregnancy, there are usually frequent ultrasounds to confirm a healthy pregnancy. Ultrasounds will focus on the uterus, and once a healthy growing baby is observed, in most cases early symptoms of heterotopic pregnancy are dismissed as normal symptoms of a healthy pregnancy. Most improperly implanted embryos are therefore not discovered until the woman is taken in for emergency surgery.
What are the treatments for heterotopic pregnancy?
The ectopic pregnancy must be terminated. A fetus cannot live outside the uterus, and the life of the mother can be in danger if any tissues rupture. If a fallopian tube ruptures, that will often need to be removed as well. Surgical removal of the extrauterine fetus usually does not affect the healthy pregnancy progressing inside the uterus. 67% of women are able to carry the healthy baby in the uterus to term.
How will I feel after a heterotopic pregnancy?
Because this complication is most common in women undergoing some type of fertility treatment, it is overwhelmingly likely that the mother wants and is eagerly anticipating a child. Because all assisted pregnancies are more likely to result in multiple pregnancies, there is also a chance that the mother was prepared for caring for multiple babies. Losing a baby due to ectopic pregnancy will be difficult and painful, even though there is also a healthy pregnancy going on. It is normal to grieve the loss of the ectopic fetus, even though it wasn’t viable. Be kind to yourself and allow yourself to feel sad about what might have been. There is also a 33% chance that both pregnancies will end, and that will be a difficult reality to face as well.
What is molar pregnancy?
A molar pregnancy is a condition caused by abnormal fertilization. It can be caused in one of two ways: either 2 sperm fertilize one egg, which creates what is known as a partial mole, or one or two sperm fertilize an empty egg, which is known as a complete mole. Because a partial mole contains chromosomes from both sperm and egg, it begins to develop some fetal tissue, but because the fetus has 69 chromosomes, 23 from the egg and 23 from each of the 2 sperm, it cannot develop normally and is not a viable pregnancy. In the case of a complete mole, only genetic material from the father replicates. There is no fetal tissue, and the early placenta develops into a series of abnormal cysts. Neither has a chance to grow into a baby.
What is the treatment for molar pregnancy?
The egg grows rapidly into a tumor-like mass, and causes strong hormonal changes. The cells must be removed through D&C, and the patient must be monitored for 4 months to ensure that all the hCG leaves her system. If it does, she will be monitored for another 6 months to ensure the levels stay down. If the hCG levels are not down by 4 months post op, this indicates that some cells were missed and have continued to grow. This can turn into a cancer called choriocarcinoma and may require chemotherapy, though this is very rare. Only 1 in 1,200 pregnancies is considered a molar pregnancy, with 1 in 40,000 developing into choriocarcinoma.
What are the symptoms of molar pregnancy?
Though this condition is rare, be sure to report any vaginal bleeding you have while pregnant, as this is the most common sign of molar pregnancy. Other symptoms include severe nausea and vomiting, and pelvic pain. Risk factors include getting pregnant while younger than 20 or older than 35, having had a molar pregnancy in the past, and having had more than two miscarriages. Most women who have a molar pregnancy are able to have a normal pregnancy after recovering.
Pregnancy Loss Support
What is grief?
Losing a baby is a terrible thing, and there is no right or wrong way to grieve. You may have overwhelming feelings of anger, sadness or guilt. Some people who are grieving get sick easily and have trouble concentrating. These are all normal parts of the grieving process. Just as there is no right or wrong way to grieve, there is no right or wrong amount of time to grieve. You may mourn the death of your lost baby for a long time, maybe the rest of your life. With time, as long as you need, you will move through grief and into healing, and start to think about the future once more.
How will my partner grieve?
Your partner may show his feelings differently than you do, and that’s ok. In general, men don’t show their feelings as openly as women do. This may lead you to believe that he doesn’t care about the loss as much as you do. Remember that he didn’t carry the baby in his body. Your bond with your baby will always be different from his. Depending on when you lost your baby, it may be more real to you than it is to him. You may seek support from family, friends, others who have suffered loss, or religious leaders. Your partner may try to work through his feelings on his own. Try to remember that there is no wrong way to grieve, and give him space to grieve in his own way.
How will my children grieve?
Your other children will grieve the loss of the baby as well, but it may look different. They may become clingy or act out. They may feel afraid that they are going to die as well, or that they are somehow to blame for what happened. When you talk to your children about pregnancy or infant loss, be truthful about what happened, but simplify it as needed. You could say “The baby didn’t grow,” or “The baby was born very small.” Avoid euphemisms such as “Mommy lost the baby,” as this may confuse children. Children may ask questions that feel uncaring to you. Try to show them love when answering questions, and remember that they are grieving as well.
How can I remember my baby?
It may help to find ways to remember your baby. You could collect items such as ultrasound pictures, baby clothes, photos, footprints, or a hospital bracelet and place them in a box or scrapbook. You can hold a funeral service for a baby that is stillborn or who died after or during birth, or hold a memorial service for a miscarriage or early pregnancy loss. Invite supportive friends and family, or keep it private. You could write your feelings in a journal, or in a letter to your baby. Tell your baby you love her and miss her. You could plant a tree or some flowers to remember your baby, or order a piece of jewelry with his initials and birthstone. Or you may prefer to heal from your pain and move forward without physical reminders of your lost baby. Anything that brings you comfort is acceptable.
Where can I find help?
Seeking help after losing a baby can help you heal. You could talk with your doctor to understand what happened and, when you’re ready, what you need to do to prepare to become pregnant again. A grief counselor or bereavement group can allow you to talk about your loss with others who have experienced something similar, which may help you move toward healing. It is especially important for women to talk through feelings, so find someone who will listen without judgement. You can also take care of yourself by focusing on healthy habits, such as eating nutritious foods and getting enough sleep and exercise. If your sadness is overwhelming and debilitating for more than 2 weeks, you may need treatment for depression.
If you need support, here are some resources that can help you.
A comprehensive site based in the UK that offers information about pregnancy complications and loss, as well as support from others who have had similar experiences. This is a good place to start if you’re searching for support.
Share collects information about local bereavement support meetings, and holds online meetings for those in states without in-person meetings available. There is also a catalogue of outside links to memorial keepsakes to help you remember your baby.
A support network created by the March of Dimes, which includes blogs, forums and support groups centered on various topics such as loss and grief, birth defects and disorders, and anything pregnancy-related.
An extensive list of sites and groups for loss support, as well as difficult issues such as infertility and cancer.
Of course there are Facebook groups where people who have had similar experiences meet to discuss related issues. Here are a few you could try:
Pregnancy or infant loss can be traumatic and painful, and that pain can last for a long time. With support, love, rest and time, you can find acceptance, hope and healing. You may always carry a wound with you, but you can also carry love, and someday, feel joy again. You can do it, mama. You can carry on. We have faith in you.