Mid-trimester (Late) Miscarriage
Unfortunately, very few centres invest enough time and resources into finding out the reasons why women had a late miscarriage and without this information, there is a high risk of recurrence. For example, a recent study found that women with a history of mid-trimester pregnancy loss had a 27% rate of repeat mid-trimester loss, and a 33% rate of pre-term delivery, compared to 1% rate of mid-trimester loss and 9% rate of pre-term delivery in the control group of women who have had a previous full term delivery.
Another study found a stillbirth rate of 5% amongst women with a prior history of miscarriage between 13 – 24 weeks, compared to a stillbirth rate of 0.5% in the general population.
Usually, there is a cause for it and ideally, this should be thoroughly investigated. Finding the cause is important for the grief process and crucial to the plan and management of subsequent pregnancies. We would highly recommend this investigation to occur before becoming pregnant again. This way we can overcome any issues before they become a problem.
Dealing with the grief of late miscarriage
Pregnancy loss at this late stage is therefore associated with major grief reaction. At St. George’s Hospital in London, we take this aspect very seriously and run a dedicated holistic service designed to support affected women during the current and subsequent pregnancies.
What can I do to manage this problem?
The main principles of management are firstly to establish the cause in the interval before the next pregnancy.
Secondly, develop a plan of care for the subsequent pregnancy based on the cause of the previous event. Thirdly, book early in the next pregnancy, initiate or repeat any relevant tests, and carefully monitor the progress of the pregnancy and respond promptly to emerging changes.
Austin Ugwumadu has a special interest in this area. You can ask your doctor for a referral to his clinic at St Georges Hospital in Tooting, London or you can see him privately at Parkside Hospital on Wimbledon Common, London.
Risk factors for late miscarriage
Women who deliver extremely premature babies, that is, between 23 to 28 weeks, deserve special attention. Their babies often survive in the short and medium term and are admitted into the Special Care Baby Unit. The women are therefore not investigated for the cause of such an early delivery, but in reality, they share common risk factors with late miscarriages. But with the delivery delayed by a few days or weeks, they are therefore at increased risk of adverse outcome in future.
At St George’s Hospital we also aim to investigate these women, study the placenta of their babies and plan the care and course of their future pregnancy in a systematic way to prevent a recurrence of adverse outcome.