- Understanding Second Trimester Miscarriage
- Why see a UC Davis Health specialist?
- Symptoms of a second trimester loss
- What causes a second trimester loss?
- Treatment of a second trimester loss
- After treatment of a second trimester loss
- After 4 miscarriages, I had depression, anxiety, and PTSD. My doctors just told me to keep trying for another pregnancy
- Medical approaches to pregnancy loss have advanced significantly, but doctors often neglect the psychological impact
- War veterans and women who suffer pregnancy loss can experience PTSD in similar ways
- I did nine rounds of IVF in three countries and had four miscarriages — then the pain settled in
- After pregnancy loss, a woman's feel-good hormones take a steep dive
- After a miscarriage, a woman can develop crippling anxiety about going through the ordeal all over again
- I couldn't enjoy my fifth pregnancy, which resulted in the birth of my daughter because I was too anxious
- Pregnancy loss leads to post-traumatic stress in one in three women — NIHR Evidence
- What’s the issue?
- What’s new?
- Why is this important?
- What’s next?
- You may be interested to read
- Genetic Testing
- What Is Genetic Testing During Pregnancy?
- Why Do Doctors Recommend Genetic Testing?
- Looking Ahead
- Miscarriage Can Trigger Post-Traumatic Stress Symptoms, Anxiety, and Depression, Research Finds
- More Than a Small Loss, Miscarriage Can Be a Deep Source of Distress
- Fertility Problems and Pregnancy Loss Are Emotional and Physical Issues
- Feeling Bad After Pregnancy Loss Is Normal, Research Suggests
- A Call for Better Support After Pregnancy Loss
- Honoring the Pregnancy Loss Can Help People Heal
Understanding Second Trimester Miscarriage
Pregnancy loss in the second trimester can be the result of a very preterm delivery ( a spontaneous miscarriage in the second trimester) or death of the fetus (called a fetal demise).
About 2-3% of pregnancies will be lost in the second trimester, a rate that is much lower than in the first trimester. Once a pregnancy gets to about 20 weeks gestation, less than 0.
5% will end in a fetal demise.
A loss at this time in pregnancy is most often a hard and sad experience. Many friends and family already know you are pregnant.
What do you do? What do you say? For most women and their partners, the process of grieving is no different than losing a person who has been in your life for some time.
You often have hopes and dreams about your child before that child is born, and losing the pregnancy in the second or third trimester is certainly a loss for a family.
Why see a UC Davis Health specialist?
Our specialists can evaluate you quickly in an office setting. Any laboratory testing or ultrasound examinations that need to be done can be performed easily and conveniently. We perform our own ultrasound examination in the office and can share the results with you immediately.
Treatment of a second trimester loss is very different than early miscarriage, and our specialists can provide all options to you and your family. We understand that losses at this time require both emotional and medical support. We are happy to review all treatment options but also know that you may need some time.
It is also important for you to know that a fetal demise in the second trimester is not a medical emergency so treatment is not immediately indicated.
If you are having very heavy vaginal bleeding or are feeling very sick, you should go to the Emergency Room to see our physicians.
Symptoms of a second trimester loss
- Bleeding: Most commonly, bleeding is a sign of a problem with the placenta and does not indicate a fetal demise. But, bleeding can be a sign that the cervix is opening without labor (called cervical insufficiency). With cervical insufficiency, the cervix begins to open early without contractions; as the cervix opens more, contractions then follow.
- Cramping: Pregnancy losses in the second trimester can be due to early labor.
- Loss of fetal movement: This can indicate a fetal demise. Most women can feel the baby moving by the 20th week. If the baby has been moving and you no longer feel that same movement, it is important to contact the doctor’s office immediately to make sure the baby is fine. Decreased fetal movement is more commonly a sign that there is a problem with the pregnancy and only rarely does it mean the fetus has died.
Most women less than 20 weeks of pregnancy do not notice any symptoms of a fetal demise.
The test used to check for a fetal demise in the second trimester is an ultrasound examination to see if the baby is moving and growing. Fetal demise is diagnosed when the ultrasound examination shows no fetal heart activity.
What causes a second trimester loss?
The causes of a pregnancy loss in the second trimester are very different than early pregnancy loss. There are medical conditions that increase the risk for cervical insufficiency or preterm labor before viability which include:
- Prior surgery to the cervix
- Use of illicit drugs, especially cocaine
- Fetal abnormalities (genetic or structural problems)
- Uterine infection (this is more common in developing countries and less common in the United States)
- Physical problems with the uterus, including fibroids or abnormalities in the shape of the uterus
There are also some medical conditions that are associated with fetal death in the second trimester which include:
- Fetal abnormalities (genetic or structural problems)
- Poorly controlled maternal cnoditions thyroid disease, diabetes or hypertension
- Lupus (systemic lupus erythematosus)
- Autoimmune or genetic conditions that increase a woman’s risk of forming blood clots in her legs or her lungs ( antiphospholipid syndrome)
- Very early pre-eclampsia or eclampsia of pregnancy
The specialists at UC Davis Health will review with you what testing is indicated to help learn more about why a second trimester loss occurred.
Despite the testing that is available, about half of the time there is no identifiable reason for a second trimester loss.
We can work with you to figure out what may be helpful with a next pregnancy or to learn more about medical issues that are important for your future.
Treatment of a second trimester loss
It is typically not safe for a woman to wait for the pregnancy to deliver on its own with a second trimester loss. There is a high chance of having significant bleeding when a pregnancy in the second trimester delivers on its own at home.
In the case of fetal demise, a dead fetus that has been in the uterus for 4 weeks can cause changes in the body’s clotting system.
These changes can put a woman at a much higher chance of significant bleeding if she waits for a long time after the fetal demise to deliver the pregnancy.
Our doctors are committed to providing all available treatment options. Testing to figure out the cause of the pregnancy loss can be performed regardless of the method a woman chooses for termination.
We understand that a second trimester loss is an emotional and stressful time and we want to ensure that the emotional needs of you and your family are met as well. We understand this is a time that you need support and we are sensitive to your wishes for remembrances and religious preferences. We will discuss these issues with you before any treatment.
When a diagnosis of fetal demise in the second or third trimester is made, options include:
- Surgical evacuation: This procedure, called a dilation and evacuation, can be performed in the second trimester, typically up to about 24 weeks. Surgical evacuation is the most common treatment women choose and involves removing the pregnancy through the cervix in the operating room while you are asleep. The cervix needs to be opened about 1-2 inches in diameter. The doctors can use different ways to open the cervix how far along the pregnancy is and your individual circumstance. The goal is to provide the safest care for each patient. After a surgical evacuation, normal activity can typically be resumed the following day. Opening or preparing the cervix for surgical evacuation of the pregnancy may involve:
- Medicines (tablets) that are put in the vagina a few hours to one day before the procedure.
- Medicine (tablets) that you hold between your cheek and gums for 30 minutes before swallowing. You would use this medicine a few hours before the procedure.
- Placing thin sticks in your cervix, called osmotic dilators, to absorb water from the cervix which causes the dilator sticks to swell slowly over 4-24 hours. Having the osmotic dilators placed is similar to getting a Pap test.
Labor induction: This treatment uses medicines to cause the uterus to go into labor. For women with pregnancies beyond 24 weeks, this is commonly the only option.
If you choose this option, you will be in the Labor and Delivery Unit at UC Davis Medical Center and will have all of the same pain treatments available to you as a woman who is naturally in labor ( IV pain medications or an epidural).
The treatment typically starts with swallowing a pill to make the uterus more sensitive to the medications to induce labor. About 24 hours later, you are admitted to the Labor and Delivery Unit and will have medicine (tablets) put in the vagina every few hours to cause labor.
Sometimes, women need medicine through an IV to also help get labor started. It may take 1-2 days for the uterus to go into labor and for the delivery to be complete. Up to 5% of women in the second trimester do not go into labor and need a surgical evacuation.
Your doctor will be able to explain more details about the pros and cons of each treatment.
After treatment of a second trimester loss
Bleeding may continue for several weeks after a labor induction but tends to be much lighter with a surgical evacuation. Any bleeding may change in color from bright red to pink or brown. Lower abdominal cramping in the few days after treatment is also common.
You should contact a doctor right away if the bleeding gets heavier instead of lighter over time, if a fever develops, or if vaginal discharge or a strange or unpleasant vaginal odor occurs. Avoid intercourse, douching, or using tampons for one week. Regular activities can be resumed right away, how you feel.
Importantly, if you want to delay getting pregnant, it will be very important to start an effective method of contraception.
After 4 miscarriages, I had depression, anxiety, and PTSD. My doctors just told me to keep trying for another pregnancy
When I got pregnant for the fifth time, after four miscarriages, my husband and I invested in an ultrasound machine to hear our baby's heartbeat at home. I promised myself I would only use it once a day, savoring the moment a decadent chocolate treat.
We listened before bed so I could sleep a little better, and stave off the nightmares of kidnappers yanking babies from my arms. In those two minutes (10 minutes? Forever?), I would have flashbacks to the traumatic checkups when the doctor said: «There is no heartbeat.
It wasn't until I heard the sweet badump badump badump that I could breathe a little bit easier.
So, when I read the results of a recent study, which found that women who experienced pregnancy loss are at a greater risk of developing mental health conditions — compared to women who delivered healthy babies — I wasn't surprised, because it happened to me.
In the largest study of its kind, scientists at Imperial College London and KU Leuven in Belgium studied more than 650 women who had a miscarriage before 12 weeks or an ectopic pregnancy, which is when the embryo begins to grow outside the womb.
The researchers compared those women's experiences to that of 171 women who gave birth to healthy babies. They found that the women who experienced pregnancy loss were more ly to develop depression , anxiety, and post-traumatic stress disorder.
Medical approaches to pregnancy loss have advanced significantly, but doctors often neglect the psychological impact
Miscarriages are common, and occur in an estimated 10% to 20% of pregnancies.
While the reproductive field has made significant advances in how it addresses miscarriages and infertility medically, doctors often overlook the long-term psychological effects patients face after pregnancy loss, wrote the authors of the study, which was published in the American Journal of Obstetrics and Gynecology.
But «overlooked» is a generous way of putting it. Each time I had a miscarriage, doctors were most concerned with how to deal with the issue medically — surgery, pills or let it happen on its own. One OB tried to send me to an abortion clinic!
But there was no acknowledgment of the potential emotional fallout.
«The experience of pregnancy loss really is so traumatic,» said Dr. Sarah Mathews, a clinical associate professor of psychiatry at the University of Pennsylvania who specializes in women's health.
«Even right after a pregnancy loss, there's not enough recognition of how this might affect a woman.
Doctors focus on the next pregnancy, rather than assessing for depression or anxiety relating to that loss.
«Once the woman is pregnant again, it really can be forgotten,» Mathews added of how most physicians will never speak of the miscarriage again, as if it disappears with the next pregnancy.
I never did forget any of my losses. I still struggle with IVF PTSD, five years after my daughter was born.
War veterans and women who suffer pregnancy loss can experience PTSD in similar ways
Criteria for post-traumatic stress disorder were met by 29% of the women observed in the study after pregnancy loss.
PTSD can manifest itself among women who have miscarriages in a similar way to how it affects veterans and terrorism survivors due to the sleeplessness, and haunting flashbacks.
Women who experience miscarriage and war veterans can experience PTSD in similar ways. AP
Pregnancy loss can feel an internal attack. It was a complete and utter destruction of my insides, my hopes and dreams, hormones, and ability to believe in the natural order of things. People generally suffer PTSD only after they're no longer in danger. For me, it was after I was done trying to have a baby.
While I was trying, even if I were depressed, anxious or angry about my pregnancy losses, I had no choice but to pull myself up by my bootstraps and make the next fertility appointment, order the latest supplement, fight with my insurance company for coverage and keep my sights on the baby.
But after I had my daughter, all that desolation I'd suppressed during IVF emerged. I was supposed to be ecstatic about the baby (I was, I loved her!), but I also had some other troubling feelings.
I did nine rounds of IVF in three countries and had four miscarriages — then the pain settled in
I had done nine rounds of in vitro fertilization in three countries with four miscarriages and one baby, and now I was finally in a safe space.
In this safe space, I could stop trying, stop covering up emotions, stop pretending — and then the tears leaked through. That was hard, I would wake up in the middle of the night — startled.
I can't believe I did all that I thought, when looking at my beautiful baby, still scared for the first few months that she would be gone.
When she came home, we replaced my home heartbeat monitor with a baby monitor, which I could check on my phone. But this time, I couldn't limit myself to checking it once a day (once an hour was more it.) I needed to make sure she was breathing.
Maybe all new moms do this. But I know that all moms who have suffered a loss definitely do this, beset by the anxiety and PTSD of loss.
After pregnancy loss, a woman's feel-good hormones take a steep dive
Among women who had miscarriages, 11% developed moderate to severe depression, compared to 2% of women who didn't experience pregnancy loss, according to the American Journal of Obstetrics and Gynecology study.
It's a stark difference. But how could it not be?
First I was looking at those cute, grainy printouts from my OB/GYN, and started dreaming of baby names, and then WHAM!
«I'm afraid there's no heartbeat,» my doctor said.
Suddenly, instead of searching for maternity yoga pants (something I was really looking forward to), I was searching for doctors in my insurance plan who could do a D&C to clean out my uterus from my not-baby.
What no one told me was that after pregnancy loss, there were physical effects too: My hormones took a precipitous dive.
When you're pregnant, the placenta produces human chorionic gonadotropin (hCG), a hormone, which makes your skin glow, your hair shine and gives you a boost of general happy feelings. When you lose a pregnancy, your hCG levels start to decrease. So, aside from feeling sad about the loss of my future baby, I was feeling physically down, depleted of my feel-good hormones.
Not to mention, there's the additional side effect of weight gain. After each loss, I put on five pounds. That's nothing compared to losing a baby, but it felt adding insult to injury: I wasn't pregnant and I still had a baby bump?!!
After a miscarriage, a woman can develop crippling anxiety about going through the ordeal all over again
Nearly a quarter of the women surveyed suffered anxiety after pregnancy loss, according to the AJOG study.
So did I.
After, I couch surfed and barely ate. My anxiety occurred around the thought of trying again — especially since trying by that point meant costly IVF. And actually, I was most anxious about the thought of getting pregnant again, staying pregnant, and getting to birth and have a baby.
This feeling is pretty common, too.
Dr. Lora Shahine, a reproductive endocrinologist, has written about how this issue has affected so many of her patients.
«It hit me a ton of bricks,» Shahine wrote in her book «Not Broken: An Approachable Guide to Miscarriage and Recurrent Pregnancy Loss,» about informing a patient that she was pregnant for the fifth time.»This was just the beginning of the limbo, waiting, and anxiety until she knew whether this would be a successful pregnancy or not.»
I couldn't enjoy my fifth pregnancy, which resulted in the birth of my daughter because I was too anxious
During my fifth pregnancy, I wish I could have been elated other expecting moms. I wish I could have relished every moment of every second of my daughter's gestation.
But I had to get past all the milestones of when I had lost the previous ones — the first ultrasound, the second ultrasound, the first trimester.
Going to the doctor for a routine checkup was particularly stressful, as I couldn't help but recall all those times I was laughing beforehand and crying after.
My losses occurred five years ago, but I can still be triggered to tears by any mention of miscarriage. That was the case when I watched Dr. Miranda Bailey's miscarriage play out on «Grey's Anatomy» or while reading about this pregnancy loss study.
Studies these can help to raise awareness about how a woman's emotional well-being needs to be addressed as much as her physical well-being after a miscarriage, Dr. Mathews said.
«We need to identify these women because we do have treatments that work,» she said, referring to therapy, those offered to cancer patients during treatment. «The only way to get them to that treatment is to assess for the symptoms.»
While it's obvious to me, and to anyone else in the pregnancy loss community how devastating miscarriage can be, it's not always so obvious to the medical community.
Doctors have said insensitive things to me , «just bad luck, I guess,» and «keep trying.
» Perhaps now, with this new available data, they won't say those kinds of things to patients struggling with pregnancy loss, and may actually offer some recommendations for supportive services.
If they need an extensive, well-funded study to make that happen, I'm all for it.
Pregnancy loss leads to post-traumatic stress in one in three women — NIHR Evidence
Almost one in three women develop post-traumatic stress disorder (PTSD) after early pregnancy loss, a new study shows. For some, signs of PTSD, anxiety and depression are still evident nine months later.
Early pregnancy losses are common, but the consequences and psychological impact are often overlooked. Current care varies, but most women receive no formal psychological support. They often rely on patient support groups for information and guidance.
This study aimed to investigate levels of PTSD, depression, and anxiety in the nine months after early pregnancy loss. Researchers hope the findings will help shape future response and support for women.
What’s the issue?
In the UK, there are an estimated 250,000 miscarriages and 10,000 ectopic pregnancies (in which an embryo starts to grow outside the uterus) every year. This makes it one of the most common reasons young women visit their family doctor or attend hospital.
Early pregnancy loss includes miscarriage (loss before 24 weeks) and ectopic pregnancy. Both can involve serious pain or bleeding and require emergency procedures in hospital.
There is evidence that early pregnancy loss has a psychologic impact. This may be anxiety, depression, or even PTSD. To date, this aspect of pregnancy loss has not been a major focus for research or treatment.
This is the first report from the larger Psychological Impact of Early Pregnancy Events study. It included 492 women seen at three central London hospitals. They completed a survey one month after early pregnancy loss. Another 87 women with healthy pregnancies acted as a comparison group.
Researchers used recognised assessment scales for moderate/severe anxiety and depression, and PTSD, to assess the impact of early pregnancy loss.
At one month, among women with early pregnancy loss:
- nearly one in three (29%) had PTSD, compared to none with healthy pregancies
- one in four (24%) had anxiety, compared to one in eight (13%) women with healthy pregnancies
- one in 10 (11%) had depression, compared to one in 50 (2%) women with healthy pregnancies.
At nine months, none of the women with healthy pregnancies had PTSD, anxiety or depression. But among women with early pregnancy loss:
- almost one in five (18%) had PTSD
- one in six (17%) had anxiety
- one in 20 (6%) had depression.
These results show that PTSD, anxiety, and depression decline over time, but they remain common at nine months.
The researchers believe this study, from Tommy's National Centre for Miscarriage Research, is the largest to assess PTSD, anxiety, and depression following pregnancy loss.
Why is this important?
For many women, miscarriage or ectopic pregnancy is traumatic and has a lasting impact. Given the numbers of miscarriage and ectopic pregnancies, the researchers are concerned that this is a hidden public health issue.
They hope their research will highlight the associated psychological distress. It could prompt those closest to the women — friends, colleagues, employers and family members — to better support them and their partners following a pregnancy loss.
These findings could encourage women with PTSD to seek help. The researchers call for clinical management to be more sensitive to the psychologic implications of early pregnancy loss; delays in access to treatment to be reduced; and for women to be able to access specialist care for early pregnancy loss.
Some women recovered from PTSD without intervention in the first three months after a pregnancy loss. But the number of women with PTSD changed little between three and nine months. The researchers therefore suggest that women should be screened for significant psychological effects three months after a pregnancy loss.
Those reaching the criteria for significant anxiety and depression, and in particular PTSD, should then be offered an assessment by a psychologist possibly leading to cognitive behavioural therapy (CBT), which is a first line therapy for PTSD in NICE guidance.
Researchers are planning randomised trials to determine the impact of the use of visuospatial cognitive tasks and trauma focussed CBT for the treatment for PTSD associated with pregnancy loss. They will compare it with the standard support that is given to for women following an early pregnancy loss.
In the meantime, guidelines have not yet changed. But the researchers hope people will be made more aware of the psychological impact of pregnancy loss and that professionals will look for it in clinical practice.
You may be interested to read
The full paper: Farren J, and others. Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study. Am J Obstet Gynecol. 2020;222:367.e1-22
An initial study by the same researchers to investigate the type and severity of emotional distress in women after early pregnancy loss. Farren J, and others. Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study. BMJ Open. 2016;6:e011864
A review of existing studies by the same researchers: Farren, J, and others. The psychological impact of early pregnancy loss. Human Reproduction Update. 2018;24:731–749
Websites for patients: The Miscarriage Association, Tommy’s Charity, and The Ectopic Pregnancy Trust
Funding: This study was funded by the Imperial Health Charity, NIHR Biomedical Research Centre and FWO (Research Foundation-Flanders).
Conflicts of Interest: The study authors declare no conflicts of interest.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Genetic testing can help doctors look for missing or defective genes. This information helps them know if a person, their partner, or their baby is ly to have certain medical conditions.
Genetic tests are when small samples of blood or body tissues are analyzed. Many different types of body fluids and tissues can be used. The type of genetic test needed to make a diagnosis depends on which condition a doctor checks for.
What Is Genetic Testing During Pregnancy?
For genetic testing before birth, a blood test can screen pregnant women for some disorders. To check for others, or if the screening blood test finds a possible problem, doctors may recommend amniocentesis or chorionic villus sampling:
- Amniocentesis is a test usually done between weeks 15 and 20 of a woman's pregnancy. The doctor inserts a hollow needle into the woman's abdomen to remove a small amount of amniotic fluid from around the developing fetus. The fluid is checked for genetic problems and can show the sex of the child. When there's risk of premature birth, amniocentesis can show how far the baby's lungs have matured. Amniocentesis carries a slight risk of inducing a miscarriage.
- Chorionic villus sampling (CVS) usually is done between weeks 10 and 12 of pregnancy. The doctor removes a small piece of the placenta to check for genetic problems in the fetus. Because chorionic villus sampling is an invasive test, there's a small risk that it can induce a miscarriage.
Why Do Doctors Recommend Genetic Testing?
A doctor may recommend genetic counseling or testing for any of these reasons:
- The pregnant woman is over age 34. A pregnant woman's chances of having a child with a chromosomal problem (such as trisomy) increase if she is older than 34. Children of older fathers are at risk for new dominant genetic mutations — those caused by a single genetic defect that hasn't run in the family before.
- A standard prenatal screening test had an abnormal result. Doctors may recommend genetic testing if a screening test showed a possible genetic problem.
- A couple plans to start a family and one of them or a close relative has an inherited illness. Some people are carriers of genes for genetic illnesses, even though they don't show signs of the illness themselves. This happens because some genetic illnesses are recessive. This means they cause symptoms only if a person inherits two copies of the problem gene, one from each parent. Children who inherit one problem gene from one parent but a normal gene from the other parent won't have symptoms of a recessive illness. But they will have a 50% chance of passing the problem gene to their children.
- A parent already has one child with a serious birth defect. Not all children who have birth defects have genetic problems. Sometimes, exposure to a toxin (poison), infection, or physical trauma before birth causes a birth defect. Often, the cause isn't known. Even if a child has a genetic problem, it might not have been inherited. Some happen because of a spontaneous error in the child's cells, not the parents' cells.
- A woman has had two or more miscarriages. Severe chromosome problems in the fetus can sometimes lead to a spontaneous miscarriage. Several miscarriages may point to a genetic problem.
- A woman has delivered a stillborn child with physical signs of a genetic illness. Many serious genetic illnesses cause specific and distinctive physical problems.
- A child has medical problems that might be genetic. When a child has medical problems involving more than one body system, genetic testing might help doctors find the cause and make a diagnosis.
- A child has medical problems known to be part of a genetic syndrome. Genetic testing can confirm the diagnosis. In some cases, it also might help find the type or severity of a genetic illness. This can help doctors find the best treatment.
Progress in genetic testing has improved how doctors diagnose and treat some illnesses. But it has limits. Genetic tests can identify a particular problem gene.
But they can't always determine how that gene will affect the person who carries it.
In cystic fibrosis, for example, finding a problem gene on number 7 can't predict whether a child will have serious lung problems or milder respiratory symptoms.
Also, having problem genes is only part of the story. Many illnesses develop from a mix of high-risk genes and environmental things, some of which a person can control. Someone who knows they carry high-risk genes might be able to make lifestyle changes to avoid becoming sick.
Research has identified genes that put people at risk for cancer, heart disease, psychiatric disorders, and many other medical problems. The hope is to someday develop specific types of gene therapy to prevent some diseases and illnesses.
Gene therapy is being studied as a possible way to treat conditions cystic fibrosis, cancer, and ADA deficiency (an immune deficiency), sickle cell disease, hemophilia, and thalassemia. But some patients have had severe complications while receiving gene therapy. So the research is carefully controlled.
Genetic treatments for some conditions are a long way off. But there is still great hope that many more genetic cures will be found. The Human Genome Project, completed in 2003, identified and mapped out all genes (about 25,000) carried in our human chromosomes. The map is only the start, but it's a very hopeful beginning.
Miscarriage Can Trigger Post-Traumatic Stress Symptoms, Anxiety, and Depression, Research Finds
It’s increasingly recognized that losing a pregnancy can be a heartbreaking event, sometimes leading to depression.
A study published online in December 2019 in the American Journal of Obstetrics and Gynecology showed that miscarriage and ectopic pregnancy can lead to enduring post-traumatic stress symptoms, including intrusive or unwanted thoughts about the pregnancy loss, nightmares or flashbacks, hyperarousal, and avoidance of anything that reminds women of their loss.
RELATED: What to Say (and Not to Say) to a Woman Dealing With Infertility
In a first-of-its-kind multicenter study, researchers followed more than 650 women who had experienced an early miscarriage (a pregnancy loss before 12 weeks) or an ectopic pregnancy (a nonviable pregnancy in which a fertilized egg implants and starts to grow outside the uterus, which can be life-threatening to the mother). They found that one month after the pregnancy loss, 29 percent of the women suffered from post-traumatic stress (PTSD) symptoms, 24 percent had moderate to severe anxiety, and 11 percent had moderate to severe depression.
That’s not so surprising, but the extent to which these symptoms lasted was: While the level of the women’s distress declined over time, nine months later 18 percent of the women had post-traumatic stress symptoms, 17 percent had moderate to severe anxiety, and 6 percent had moderate to severe depression. The proportions were higher for all these conditions among those who’d experienced ectopic pregnancies.
RELATED: 16 Celebrities Who Spoke Out About Their Miscarriages
It should be noted that the researchers used a questionnaire to screen for post-traumatic stress; they did not do a clinical interview that would be necessary to make a formal diagnosis of post-traumatic stress disorder, or PTSD.
The bottom line: “This research suggests the loss of a longed-for child can leave a lasting legacy,” says Tom Bourne, PhD, the lead author of the research from Tommy's National Centre for Miscarriage Research at Imperial College London. And the effects can be far-reaching, as a study coauthor, Jessica Farren, PhD, suggests: «Post-traumatic stress can have a toxic effect on all elements of a person's life, affecting work, home, and relationships.»
In an interesting twist, a study published on October 8, 2020, in Ultrasound in Obstetrics and Gynecology found that three months after the early pregnancy loss, 8 percent of male partners experienced post-traumatic stress symptoms and 6 percent suffered moderate to severe anxiety.
The significance: “Partners are often ignored when a woman experiences pregnancy loss,” notes Dr. Bourne, the lead author of this study too.
“This research suggests that although partners do not suffer PTSD as often as women, there still could be many thousands of partners living with post-traumatic stress, which is a serious condition that requires treatment.»
RELATED: What Is Resilience? Your Guide to Facing Life's Challenges, Adversities, and Crises
More Than a Small Loss, Miscarriage Can Be a Deep Source of Distress
After all, pregnancy loss involves not only the loss of a desired child, as the researchers noted, but it also may “challenge an individual’s sense of control over life, and pose a threat to plans of parenthood.
” What’s more, miscarriage and ectopic pregnancy may involve symptoms of physical discomfort, including pain or bleeding, as well as medical interventions.
A prolonged period of uncertainty may follow, as the woman waits for diagnosis, resolution, or the green light to try for another pregnancy.
RELATED: The United States of Stress: 2019 Special Report
Fertility Problems and Pregnancy Loss Are Emotional and Physical Issues
“It’s a significant loss, a death of a sort, in contrast to the hopes and joy of starting or adding to your family,” notes Catherine Monk, PhD, a professor of medical psychology in the departments of obstetrics and gynecology and psychiatry at the Columbia University Medical Center in New York City.
“It’s also the loss of love and anticipated love. These are real losses, and people should take their own feelings seriously, even if other people do not.
” The magnitude of the distress can be affected by other factors, such as a previous pregnancy loss or death of a loved one, or if someone has been trying to get pregnant for a long time, Dr. Monk adds.
“For women who really struggled to get pregnant, a miscarriage may be the end of a dream,” says Alice Domar, PhD, the director of integrative care at Boston IVF and the author of Conquering Infertility. “It can be so devastating that they may not want to try again.”
Feeling Bad After Pregnancy Loss Is Normal, Research Suggests
Making matters worse, someone can have post-traumatic stress symptoms and be depressed or have anxiety after a miscarriage or ectopic pregnancy, Dr. Domar notes.
“This is one of the first studies to show that it’s pretty normal to feel psychologically lousy for a long time after a pregnancy loss,” she says.
“The take-home message is that feeling anxious, depressed, or having post-traumatic stress symptoms is a normal reaction to a pregnancy loss, whether it’s a miscarriage or an ectopic pregnancy.”
Men need to recognize their feelings about early pregnancy loss, too, Domar says. “You just don’t see men acknowledge this — part of it is that they’re very intent on supporting their wives,” she explains. “And early pregnancy loss is a very abstract experience for men. It happens to her body, not his. He may not have even seen the baby on ultrasound.”
RELATED: Celebrity Miscarriage Revelations Spur Personal Tweets About Fertility Problems
A Call for Better Support After Pregnancy Loss
As many as one in four women who find out they’re pregnant will have a miscarriage, according to the U.S. National Library of Medicine. By contrast, ectopic pregnancies are less common, occurring in up to 2 percent of the general population and up to 5 percent of women who used assisted reproductive technology.
Some women stay silent about these losses when what they really need is support. “If you’re not getting support for your feelings, there are support groups for pregnancy loss that can validate your feelings,” Monk says.
In addition, Domar says, cognitive behavioral therapy (CBT) can be helpful. By identifying and reframing unhelpful thoughts, accepting your feelings of loss, and finding ways to reengage in activities that bring you joy and a sense of meaning, you can use CBT to come to terms with the emotional pain of losing a pregnancy.
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Honoring the Pregnancy Loss Can Help People Heal
For men and women, doing something to acknowledge an early pregnancy loss — whether it’s planting a tree, writing a letter or poem, or lighting a candle to honor the loss — can be beneficial in the healing process.
However they do it, men should “acknowledge they’ve had a loss, too, and [women] have to acknowledge their partners’ loss,” Domar says.
After all, they went into the pregnancy experience together, so an early pregnancy loss can cause some degree of distress for both partners.