Experiencing the loss of a baby
Sadly, one in four women will lose a baby during pregnancy or birth. Some pregnancies end early, others develop problems along the way that result in medical complications for both mum and baby.
At Tommy’s, we believe that, through our research, we can discover how to prevent the loss of tiny lives. We also want to find out how to protect premature babies from health problems and increase their chance of survival.
We understand the importance of providing parents with open and honest advice based on fact, which can help to understand what has happened, the possible reasons for it and how to prevent it happening again.
We focus on the most prevalent and traumatic problems in pregnancy, which are detailed below.
What is a miscarriage?
A miscarriage is the loss of a baby from the date of a missed period up to and 24th week of pregnancy.
The medical profession describes miscarriages as either ‘early’ or ‘late’. An ‘early miscarriage’ may happen before week 13 of pregnancy. A ‘late miscarriage’ may occur during weeks 13 to 24 of pregnancy.
How common is miscarriage?
Unfortunately, more common than many of us realise – 15% of all recognized pregnancies ends in a miscarriage
. Research shows that many more pregnancies are lost in the very early stages, without the person's knowledge. It has been estimated that if these `unrecognised' miscarriages are included then the rate is about 40-60%.
Can we assess each woman’s risk of having a miscarriage?
Although about 15% of known pregnancies end early, there is evidence that the older the woman, the greater the risk, largely because the risk of chromosomal abnormalities in the baby increases with the age of the mother.
A Swedish study, calculating the relative age risks, shows that the risk of miscarrying doubles between ages 29 (11.9%) and 39 (24.6%), and for women between 40-44 this doubles again (51%).
Women who have experienced miscarriages previously are also more susceptible, and with each miscarriage experienced this risk goes up (from 20% having experienced one miscarriage, to 43% having experienced three).
What are the causes of miscarriage?
Sadly, the reasons why some pregnancies come to an early end cannot always be confirmed. There are many possible causes and much still remains to be learnt about why miscarriages occur.
However, we do know that, broadly speaking, the causes can be genetic, hormonal, or structural. A miscarriage can also be linked to blood clotting disorders or to infections.
What can I do to try to reduce the risk of a miscarriage?
There are a number of things you can start to do straight away, such as stop smoking, reduce alcohol consumption, reduce stress levels and take folic acid supplements. You should also try to exercise regularly, eat healthily and cook safely.
Avoid the risk of food poisoning by cooking food at high temperatures, ensuring that the food is hot throughout before eating. Keep raw and cooked meat and fish apart and wash hands, utensils and chopping boards thoroughly after coming into contact with raw meat and fish.
Avoid listeria infection by not eating unpasteurised dairy products and pate.
Avoid toxoplasmosis by not eating raw or undercooked meats, by washing all fruit and vegetables, and avoiding contact with cat faeces.
Find out more about Miscarriage.
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Stillbirth refers to the death of a baby after 24 weeks of pregnancy but before birth. The medical profession describes stillbirth as either ‘intra-uterine’ or ‘intra-partum’. An intra-uterine stillbirth means that the baby has died in the womb. An intra-partum stillbirth means that the baby dies during labour.
How common is stillbirth?
Around 4,000 babies are stillborn in the UK each year.
In England and Wales the stillbirth rate is four babies for every 1,000 births. In Scotland the rate is slightly higher – five stillbirths for every 1,000 births.
Can we assess the risk of having a stillborn baby?
The risk of a baby being stillborn is higher if the pregnancy is a multiple pregnancy. Research also suggests that the risk of experiencing a stillbirth is more common for women who smoke or who are over 35 or under 20.
Underweight, overweight, obese and very obese women also have an increased risk of stillbirth compared to women of a normal weight (BMI 18.5-24.9 pre-pregnancy). Women of Black and Asian ethnicity also have increased rates of stillbirth compared to women of white ethnicity. Women who come from socially deprived backgrounds are at an increased risk of stillbirth.
Some pre-existing medical conditions, such as diabetes, may also increase a woman’s risk of experiencing a stillbirth. If you have a pre-existing medical condition and are trying for a baby, it’s important that you talk to your health professionals about any potential risks. Your health professionals can monitor your baby’s progress as well as advise you on the best healthcare plan for you and your baby throughout your pregnancy.
What are the causes of stillbirth?
A stillbirth might be due to one single cause or to a combination of several. However, the majority of stillbirths (74%) remain unexplained – even a post-mortem may not be able to give you all the answers you need.
We do know that stillbirth can occur if there are problems in the genetic development of the baby or if the baby is of low birth weight.
Pregnancy-related disorders such as pre-eclampsia, bleeding, obstetric cholestasis, as well as infections can all cause the baby to be stillborn. In addition, problems may also occur in the natural progress of a pregnancy. Prematurity and birth trauma can also end in stillbirth.
A full list of possible causes includes, Genetics
, Obstetric cholestasis
, Rhesus incompatibility
, Immunological disorders
(e.g. Toxoplasmosis), Antepartum haemorrhage
, Birth trauma
For more details about each of these potential causes, please visit our Stillbirth page.
What can I do to try to reduce the risk of a stillbirth?
There are a number of ways to help reduce your risk of experiencing a stillbirth, including Stop smoking, Track your baby’s movements, Attend all antenatal appointments, Report any pain or bleeding, Treat the risk of infection seriously (such as Listeria).
What are the implications for future pregnancies?
For women who have experienced an unexplained stillbirth (74% of all stillbirths), there is no increased risk of it happening again.
However, for women who have experienced a stillbirth, a subsequent pregnancy may be very stressful. Some women may want to conceive again as soon as possible. Other women may want to wait a long time. This decision is a very personal one.
For women who were very ill during pregnancy or labour, a return to full health is important.
In some cases, there will be clear medical reasons why a woman should wait before trying for another baby and you will need to discuss these with your GP/Consultant. If the baby had a genetic abnormality, genetic counselling may be advisable for affected couples who can be given advice on potential issues unique to their genetic combination and the options available to them.
Find out more about Stillbirth.
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What is a premature birth
A premature (or pre-term) birth is the birth of a baby before 37 completed weeks of pregnancy.
Babies are considered to be full term from the 38th week of pregnancy. At this point, they will have had enough time in the womb for their bodies to develop and function well, and they will have the best chance of healthy development.
How common is premature birth?
Despite improvements in antenatal and neonatal care, the number of premature babies born each year has not significantly decreased in the last 15 years.
Since the government started producing figures in 1994/5, the rate of premature births in the UK has stayed at around 7% of all births. That equates to about 45,000 premature births each year – or 125 every day.
Can we assess each woman’s risk of having a premature baby?
Research has identified some factors that may increase a woman's risk of having a pre-term birth.
The risk of experiencing a premature birth is slightly higher for women who are under 20 or over 35.
The risk is also higher if the pregnancy is a multiple pregnancy. The overstretching of the womb that occurs in a multiple pregnancy is thought to increase the risk of premature labour.
Smoking, using recreational drugs, having a high caffeine intake, having a poor diet, being underweight and undertaking over-strenuous physical activity can also all increase the risk of having a premature baby.
However, many women with no known risk factors can still have a pre-term baby.
What are the causes of premature birth?
Much still remains to be learnt about why women go into pre-term labour. However, we do know that the causes of pre-term births can be structural or the result of pregnancy-related conditions, blood-related conditions or infections.
A full list of causes includes Structural (If there is not enough room in the womb for the baby to grow), Pregnancy-related conditions (such as pregnancy-induced diabetes), Blood-related conditions, Infections (such as gonorrhoea, Chlamydia or group B streptococci) and Medical intervention (where a premature delivery is necessary for the health of the baby or mother).
To find out more about each of these causes, please visit our Premture birth page.
What happens if a woman has a premature baby?
Whilst the experience of a premature birth may be very stressful for all involved, there is seldom any adverse effect upon the mother's physical health. For the mother, physical recovery from premature labour and delivery should be no different than recovery from a later delivery.
Once pre-term labour is suspected most women will receive tocolytic drugs to stop the contractions. These drugs may stop labour altogether or delay it long enough for the mother to be given steroids and/or be transferred to a hospital with an available special care baby unit (SCBU) cot. Steroids help the baby’s immature lungs develop before delivery.
The effects on the baby of pre-term delivery depend on how many weeks the baby has been in the womb before delivery (gestational age).
Babies born closer to their due date and with a good birth weight will have a greater chance of survival than very small, very premature babies. Premature babies have less time in the womb to mature and develop. As a result they're often at increased risk of medical and developmental problems. However, neonatal care is making huge advances and there are many wonderful stories of tiny babies surviving despite the odds against them.
What can I do to try to help reduce the risk of having a premature birth?
There are a number of ways to help reduce your risk of experiencing a stillbirth, including stop smoking, tailor your lifestyle (reduce caffeine and alcohol intake, eat healthily and exercise), visit the dentist (to identify any signs of gum disease and treat), attend all antenatal appointments, report anything that seems out of the ordinary, and take time to rest.
What are the implications for future pregnancies?
If you've had one premature birth you have about a 20% chance of having another one on your next pregnancy. This means women who have had previous preterm births are about two-and-a-half times more likely to deliver early next time round compared to women on their first pregnancy.
But, the other side of the coin is that four out of five women who have had previous premature births will have perfectly normal pregnancies next time around.
Find out more about Premature birth.
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What is pre-eclampsia?
Pre-eclampsia is a pregnancy-related disorder which may occur after 20 weeks of pregnancy. Signs of pre-eclampsia are usually high blood pressure combined with the presence of protein in the urine.
Even if there is no protein in the urine, other symptoms together with high blood pressure may indicate that pre-eclampsia is present. These include headaches, blurred or altered vision, upper abdominal pain, oedema (swelling of the face, wrists or ankles), abnormal blood test results.
Left untreated pre-eclampsia can develop into a more dangerous condition – eclampsia.
How common is pre-eclampsia and what causes it?
The British Journal of Obstetrics & Gynecology estimates that 10% of pregnant women develop pregnancy induced hypertension (high blood pressure) and pre-eclampsia. They also say that pre-eclampsia complicates 2-3% of UK pregnancies (that's almost 20,000 per year) and that around 1,000 UK babies die each year from its effects.
So, are the risk factors higher for some women?
Although women with previous normal pregnancies have less chance of developing pre-eclampsia in subsequent pregnancies, mothers who start another family with a new partner have the same risk as women who become pregnant for the first time.
There are other risk factors which make the likelihood of developing pre-eclampsia higher, including being pregnant with twins or more (multiple pregnancy), being closely related to someone with a history of pre-eclampsia, being over 35 or having experienced pre-eclampsia in a previous pregnancy.
What happens if a woman develops pre-eclampsia?
If a woman shows symptoms of pre-eclampsia at any stage during her pregnancy, she will be monitored carefully. Sometimes, a woman will have to be admitted to hospital so that her symptoms, especially blood pressure, can be managed closely.
The presence of pre-eclampsia may mean labour needs to be induced early to stop the more severe condition of eclampsia developing.
At least 15% of all premature births are a result of the need to deliver early due to the mother developing pre-eclampsia. Babies born to mothers with pre-eclampsia may also be small for their gestational age because their growth may have been affected by the disorder.
If pre-eclampsia does develop into eclampsia, a woman might suffer fits, liver and kidney failure, difficulty breathing, and/or problems with blood clotting and, in severe cases, may even die; 7-10 women in the UK die each year from the effects of pre-eclampsia.
What can be done to treat pre-eclampsia?
Doctors can give drugs to alleviate some of the symptoms, but the only ‘cure’ for pre-eclampsia is to deliver the baby and the placenta.
Find out more about Pre-eclampsia.
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What is toxoplasmosis?
Toxoplasmosis (or toxoplasma infection) is caused by a parasite, a microscopic organism, called toxoplasma gondii. It does not usually have any obvious symptoms. Some people may have mild flu-like symptoms. Very rarely, some people may experience a more long-term illness similar to glandular fever.
The only conclusive method of finding out if you have become infected is to have a blood test.
How common is toxoplasmosis?
While as many as half the population may have had it at some point in their lives, around 2,000 UK women per year contract toxoplasmosis during pregnancy. In about 800 of these cases the infection will pass from mother to baby and around 80 babies per year are severely affected.
Once you have had the infection you are then immune for life, you cannot catch the infection again.
Most pregnant women may never know they have been infected unless they experience problems during their pregnancy that necessitate tests.
If a pregnant woman feels there is a risk that she may have become infected or would like to know if she has already had the infection before her pregnancy (and is therefore immune) then a blood test can be carried out.
How could someone get toxoplasmosis?
Ongoing research is giving us more and more insight into how the parasite is transmitted, but here we list the main ways that someone might get infected.
You could catch the infection by eating anything infected with the parasite (such as raw and undercooked meat or unwashed fruit and vegetables), receiving blood or organ transplants infected with the parasite, handling cat litter or newborn lambs.
How can someone find out if they are infected?
The incubation period is 5–23 days after coming into contact with the parasite. However, toxoplasmosis does not usually have any obvious symptoms and many people do not know they are infected. The only conclusive method of detecting if you have become infected is to have a blood test.
The toxoplasmosis blood test
The toxoplasmosis blood test involves taking a sample of blood from the mother to look for antibodies to the infection. Antibodies are part of the body's response to an infection. It may take three weeks for these antibodies to be present following an infection, so the blood test must be done three weeks after the event that caused the possibility of infection.
If the infection has occurred recently or is currently active then there is a risk that the baby will become infected. It can take between four and eight weeks for the infection to pass to the baby.
What is the risk of a baby getting toxoplasmosis?
It has been estimated that 40% of pregnant women with toxoplasmosis will pass the infection on to their baby in the womb. This means that about 800 babies each year are infected with toxoplasmosis.
How can toxoplasmosis affect the baby?
If toxoplasmosis is caught in early pregnancy and is transmitted to the baby then there is a high risk of miscarriage.
If infected during the first or second trimester the baby may be born with: hydrocephalus (water on the brain), brain damage, epilepsy, deafness, blindness or growth problems.
The developmental problems may be so severe that the pregnancy ends in a stillbirth.
If toxoplasmosis is caught in the third trimester of pregnancy and is transmitted to the baby then there may not be such severe and obvious problems. However, although things may appear to be fine at birth, health problems may develop, particularly with vision, later in life.
Can toxoplasmosis be treated in pregnancy?
If a current infection of toxoplasmosis is confirmed in pregnancy a woman may be offered an antibiotic, spiramycin, which is thought to reduce the risk of transmission to the baby.
If there is concern that the baby may already be infected, and the woman is more than 15 weeks pregnant, then she may be offered an amniocentesis (the removal of a sample of amniotic fluid from around the baby through a special needle, which is then tested for toxoplasmosis). If the baby is infected then the use of certain antibiotics may reduce the severity of the infection.
At 20 weeks of pregnancy an ultrasound scan may also highlight any obvious physical problems in the baby. Termination of pregnancy is also an option for some women, when an infected baby with severe developmental problems has been confirmed.
What can I do to try to reduce the risk of catching toxoplasmosis?
- Do not eat rare meat with any pinkness or blood in it, cured meats, such as Parma ham and salami.
- Wash all fruit and vegetables, including ready-prepared salads, thoroughly to remove all traces of soil.
- Do not eat unpasteurised goat's milk and products made from it.
- Always wear gloves when gardening or handling dirty cat litter.
- Take care when visiting farms and wash hands thoroughly after any contact with sheep. Avoid handling newborn lambs.
Find out more about Toxoplasmosis.
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What is a Molar pregnancy
A molar pregnancy is a very rare complication of pregnancy. It occurs when something goes wrong during the fertilisation process. It is caused by an abnormal cell growth of all or part of the placenta.
In a normal pregnancy the fertilised egg is made up of 23 of the mother’s chromosomes and 23 of the father’s chromosomes. In a complete molar pregnancy the egg contains no maternal chromosomes and only the 23 paternal chromosomes, meaning there is no fetus or amniotic sac present. The placenta is abnormal and develops rapidly with cysts present. These cysts grow in clusters like grapes and are visible by ultrasound.
A partial molar pregnancy occurs when there are 23 chromosomes from the mother and double from the father, making 69 chromosomes rather then the normal 46. This can occur because two sperm enter the egg and fertilise it or the sperm replicates itself once inside the egg. There will be some normal placental tissue amongst the abnormal cells and an embryo does develop. This may be a fetus or fetal cells but is genetically abnormal and not compatible with life.
How common is a molar pregnancy?
About 1 in 1000 pregnancies in the UK results in a molar pregnancy. However, the incidence in Southeast Asian and Mexican women are higher. This raised level is unexplained at present.
What are the possible risk factors to having a molar pregnancy?
A molar pregnancy is thought to be caused by a problem with the genetic information from either the sperm or the egg. Factors that may increase your risk of having a molar pregnancy include women who are under 20 yrs or older then 35 yrs, women with a previous history of a molar pregnancy, women who have a low carotene intake, women who have a diet low in carotene have a higher incidence of a complete molar pregnancy and possible ovulatory disorders.
Treatment of a molar pregnancy
Once a molar pregnancy has been diagnosed it is standard procedure to offer types of surgical evacuation to remove all the abnormal cells. A sample of the removed tissue will be sent to the laboratory for examination. It might take several days for the diagnosis to be confirmed.
After this procedure you will be referred to a specialist unit to be monitored. The unit will monitor your HCG levels (pregnancy hormones) to make sure that they are decreasing. This is the sign that there is no abnormal tissue left.
It is important to monitor you for at least six months after the pregnancy as tiny cells of the molar pregnancy can spread and grow quickly for up to several months after.
Implications of molar pregnancy on future pregnancies
The outlook for future pregnancies is good. The risk that a mole will develop in a future pregnancy is about 1-2%
For more information visit www.molarpregnancy.co.uk
Find out more about Molar pregnancies.
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What is an ectopic pregnancy?
An ectopic pregnancy occurs when a fertilised egg attaches itself somewhere outside the uterus.
The huge majority of ectopic pregnancies, over 95%, occur in a fallopian tube which is known as a tubal pregnancy. Ectopic pregnancies can also occur in an ovary, in the abdominal space, or in the cervix (neck of the uterus) but this is rare.
How common is an ectopic pregnancy?
The incidence of ectopic pregnancy is about 1:100 UK pregnancies.
Risk factors for ectopic pregnancy
The risk of having an ectopic pregnancy is increased if you have had previous surgery or damage to the fallopian tubes
, you have had pelvic inflammatory disease
, you have had a previous ectopic pregnancy
, you have become pregnant by IVF
or you smoke
Signs and symptoms of an ectopic pregnancy
If you are pregnant, the following are the signs that it could be an ectopic pregnancy:
1. Vaginal bleeding which can be heavier or lighter than usual but in appearance looks dark and watery
2. One sided abdominal pain which can be persistent and severe
3. Sudden severe pain spreading across abdomen
4. Shoulder tip pain
5. Fainting, increased pulse rate, sickness and paleness.
Treatment of an ectopic pregnancy
If an ectopic pregnancy is suspected an ultrasound scan is done as well as a pregnancy test. If on scan the uterus is empty and the pregnancy test positive then this indicates an ectopic although these findings would be similar with a recent miscarriage. Sometimes the ectopic pregnancy can be seen on scan.
If there is an early diagnosis before the fallopian tube ruptures it is possible to have less invasive surgery, remove the ectopic pregnancy and leave the tube intact. Often though, although keyhole surgery might be possible the affected tube is also removed. Occasionally, abdominal surgery is required to remove the ectopic particularly if the tube is ruptured and a blood transfusion needed to replace lost blood.
Alternatively, the drug methotrexate can be used which shrinks the pregnancy cells and eventually the ectopic disappears. Success rates using this type of treatment are slightly lower than surgery.
I've already had one ectopic pregnancy, what about future pregnancies?
The overall chance of a repeat ectopic pregnancy is 7-10% depending on the type of surgery undertaken but if the second tube is damaged then there is 30% chance of not being able to conceive plus an increase risk of another ectopic. If a fallopian tube is removed a woman will continue to ovulate but her chances of conceiving are reduced by 50%
Before trying for another baby it is important to allow time to heal physically and emotionally. Ectopic pregnancy can be a difficult experience for you and your partner. It might have been a frightening time, you may have had extensive surgery and you will have lost your baby and your fertility may be reduced. Although the thought of having another ectopic pregnancy might make you anxious you also have 50% chance of a normal healthy pregnancy.
Find out more about Ectopic pregnancies.
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