Miscarriage

A miscarriage is the loss of a pregnancy in the first 24 weeks. There are many causes of miscarriage, and for some parents the reason for their loss will never be known. About a fifth of all pregnancies end in miscarriage, most of these before the twelfth week.

Signs and symptoms

• Bleeding - this may be light spotting over a number of days and/or a sudden heavy bleed
• Period-like pain or pain in the lower back
• Potential signs and symptoms of shock, caused by blood loss
• Passing the foetus and other products associated with birth (this may just look like a heavy blood clot)

Many miscarriages can take several days from start to finish and may not start with a heavy bleed or severe pain. Some women who are miscarrying may not have realised that they were pregnant as many miscarriages take place in the first weeks after conception.

Pregnant women suffering a bleed should always seek early medical advice from their doctor or midwife. An investigation may show that the pregnancy has not ended or that miscarriage is threatened but not inevitable.

First Aid Treatment

1. Overall, listen to the wants and needs of the woman. She will often be very distressed and scared. Where possible, help her to a position of privacy and if possible, ensure that she is treated by another woman and has support from her partner or friend.
2. If bleeding or pain is severe, or there are signs of shock, call an ambulance.
3. Reassure the woman and offer her a sanitary pad or towel.
4. Keep anything that is passed from the vagina out of sight of the woman, for medical staff to examine.

Support groups

Most women who have a miscarriage do not have problems with subsequent pregnancies but a woman should take time to grieve and talk about her feelings before becoming pregnant again. Group therapy with others who have had the same experience is a good way of helping a woman come to terms with the loss of her baby. The woman's doctor should be able to provide details of appropriate support groups in her area.

Ectopic pregnancy

In this circumstance, the fertilised egg has become embedded in the Fallopian tube rather than the womb. As well as ending the pregnancy, this is a potentially life­threatening condition for the mother. The woman will usually have severe pain in the abdominal area, with potential bleeding and signs of shock. Call an ambulance immediately.

Placenta praevia/placental abruption

A bleed in later pregnancy is more unusual. A painless bright red bleed may be an indicator that something is seriously wrong with the placenta, causing potential life­threatening problems for both the mother and child. Support the mother in a position of rest, call an ambulance and treat for shock.