Likelihood of miscarriage?

November 28, 2009 10:52 AM

Question about finding risk statistics for early pregnancy. I am newly pregnant and am a 'facts and figures' type person and really want to find out what the likelihood is of early miscarriage, 'missed abortion', ectopic and molar pregnancies in the first trimester. I know that early miscarriages are not at all uncommon, but I need numbers!

This is anonymous as I don't want to risk family & friends finding out that I'm pregnant.

Yes, I'm pregnant! It was planned, and we're overjoyed! Five weeks today, so there's still a long time to go. I'm a nervous wreck, and due to a combination of factors, I can't get access to the answers I need.

I live in the Netherlands. I speak fluent Dutch, but I'm not a local and this is my first pregnancy here. The Dutch medical system tends to be fairly hands-off, which I am used to and accept, but I am so emotional right now (hormones!) and I cannot reconcile my fears with the lack of available knowledge. Although I have seen my doctor, I have not been examined, had any sort of tests, nor had these scheduled or been given any indication of when these might occur. It appears that in this country I will not be checked at all until at least around ten weeks.

I don't know whether this is due to hormones or what, but I am a bit worried that something might be wrong and would like some reassurance. It appears that I'm not going to get any sort of concrete reassurance here - I have even had brown spotting since last Saturday, along with all sorts of cramping (although this can be normal during pregnancy) and I just got told that I had to wait and see, and that time would tell whether or not it was a miscarriage. I just find it very hard to accept that there is a good possibility of me having a healthy, viable pregnancy right now and I worry that there is something wrong that will not be discovered until I have a scan at around ten weeks. I realise that there is always that possibility, but when your HCG levels haven't even been checked, you start to worry that even the most obvious signs might be ignored. I feel that I could cope with a miscarriage, but that finding out about a 'missed abortion' or worse, a molar pregnancy, at such a late stage would be emotionally devastating for me when there was the possibility of blood tests indicating a heightened risk at an earlier stage.

I have changed doctors because I felt my long-term doctors were too blase, but my new doctor, though very nice and I believe very professional, is no more interested in running blood tests etc than the old ones were. I just keep getting told that I will have to "wait and see" and that "nothing can be done".

To compound matters, I am currently changing SSRIs (I suffer from relatively mild depression and anxiety) due to the pregnancy. I am very happy with the medical supervision I'm receiving in this regard, so that's not my question, though it probably has an enormous impact on my ability to cope with uncertainty right now.

My question is this:
Given that I am only five weeks pregnant, am 36 years old, and have had no blood tests or exams, what are my risk factors for various types of problems during pregnancy? I'm looking for any sources that might suggest things such as "X percentage of women who have a positive pregnancy test after the first day of a missed period have molar pregnancies/missed miscarriages/etc etc."

The irony of having to turn to the internet for this kind of information is certainly not lost on me. I find it incredible that I have a full insurance in a so-called civilised country and I can't get anyone to even tell me exactly when I can expect to have a blood test, for example. I'm just feeling more and more trapped and helpless, and arming myself with statistics is the only way I can think of to try to cope.

The other irony, of course, is that if I should decide I want a termination then I would get a medical examination and some blood tests, maybe even a scan to determine the exact age of the embryo. In my current useless emotional state, that only makes me cry more. Please help me with some stats!

posted by anonymous to Health & Fitness (23 answers total)

There aren't useful statistics for this sort of thing. Plenty of women miscarry without knowing they were pregnant. You can find some things that may or may not be of interest via scholar.google.com but there's not going to be a % odds of miscarriage out there that's meaningful.

The care you are getting sounds normal and appropriate. I don't know if that's any reassurance. But they are quite right in the "wait and see" and that "nothing can be done."

Why do you want "some blood tests"? What sorts of examinations do you want? Some of this doesn't make a lot of sense. It sounds like you would be better off discussing these worries with the doctor treating you for anxiety rather than with an obstetrician.
posted by kmennie at 11:19 AM on November 28, 2009 [3 favorites]

Are there doula or midwife programs where you are? I fully believe in being under a doctor's care during pregnancy, but sometimes you just need advice/reassurance that isn't medical, exactly. Doulas and midwives (generally) are well educated about the pregnancy process and can probably help you a good deal.
posted by thinkingwoman at 11:22 AM on November 28, 2009 [3 favorites]

in the 2 countries I've been pregnant in: US and Armenia, getting any medical attention before 8-10 weeks would be odd.
posted by k8t at 11:32 AM on November 28, 2009

Welcome to life as a parent :-) It's uncertain, statistically impossible to assure almost any of it, and exciting even when it's planned.

I know it's hard not to obsess. Try talking to a very close friend about this all - especially if she's had a baby. This kind of excitement, 'now what? that's it? wait?' nerves are pretty common in first-time parents (gestational moms especially).

And, start meditating or doing some breath exercises each day. Write down what you feel afterwards, just to keep a little record of all the changes. Just check in with your body, talk to your breath, talk to the baby, be curious to acknowledge the changes, and generally bear witness to your body. That kind of calm, meditative exercise will be good now and once your babe is born. I prescribe fifteen minutes a day!

And congrats.
posted by barnone at 11:38 AM on November 28, 2009 [1 favorite]

I recommend joining the forums at Fertility Friend (.com). Because they've struggled with fertility, the women there the most medically knowledgable people on the Internet when it comes to pregnancy.

10 weeks doesn't sound that late to me -- in the really early weeks there isn't any heartbeat to see, so a scan isn't of much use yet. But if you're interested in further testing, yeah, you may want a more medicalized practice. For example, I had a CVS done, and the upper window on that is like 12 weeks or something, and I felt rushed to find a good practitioner to set it up between then and my initial 8 week scan.

FYI, even in the US, HCG levels aren't typically checked, even if you are spotting, unless there's been a history of miscarriage or you're being treated for infertility.
posted by xo at 11:41 AM on November 28, 2009

I had a miscarriage back in September and my OB told me that 20-25% of pregnancies end in miscarriage, most with no discernible reason. He also told me that until I've had 3 miscarriages with no successful pregnancy, they wouldn't do any additional testing to determine if there is a reason (correctable or not) that a pregnancy couldn't be maintained. I'm in the US though, so YMMV in different countries.

Congratulations on your pregnancy. I wish you all the best.
posted by chiababe at 11:46 AM on November 28, 2009

This site seems to have some pretty detailed statistics. According to it the risk in your case is 10%. Another source here. The interesting statistic here is over age 35 your risk is as much as double those under 35.

My wife had two miscarriages before having our two children. She was over 35.

Regarding the blood tests, exams, I don't know. After our second miscarriage she gave herself daily progesterone injections (I believe it was Luteal Phase defect). That did the trick.

Hang in there. It sounds to me like you are getting good care.
posted by cosmac at 11:46 AM on November 28, 2009

FWIW I had your early symptoms with my first pregnancy and I wound up with a healthy baby. In fact, I had bleeding with two of my three pregnancies and afaik have never had a miscarriage (unless, as some state above I had one without knowing I was pregnant.)
posted by St. Alia of the Bunnies at 11:54 AM on November 28, 2009

Congratulations! I understand just how stressful a time this is. Unfortunately, there is not much that can be done either for the pregnancy or for your anxiety! I too love scouring the internets for statistical data in the hopes that it will allay my worries, but frankly, it doesn't really work (for me). In part because there will always be conflicting data and in part because risk statistics are only informative on the population level and are incredibly hard to interpolate for each of our individual experiences.

Without any history of problems, it is uncommon to have a prenatal appointment before they can do an abdominal ultrasound- at 9 or 10 weeks. In part this is because there is no way to prevent a miscarriage if it were to happen/be happening.

Please take care of yourself, take your folic acid, and rest as much as you need to.
posted by picklebird at 12:03 PM on November 28, 2009

The best information we have right now is that roughly half of all conceptions don't develop beyond five weeks, for any one of a zillion reasons. After six weeks, your chances of problems roughly (ROUGHLY) halves; after 8 weeks it halves again, and after 10 weeks you're quite likely to be OK, though of course nothing is certain.

Molar pregnancies are really, really rare. Ectopics are less rare, but pretty easy to spot if something goes wrong. The brown spotting and cramping is really common; if it hasn't changed, you can breathe easy. I've had 5 early miscarriages and 1 term birth, and I spotted on and off throughout my successful pregnancy, but with the miscarriages, I went from brown to pink to red to bleeding within the course of 24 hours.

The only time I've ever had early ultrasounds was to rule out an ectopic pregnancy; they are not typically done in my country (US) before 20 weeks unless you're having an NT test done.

Pregnancy is terrifying. Or anyway, it is for me. :-) MeMail me if you want some resources to message boards, &c, or if you just want someone to freak out to. I had a freakout buddy throughout my keeper pregnancy and it was the best thing ever.
posted by KathrynT at 12:20 PM on November 28, 2009

Was coming here to say exactly what xo and KathrynT said so I'll just defer to them and offer my congrats. I'm just like you, I need info to settle my nerves and then I get worked up over something else , that is parenthood for you. I had infertility treatments with both, bled heavily in the early weeks with both and had an NT test performed incorrectly and was told that my son had a 95% chance of having Down Syndrome. It was only because of my obsession with my pregnancies and knowing EXACTLY what was going on, that I knew the tech had done the test wrong and the Dr. was quoting us bad statistics. My point is, people may tell you to just relax and I agree that you should enjoy your pregnancy. But, people like us need to know the facts and in my case, it made a huge difference in how we handled a terrifying week. Feel free to memail me too. You have to let nature take its course in these early weeks but it helps to have someone to worry with.
posted by pearlybob at 12:33 PM on November 28, 2009

You would probably feel better with a book by Henci Goer within reach on your bookshelf. She has written The Thinking Womans Guide to a Better Birth and Obstetric Myths Versus Research Realities. Note that neither of these will give you more reason to worry. The first time I was pregnant I felt similar to you (in fact, at exactly your point in my first pregnancy I was on a small island, cramping and googling "ectopic pregnancy symptoms" so I could prepare to evacuate to medical care should I need it). But I believe pregnancy is best experienced as a nothing's-wrong-until-you-know-it's-wrong state of being. The Goer books will help with that a little. (I also used research to my--and I believe my baby's--benefit when I refused to let my midwife induce my second at 40 weeks. The medical profession is very willing to throw research and numbers at you but they don't like it much when you use them to advocate for yourself. Keep that in mind and choose your battles.)
posted by cocoagirl at 1:36 PM on November 28, 2009 [2 favorites]

Just to defend the medical care you're receiving, my OB here in the US sees patients at 9 weeks for the first time. All that happens is that she checks to make sure the pregnancy is in the uterus, where it should be. I've never heard of testing the level of pregnancy hormones in a regular ol' pregnancy.

If you're 5 weeks along, symptoms will start in about a week, and that should reassure you that your hormone levels are right where they should be. (You may, in fact, have to remind yourself that you asked for this, when you're pulling your face up from the toilet bowl for the fourth time that day.)

Congratulations!
posted by palliser at 1:49 PM on November 28, 2009

cocoagirl: "I believe pregnancy is best experienced as a nothing's-wrong-until-you-know-it's-wrong state of being"

This is dangerous advice because many of the processes leading to spontaneous abortion are silent, insidious, and easily reversible when detected early. I've seen a big difference in morbidity and mortality between populations of babies delivered to women who received high standards of prenatal care, and populations of women that received little-to-none. You can probably guess which route I'd advocate.

eMedicine - First-Trimester Pregnancy Loss

The overall miscarriage rate is reported as 15-20%, which means 15-20% of recognized pregnancies result in miscarriage. The frequency of spontaneous miscarriage increases further with maternal age ... About 80% of miscarriages occur within the first trimester. The frequency of miscarriage decreases with an increasing gestational age. Recurrent miscarriage, defined as 2-3 pregnancy losses, affects about 1% of all couples ... the distribution of miscarriage rates by age occurs as follows: younger than 35 years old, 15% miscarriage rate; 35-39 years old, 20-25% miscarriage rate; 40-42 years old, about 35% miscarriage rate; and older than 42 years old, about 50% miscarriage rate.

posted by meehawl at 2:00 PM on November 28, 2009

meehawl, this is an honest question -- I had never understood spontaneous abortion to be reversible. My understanding is that early miscarriage is thought to be a result of abnormality in the embryo. I know the miscarriage rates vary greatly according to age, but I wonder if you could elaborate a bit on the "reversible" part.
posted by palliser at 2:23 PM on November 28, 2009

I had spotting from week 4 to week 5 (baby anachronism is now 5.5 months old, so it turned out well) - my doctor sent me for an ultrasound to check that there was no ectopic type issues at which point only the egg sac was actually visible. After that ultrasound I had another done at 8 weeks to confirm viability - this seems pretty common in Australia. My sister in law had the same scan at 8 weeks but found out she'd had a missed miscarriage and needed surgery. It is very rare though, at least the ectopic/missed miscarriage bits. Apart from confirming the pregnancy there was nothing they could do at that point if I were miscarrying. Unless there is a history of miscarriage, there's very little the doctors can/will do because there's simply no 'reason' they can fix. After several miscarriages at 7 weeks one of my workmates has had to take hormones to carry to term - that was after several miscarriages at the same general time of the pregnancy, while under care of an ob. and after multiple blood tests.

When they say there's nothing they can do, they do mean it. Most pregnancies are healthy and viable and NORMAL. And there's a big difference between care at the start of a pregnancy and care at the end. At the end there are silent issues, or close to silent issues, that to drastically affect the health and life of mother and child. What can and will be done at 5 weeks is different to 10 weeks which is different to 20 and 34 and 30 and 32 because the reasons are different.
posted by geek anachronism at 2:58 PM on November 28, 2009

One risk factor that has come up in studies recently that I was not aware of is good periodontal health. The studies have been showing a lower incidence of miscarriage among women that get more frequent dental cleanings and checkups. To the point that some health insurance companies in the US have started providing for additional cleanings for pregnant women.
posted by slavlin at 4:01 PM on November 28, 2009

palliser: I believe he means that the processes leading to spontaneous abortion are reversible, not the spontaneous abortion itself.
posted by phrontist at 4:28 PM on November 28, 2009

If you want to DO something, start taking a prenatal vitamin, esp folate, if you aren't already. It can't hurt. Your doctors aren't being blase, they're being practical. There's not much to measure at this point, other than hCG, and that's only a very gross measure of viablility. There is no test they can give you to tell you what your exact odds of this pregnancy going to term are. Assume it will be viable and start establishing good habits you can carry through this pregnancy or the next one. I like the suggestions to log your body feelings and meditate.
posted by slow graffiti at 5:17 PM on November 28, 2009

palliser: I believe he means that the processes leading to spontaneous abortion are reversible, not the spontaneous abortion itself.

Well, but that's kind of what I'm still curious about -- and I think is relevant to the OP, as she's wondering what could be done to protect her pregnancy. What are the processes leading to spontaneous abortion that can be reversed? I went ahead and read meehawl's linked article, and it basically said if you're having a threatened miscarriage, they'll tell you to rest and drink fluids and maybe take progesterone, but that nothing has been shown to actually help. That was always my impression -- if it's going to happen, it's going to happen; all we can do is wait and see; basically just what the OP's doctors have been telling her.
posted by palliser at 5:45 PM on November 28, 2009

I have no statistics to offer, but I'm currently pregnant (yay!) and had spotting during my first trimester after having sex and after a pap smear. The cervix is extra sensitive during pregnancy and prone to bleeding.
posted by defreckled at 8:02 PM on November 28, 2009

a big difference in morbidity and mortality between populations of babies delivered to women who received high standards of prenatal care, and populations of women that received little-to-none

Yes, but there is a big difference between the population of women that receive good prenatal care, and the population of women who do not.

If you poke around the evidence you find that a lot of what passes for prenatal "care" is a crock, feel-good stuff that does nothing of value.* I doubt the OP is well-served by being further led to believe that medicine has miracles to offer in early pregnancy. It does not.

* For the majority of women. But it does often do what it's partially meant to do, viz: get the ignorant to lay off the beer and smokes, take a vitamin, etc
posted by kmennie at 8:42 PM on November 28, 2009

This topic seems to have drifted quickly from the probability of spontaneous abortion in broad populations of women into a pronouncements about the apparent futility of prenatal care, especially in the first trimester.

kmennie: "a lot of what passes for prenatal "care" is a crock, feel-good stuff that does nothing of value.* I doubt the OP is well-served by being further led to believe that medicine has miracles to offer in early pregnancy. It does not."

That's simply not true. While it's true that interventions are currently limited when it comes to treating many defects in embryo metabolism and genetics/chromosomes such as trisomy or mosaicism, other interventions to arrest, revers,e or divert processes such as maternal inflammation, infection, parasitism, or maternal metabolic disarrays are possible and can produce benefits. The use of, say, heparin during first trimester within a woman at risk for antiphospholipid syndrome or other related coagulopathies comes to mind. Or, similarly, the careful control of maternal lupus during pregnancy, or even more basic: hypertension. Early screening for organisms such as toxo, syphilis, CMV, EBV, etc. Ureaplasma has been implicated in repetitive abortions, and its eradication with decreased recurrence. First trimester ultrasound can demonstrate an empty sac or acardiac embryo, providing indication that the fetal viability is virtually extinct and continuing the pregnancy is futile. Early US can also demonstrate twin-to-twin transfusion syndrome, enabling serial amnioreduction or other interventions to be performed. Surgical interventions, even during pregnancy, for such conditions as incompetent or hypoplastic cervix (using, say, the McDonald Cerclage with Mersilene Band) can often be attempted up to 28 weeks.

These are of course population-specific and do not apply in general to an undifferentiated population. You seem to be saying that those who receive more prenatal care are different, that they occupy a different SES and so their outcomes will be better. This article has links to many references that demonstrate significant outcome disparities between similar populations receiving dissimilar prenatal care. Mainly in the area of reduced birth weight which is, of course, a pretty good predictor for increased infant neonate mortality and morbidity. It's difficult to evaluate prenatal care fully because running RCTs on pregnant women is never going to fly. But alternating delivery schedules has produced some good results. Your line of reasoning would seem to say that the OP is wasting her time bothering with prenatal care, by linking my pro-prenatal care in general statement to her condition in particular. I apologise if you formed that opinion from my statement (and I perhaps could have used a more general phraseology), but I believe your conclusion is based on faulty logic.
posted by meehawl at 6:57 PM on December 2, 2009 [2 favorites]