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Second trimester miscarriage
Second trimester miscarriage may also be referred to as “late miscarriage”. As this can feel an inappropriate term for many people who have experienced this type of pregnancy loss. This page will use the term “second trimester miscarriage” only.
Second trimester miscarriage is a deeply distressing experience, occurring between 13 and 24 weeks of pregnancy.1 Symptoms of second trimester miscarriage are similar to other miscarriage symptoms:2
- Vaginal bleeding with or without abdominal pain or cramping
However, in second trimester miscarriage, there are additional symptoms to be aware of. These include:
If you experience any of these symptoms, contact your healthcare provider or maternity unit immediately.
Causes of second trimester miscarriage
There are certain risk factors for miscarriage in every pregnancy. However, some factors are more strongly associated with second trimester miscarriage.
These include:
Issues with the placenta
A large proportion of second trimester miscarriages are attributed to issues with the placenta. This organ is pivotal for providing oxygen and nutrients to baby. Inflammation or infection of the placenta has been shown to be strongly associated with second trimester miscarriage.3
Antiphospholipid syndrome (APS)
APS has been associated with up to 15% of miscarriages, which can occur at any stage of pregnancy.4 APS is a type of autoimmune disease that increases the risk of developing blood clots.4,5 Blood clots can restrict the blood flow to the placenta, restricting oxygen and nutrients to baby.1
Cervical insufficiency (incompetent cervix)
In some pregnancies, the cervix can shorten or open too early, sometimes because of the shape of the uterus, an underlying health condition, or previous injury. This is often called cervical insufficiency or “weak cervix”. When this occurs, it can increase the risk of second-trimester pregnancy miscarriage.6
Management of second trimester miscarriage
The management of second trimester miscarriage can be particularly traumatic. It is important to seek support to provide you with the physical and emotional support you may need. For management of second trimester miscarriage, a family member or friend can stay with you throughout.
Induction:
- Medication will usually be offered to help start the process to safely pass the pregnancy, either at home or in the hospital.1 A combination of mifepristone and misoprostol is usually recommended first.7
- Mifepristone works by blocking the hormone progesterone and helps the body prepare for miscarriage.7 After taking mifepristone, it may take a day or two for labour to begin, and you might be able to stay at home during this time.1,2
- Once labour starts, misoprostol8 (a type of prostaglandin medication) is given every few hours.1 This medication helps to soften the cervix and trigger contractions.1
Remember that any medicine may have side-effects. Talk to your healthcare provider for more information.
After delivery: 1
Some people find it is helpful to have some quality time with their baby after delivery, others find this is too painful. Your grief is yours, and only you know what will feel right to you, everyone else will provide support, no matter what you decide.
It may be helpful to think about what may bring you some comfort.
These could include:1
- Requesting a copy of any scan pictures
- Your baby’s hand and footprints, if possible
- Photographs
- Making a record in the hospital’s remembrance book
- Requesting time in the hospital chapel, if they have one
Your healthcare team should be able to assist and help organise any of these, especially if you do not feel able to.
The emotional impact
The intense bodily experience associated with second trimester miscarriage can trigger a unique and complicated experience of grief, that may be difficult to explain or describe.9 You may feel like you have lost a part of you, and it may feel difficult to navigate those feelings.
Post-traumatic stress is more likely in those who have experienced second trimester miscarriage, compared to those who have had a miscarriage within the first trimester.10 Therefore, it is crucial to seek support and guidance if you are struggling to cope.
What now?
It is normal to feel confused and apprehensive after second trimester miscarriage. You may have questions for your healthcare provider, such as:
Half the time, there are no clear reasons for a second trimester loss. Testing will likely be offered to you to help identify any underlying issues that may have increased the risk of pregnancy loss.11 These will be the same as the tests for recurrent miscarriage.
Having one pregnancy loss does not mean you will not continue to have a healthy pregnancy next time. You are more likely to have additional support if you were to get pregnant again, which may involve testing for certain disorders that are associated with pregnancy loss.11
Bleeding following either a spontaneous or managed second trimester loss is normal. This may continue to be heavy for up to two weeks and then get lighter for a further 6 weeks.
Your next menstrual cycle may begin from ~4–6 weeks after a pregnancy loss. Therefore, it can be difficult to decipher between your period and post-pregnancy loss bleeding.1
Try and share your thoughts with your healthcare provider to get the best support and advice.