The way women are treated when they are going through the anguish of a miscarriage or complications in early pregnancy often leaves them scared, distressed and lonely. For a significant number of women, their first stop when they experience abnormal symptoms in early pregnancy is an emergency room. October 15th is Pregnancy and Infant Loss Remembrance Day in Canada. To help women feel supported on this day, Dr. Catherine Varner and the care team in Mount Sinai Hospital’s Schwartz/Reisman Emergency Centre answer your questions on pregnancy loss and the supports available.
How common is miscarriage?
One of the most common misconceptions about miscarriage is that it’s rare. Unfortunately, one in five pregnancies will end in loss and the vast majority of these losses occur in the first trimester. - Dr. Catherine Varner, Emergency Physician, Mount Sinai Hospital
What do you like to tell patients experiencing a pregnancy loss?
When I have patients coming to the emergency department who are experiencing a miscarriage, I like to let them know right away that there’s nothing that they’ve done wrong and that there’s nothing that they could have done to stop the miscarriage and that there’s no treatment we can do to stop the miscarriage. - Angela Somers, Registered Nurse, Mount Sinai Hospital
I want to tell every parent who has experienced a loss during their pregnancy that it is not their fault. It is not something that they have caused or that they could have stopped. We will work together to support you through this process and you will get through it. -- Mona Shannir, Social Worker, Mount Sinai Hospital Women’s and Infants Program
If I’ve experienced a miscarriage, does that mean the odds are higher I will experience more in the future?
The risk of miscarriage is lowest in the patient who has never had a miscarriage before. That risk increases about 10 per cent for each subsequent miscarriage but the vast majority of patients who have one miscarriage can go on to have a normal pregnancy. - Dr. Varner
Can COVID-19 vaccines cause miscarriage?
Receiving the COVID-19 vaccine is safe in pregnancy. A recent study in the New England Journal of Medicine showed that there is no increased risk of adverse events to the mom or the baby after receiving the COVID vaccine and there is not an increased risk of miscarriage compared to the general population. - Dr. Varner
Is the rate of miscarriage higher for those who have been infected with COVID-19 vs the general population?
We know that pregnant women are at higher risk for severe illness related to COVID-19 infection such as ICU admissions and death. What we don’t know yet is whether or not having a COVID-19 infection in the first part of pregnancy puts one at risk of miscarriage. Larger studies are needed to look to see if there is a higher risk of miscarriage following COVID-19 infection. - Dr. Varner
When should I be worried when experiencing symptoms during my pregnancy?
Nearly half of all pregnancies will have some spotting or bleeding at some point during the pregnancy. If this bleeding occurs in the first trimester and it’s mild, it’s very appropriate to follow-up with your family physician on an urgent basis. However, if the bleeding becomes heavier, if you start having abdominal pain, or you’re feeling unwell, we would want to care for you in an emergency department. - Dr. Varner
Where should I go for medical care when experiencing a miscarriage?
I always tell my early pregnant patients about red flags, like what to watch for in the event of complications related to early pregnancy and when they should seek care in an emergency department. If they’re having heavy vaginal bleeding like they’re soaking pads every hour for two hours straight, if they’re passing very large clots or if they’re feeling unwell or like they’re going to pass out from pain, I would want them to come to an emergency department to seek care. - Dr. Varner
What is the Early Pregnancy Assessment Clinic at Sinai Health? How do I access it?
At Mount Sinai Hospital, we have an Early Pregnancy Assessment Clinic. This is for first trimester complications like vaginal bleeding or abdominal pain. Patients can access this clinic through referral from their family physician, their midwife, an OBGYN or the emergency department. - Dr. Varner
What sort of care should I expect in an emergency department?
It can feel incredibly overwhelming when you come to the emergency department with symptoms such as abdominal cramping and spotting. You should expect to receive blood tests and potentially go for an ultrasound. In all likelihood, you would still be discharged home, depending on what symptoms and what the results say. - Anika Andal, Registered Nurse, Mount Sinai Hospital emergency department
What should I ask during my emergency department visit?
Even at the end of an emergency department visit for vaginal bleeding or abdominal pain in early pregnancy, sometimes it’s too early to know what the outcome of the pregnancy will be. One of the most important questions that I encourage patients to ask is ‘What’s Next?’, ‘Who am I going to see in follow up?’ and finally, ‘When should I return to the emergency department?’ - Dr. Varner
What are some good resources for those looking for information and services on pregnancy loss?
There are several resources for parents who are experiencing an early loss such as the PAIL network. The PAIL network is a network with other parents who have experienced an early loss or even a late loss throughout their pregnancy and they’re able to offer a hand whether it’s a listening ear or other resources, how to support parents with grief, and overall how to get through that process together. - Mona Shannir, Social Worker, Mount Sinai Hospital Women’s and Infants Program
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