Recurrent pregnancy loss or recurrent miscarriage is emotionally and physically devastating to undergo. Rarely addressed, however is the “limbo” that patients are in prior to the actual physical loss of the pregnancy. Formerly one could only be given the diagnosis of recurrent pregnancy loss if she had experienced 3 consecutive miscarriages. Today, as serial ultrasounds can be employed as early as 5 weeks of pregnancy, abnormal growth can be detected before 7 or 8 weeks. It is heartbreaking for both the patient and the doctor to see that the pregnancy is viable – or growing – but just not growing normally.
This is the devastating “limbo period”. The patient is pregnant but this pregnancy will not produce a human being. She feels pregnant. It is impossible to accept that this is not normal! For the doctor it is heartbreaking as well: the measurements of the yolk sac and embryo are abnormal, as is the sac size and shape. There is nothing we can do except wait for the heartbeat to stop in a few days or weeks. Once this occurs, it is acceptable to wait a week to see if the patient miscarries on her own but this, again, is another “limbo” period. A gentle suction curettage should be done to “clean out” the uterus and allow cycles to resume.
And then what? For many women this scenario has happened before. Is it fair to have to endure 3 consecutive miscarriages before instituting a workup for recurrent pregnancy loss? Of course not! Fortunately there are tests that can be done and up to 60% of patients will have successful pregnancies following a recurrent miscarriage. Although this is an encouraging statistic it is vitally important for the loss of the pregnancy and the ensuing grief to be acknowledged and respected.