Late miscarriage?

Late miscarriages are usually not due to hormonal insufficiency because, from about the 10th to 11th week of pregnancy, the placenta begins to support the fetus with adequate levels of progesterone and other hormones. An incompetent or weak cervix is an important cause of miscarriages after the 12th to 16th week. The cervix opens and the membranes rupture, either because infection reaches the membranes, from the vagina, or because of under pressure on the cervix, possibly from an abnormally shaped uterus.

Another cause of a late miscarriage may be a multiple pregnancy: two, three, or more fetus may overdistend the uterus to such an extent that the cervix begins to open, through this would not usually happen until after the 20th week.

Unlike first trimester miscarriage, which begin with cramping and bleeding, these middle trimester losses if due to an incompetent cervix usually begin with passage of amniotic fluid from ruptured membranes, or with a painless gush of fresh blood. On examination the cervix tends to be dilated. The miscarriage then usually proceeds quickly and somewhat painlessly over a very short period of time—hours rather than days—in contrast to the earlier, prolonged painful miscarriages under 12 weeks.

Providing the membranes have not ruptured and the cervix id under three centimeters dilated when the patient is examined, it may be possible even at this late stage for your doctor to close off the cervix by placing a stitch in it, thus, enabling the pregnancy to continue. But if there are contractions or bleeding, your doctor will not even attempt to put in the stitch until these have settled down.

Sometimes in the mid-trimester the baby may die and be retained, or it may be expelled following a period of bleeding and cramping.