Surgeons Twice as Likely to Miscarry

[Dusn]

My medical school embryology professor, who studied this for a living, told us that at least 70% of pregnancies end in miscarriage, and he thought the real number was even much higher. It's just that most women don't know that they were ever even pregnant when they miscarry, especially if it occurs at about the same time as their normal period - which very often happens.

When my first daughter was born, we were pretty relaxed about the whole thing and my wife never checked a pregnancy test until she was clearly pregnant. As far as we know, she never had a miscarriage back then but she also never really checked.

This time around, due to other reasons, we're a lot more anxious. She starts checking a highly sensitive pregnancy test, daily, at about 3 weeks (1 week prior to the expected period). She has had 4 positive pregnancy tests that turned positive the day, or sometimes even just hours, before miscarriage bleeding. If she had not tested repeatedly before her expected period, she would have had no idea that she was ever even pregnant for any of them. We would have assumed that she just never got pregnant and was having her normal period. Workup for causes of repeated miscarriage have been negative.

Has anyone else had a similar experience?

My point is that early miscarriage rates are going to be highly influenced by how often and how early you test, and also with the sensitivity of the test. Also, the user needs to realize that a faintly positive pregnancy test is still positive. All these factors are going to be hard to control for in a study of surgeons vs non-physicians.

[ObgynMD]

My medical school embryology professor, who studied this for a living, told us that at least 70% of pregnancies end in miscarriage, and he thought the real number was even much higher. It's just that most women don't know that they were ever even pregnant when they miscarry, especially if it occurs at about the same time as their normal period - which very often happens.

When my first daughter was born, we were pretty relaxed about the whole thing and my wife never checked a pregnancy test until she was clearly pregnant. As far as we know, she never had a miscarriage back then but she also never really checked.

This time around, due to other reasons, we're a lot more anxious. She starts checking a highly sensitive pregnancy test, daily, at about 3 weeks (1 week prior to the expected period). She has had 4 positive pregnancy tests that turned positive the day, or sometimes even just hours, before miscarriage bleeding. If she had not tested repeatedly before her expected period, she would have had no idea that she was ever even pregnant for any of them. We would have assumed that she just never got pregnant and was having her normal period. Workup for causes of repeated miscarriage have been negative.

Has anyone else had a similar experience?

My point is that early miscarriage rates are going to be highly influenced by how often and how early you test, and also with the sensitivity of the test. Also, the user needs to realize that a faintly positive pregnancy test is still positive. All these factors are going to be hard to control for in a study of surgeons vs non-physicians.

Your professor’s research is fascinating. Would you mind sharing sources? I really thought the number was closer to 20-25%. Most people, even doctors, don’t do a urine pregnancy test until they miss their period. Also curious to hear which pregnancy test your wife used!

[Dusn]

Your professor’s research is fascinating. Would you mind sharing sources? I really thought the number was closer to 20-25%. Most people, even doctors, don’t do a urine pregnancy test until they miss their period. Also curious to hear which pregnancy test your wife used!

I don't have his research specifically. But here are some links with higher rates reported.

This NEJM review cites the incidence of pregnancy loss after implantation at 25-40%: https://www.nejm.org/doi/10.1056/NEJ...er=Z39.88-2003

This paper cites 50-75%: https://obgyn.onlinelibrary.wiley.co...d=nlm%3Apubmed

It's a very hard thing to study. The incidence that my professor was studying (prior to implantation) is probably irrelevant to the topic of this post (because even surgeons don't know if they're pregnant prior to implantation) and very difficult to study because he said that it involved going through menstrual blood every month to find the egg and then evaluate whether it's fertilized or not. I don't think he got many women to volunteer for this study Now, 20 years later, I only remember him telling us about it because of how bizarre it was. I don’t think he published it.

The test my wife uses is "First Response pregnancy with Early Results tests." It's an OTC HCG urine test and says you can test up to 5 days before your missed period. But it can give a negative result 2 days prior that can turn positive the day after. I wouldn't recommend doing this for anyone's mental health though because, at least in our case, she’s gotten a number of positives that we would never have even known about without early testing. I am curious about how often this happens with these early pregnancy tests - and if anyone here happens to know?

[matia]

Another vote for chronic stress. There’s NOTHING more stressful than the responsibility knowing that the actions of ones hands can hurt or kill another human being.

it’s just a thing that no one can fully grasp.. even doctors who aren’t surgeons

even in the cardiology world where it’s technically the same specialty, I’ve yet to meet a general cardiologist who truly understands what high risk interventions are like to the primary operator.

The stress of clinic and OR are very different types of stress, but stressful nonetheless. I can't say in my opinion that one is easier, especially when you are running non stop without a break in clinic, getting pulled in 1000 directions and on call dealing with emergencies, clinic can be quite stressful.

When I was pregnant with my first, I had been having premature contractions for weeks that I wasn't even aware of because we are taught to not listen to our body but push through. I eventually ended up in the L&D ED for preterm in preterm labor and while there I was still answering pages and putting orders on my patients. Clearly this is not healthy so not surprised that so many of my female colleagues have miscarriages, preterm deliveries and struggle to get pregnant. Stress in this profession is high and we are conditioned to put work/patients above everything, to just suck it up and not cause ripples/inconveniences which lead to really poor self care. This is especially true in the surgical specialties.

[Jenn]

When I had my first child, year after residency at same hospital, my department chair stopped in to congratulate me but clearly his main concern was that my delivery was not preterm- "38 weeks oh good!" (but early for a first pregnancy). I recall my last night on call in pregnancy- rushing to the ICU with a woman in preeclampsia after delivering twins. Had a few Braxton-Hicks after that marathon. A woman in the program before I arrived had quit military with postpartum depression after pregnancy during internship. And have a friend who reported she was given charts to review when she was inpatient bed rest for preterm labor.

My department's actions that baby helped drive me from the military. 1- residency chief asking me to curtail my 6 weeks maternity leave to pull call while the bulk of the department went off on a conference; including my husband, and offering that his wife would babysit my 4 week old for me and saying "you just had a baby, it's not like you're sick or anything". Said No and left town with baby. 2- They insisted I return to work for 2 weeks before outprocessing to move to a new duty station despite me asking for leave I had saved up to add a few weeks onto maternity leave, saying "patient continuity is important!" Again guess they were afraid I'd never return to duty like the intern with postpartum depression. How jealous 8 years later to meet British officers who got 6 months maternity leave. And 30 years later of that baby grown and working for the government who got 12 weeks leave plus flexible schedule postpartum (but I'm also jealous of her 40 hour work week).