Pregnancy Loss Terminology
To mark Pregnancy and Infant Loss Awareness Month, I wanted to provide a quick summary of the often very confusing, overlapping and sometimes misused terminology around pregnancy loss. Pregnancy Loss is nearly always deeply distressing for many people involved, not just the couple at the centre of the loss.
When supporting others going through a pregnancy loss, it is really important to refer to the loss in the right context. However a lot of this terminology is not commonly known, and so it can cause anxiety for all involved from the very outset! I would like to clear a few things up and hopefully guide you through the different terminology.
Some of this terminology overlaps or may just be two ways of describing the same thing however I have listed all the different terms to seek clarity and avoid ambiguity
A Molar Pregnancy is when, due to the absence of a nucleus in the female egg, a mass of cells grows in the uterus instead of a healthy foetus. This mass is often removed (usually under general anaesthetic).
An Ectopic Pregnancy is when the embryo attaches outside of the uterus instead of inside, usually to the walls of the fallopian tubes. It is for this reason that ectopic pregnancies are sometimes known as Tubal pregnancies. In virtually all cases, the pregnancy must be terminated/aborted.
An Abortion/Termination is the ending of pregnancy due to the removal of an embryo or foetus before it can survive outside the uterus. The word abortion is often used only for induced abortions, when deliberate steps are taken to end a pregnancy for a number of reasons:
- To save the woman’s life
- To prevent grave permanent injury to the woman’s physical or mental health
- Under 24 weeks to avoid injury to the physical or mental health of the woman
- Under 24 weeks to avoid injury to the physical or mental health of the existing child(ren)
- If the child was likely to be severely physically or mentally handicapped
Around 56 million abortions are performed each year in the world, with about 45% done unsafely (by unskilled individuals)
Currently, in the UK, the legal limit for abortion is 23 weeks and 6 days gestation.
A Late Termination of Pregnancy / Termination for Medical Reasons (TFMR) is the ending of a pregnancy if the foetus is not expected to survive the pregnancy, be born alive, or survive outside the womb. A late termination may also be used in rare cases in order to save the life of the mother.
A Medical Termination is when the woman takes medicine that results in pregnancy loss/fetal death.
A Surgical Termination is when the foetus is surgically removed usually under general anaesthetic.
A Pregnancy Loss/Late Foetal Loss is when the foetus dies before 24 completed weeks of pregnancy
A Miscarriage can be classed (usually by medical professionals) as a spontaneous abortion (not to be confused with an induced abortion) but often refers to a pregnancy loss before 24 completed weeks of pregnancy. 80% of miscarriages occur in the first 12 weeks of pregnancy, with the underlying cause in about half the cases involving chromosomal abnormalities. However a miscarriage may also define a pregnancy that has ended at 23 weeks, a lot further on. Depending on the stage of pregnancy, the woman may be advised to give birth to the infant.
The term Stillbirth refers to when an infant is born dead after 24 completed weeks of pregnancy. Stillbirth occurs in around 1 in every 200 births in England. Under UK law, all stillbirths should be registered (by the form of a death certificate) and will require an official burial or cremation, which does not apply to still born infants born before 24 weeks gestation. It is perhaps interesting to know that women in these situations are advised to give birth to their infants as it is best for the woman’s physical/mental health.
A Live Birth is the birth of an infant regardless of gestational age, that shows any signs of life (voluntary movement, heartbeat, pulsation of the umbilical cord). This infant will be required to have a birth certificate under UK law (regardless of whether it lives for 8 minutes or 80 years). If an infant is born showing signs of life at any gestational age, but due to it’s prematurity, dies shortly after birth, it will be required by law to have a birth and death certificate.
A Neonatal death is the death of a liveborn infant occurring before 28 completed days of life (Day 0-27). The most common causes of neonatal death are preterm birth and congenital anomalies (problems the infant was born with for example a hole in the heart). On average 3 out of 1000 live births result in neonatal death. Infants who die after this period (28 days – 1 year) are classed as an infant death.
Having read all of these different terms, you may be a little confused (so was I). I thought perhaps an example might help and this is where I can speak from very personal experience. As some of you may or may not know, in March 2018, I gave birth to my son Bertie. Bertie has been referred to (by both medical professionals as well as well meaning friends and family) as a miscarriage, an abortion, and a stillbirth, all of which have been rather upsetting to me (not to mention incorrect).
Bertie was born at 24 weeks and 2 days gestation, right on the cusp of the legalities of life and for this reason he is a really good example.
Bertie was a live birth because he was born with a pulse.
Had Bertie been born with a pulse 7 days earlier, at 23weeks and 2 days, he would have been a live birth and he would have required a birth certificate.
Had Bertie been born without a pulse at 24weeks and 2 days, he would have been a stillbirth, he would have been stillborn. He would not have required a birth certificate but he would have been issued with a death certificate.
Had Bertie been born without a pulse 7 days earlier, at 23weeks and 2 days, he would have been a miscarriage, or a late pregnancy loss. Heartbreakingly, he would not have required a birth certificate or a death certificate which can be extremely traumatic for a family in these circumstances. Other things linked to the 24th week of pregnancy such as maternity leave and child benefit can also be hugely difficult for parents whose pregnancies end at this late stage.
I really hope this post will help you to start a conversation with a friend or family member who has recently lost their baby/grandchild/niece/nephew, or simply to clarify pregnancy loss in all it’s many forms for you.
Referring to a loss using the right terminology is really important, however if all of the above sounds too clinical, one of the loveliest ways to start a conversation about pregnancy or infant loss is to simply ask “What was their name?”
For more information, please visit Tommy’s Baby Loss information here