In Hong Kong, a miscarriage is defined as a pregnancy loss before 24 weeks gestation. Pregnancy loss at or after 24 weeks is considered a stillbirth. These definitions vary between countries. The US and Australia defines miscarriage as a loss of pregnancy before 20 weeks, Singapore before 22 weeks, and the UK before 24 weeks.
The majority of miscarriages occur before the twelfth week of pregnancy. Miscarriage is common and it is estimated that 1 in 4 women will miscarry in the first 3 months of pregnancy. The risk of miscarriage decreases significantly after the first 12 weeks.
Miscarriage and Pregnancy Loss
Causes of Miscarriage
Often the cause of a miscarriage is unknown, though it is very unlikely that is was caused by something you did or didn’t do. The most common cause of early miscarriage is chromosomal problems with the baby, and this occurs by chance. Tommy’s, the UK’s leading charity for understanding and preventing miscarriage, outlines some of the causes of miscarriage with a focus on late and recurrent miscarriages. In these cases, causes may include:
• Cervical weakness
• Uterine abnormalities
• Genetic factors
• Antiphospholipid syndrome (APS)
• Food poisoning
• Maternal age
Types of Pregnancy Loss
There are several types of miscarriage and pregnancy loss, which occur at different stages of pregnancy Tommy’s provides information on the different types of pregnancy loss, including:
• Early Miscarriage
• Late Miscarriage
• Complete miscarriage
• Incomplete miscarriage
• Missed miscarriage
• Chemical pregnancy
• Molar pregnancy
• Recurrent miscarriage
• Ectopic pregnancy
Once an ultrasound has confirmed that a miscarriage will occur, you should discuss your treatment options with your doctor. There are three ways to manage a miscarriage, though you may not have a choice depending on your individual case. The Tommy’s website provides useful information on the three treatment options, though please note that some information is specific to the UK.
This is also referred to as a natural miscarriage and involves waiting for your body to dispel the pregnancy without medical intervention.
Medical management involves taking medication to prepare your cervix and start or speed up the miscarriage process. This method allows you to miscarry at home while having some control over when the process occurs.
The surgical procedure to remove the miscarried baby is called a Dilation and Curettage, common referred to as a D&C. The procedure usually takes place in a hospital under general or local anaesthetic.
Experiencing Miscarriage and Pregnancy Loss in Hong Kong
Recurrent Miscarriage and Testing
According to the Hong Kong Department of Health and Hospital Authority, recurrent miscarriage is defined as the loss of three or more consecutive pregnancies. You may not be referred for additional testing or investigations under the public system until your third miscarriage or first late miscarriage (between 13 and 23 weeks). Private obstetricians or fertility specialists are more likely to recommend further testing after your second miscarriage. You may also be offered further testing after your second miscarriage if you are in your late 30s or 40s, or if it took a long time to conceive.
The Assisted Reproductive Technology Unit of the Prince of Wales Hospital has prepared a document outlining some of the main causes of recurrent miscarriage and the recommended tests and treatments.
Your baby after miscarriage
Depending on the gestational age, you may be able to see or hold the baby after you miscarry. This may not be offered to you by your doctors or nurses, so it is important to ask.
If you suffer a miscarriage before 24 weeks, you will likely not be offered the option of cremating or burying the baby. However, there are services that you can access if you ask the hospital and attending doctors or nurses. According the Food and Environmental Hygiene Department (FEHD) which oversees all cemeteries and crematoriums in Hong Kong, services are available for the burial and cremation of miscarried babies (referred to by as the FEHD as “abortuses”). There is an application process for both burial and cremation, and you should inform hospital staff as soon as possible if you intend to access these services.
There are two public cemeteries and 6 private cemeteries that offer burial services for babies after miscarriage.
Garden of Serenity, Tsuen Wan Chinese Permanent Cemetery
Garden of Serenity, Tseung Kwan O Chinese Permanent Cemetery
Angel's Garden, Holy Cross Catholic Cemetery in Chai Wan
小小淨土, Hong Kong Buddhist Cemetery
The Garden of Angels of Tao Fong Shan, Tao Fong Shan Christian Cemetery
Flowers of Paradise, Muslim Cemetery in Happy Valley
Home of Forever Love at Kwai Chung
Maternity Leave after Pregnancy Loss
As of 2020, the official definition of a miscarriage in Hong Kong was changed from a loss before 28 weeks of pregnancy to before 24 weeks of pregnancy. A female employee is therefore entitled to maternity leave if she suffers a pregnancy loss at or after 24 weeks of pregnancy. Under Hong Kong labour laws, employers must provide 14 weeks statutory maternity leave at four-fifth of the average daily wage, capped at HK$80,000 per employee.