“Pregnancy loss is common but you will never think about it until it happens to you one day.”

Pregnancy loss (including miscarriages, stillbirth or neonatal death) is an unexpected experience to couples who wish to get pregnant.

According to the Hong Kong Births and Deaths Registration Ordinance, miscarriage refers to the spontaneous loss of pregnancy before 24 weeks of pregnancy while stillbirth refers to that spontaneous loss of pregnancy at or after 24 weeks. Neonatal death refers to a child who has died during the first week of life.

Miscarriage is not rare and it is also one of the most common complication during early pregnancy. On average, 10 to 15 out of 100 pregnant women have experienced miscarriage. The probability of miscarriage will increase with age and is estimated to be at 20% if the mother is 35 years old.

• Threatened miscarriage
  Although vaginal bleeding before 24 weeks of pregnancy may not be life-threatening for the foetus, you should seek medical consultation without delay.
• Incomplete miscarriage
  When a miscarriage happens, part of the fetus or placenta may not be expelled from the uterus, resulting in continuous vaginal bleeding and lower abdominal cramping. If necessary, healthcare professionals may discuss with you and/or your partner about terminating the pregnancy through medical procedures, such as medication or surgery.
• Complete miscarriage
  If you have passed all your pregnancy tissues, vaginal bleeding may still continue for a few days.
• Recurrent pregnancy loss
  This refers to the loss of two or three pregnancies. There are various reasons accounted for recurrent pregnancy loss. Amongst all the risk factors, some can be lowered by medical treatment, you may ask your medical officer for enquiry.

Though causes of miscarriage are sometimes unidentifiable or related to uncontrollable factors, such as chromosomal and placental issues, there are methods to reduce the risk. Pregnant women and their partners can nevertheless reduce other risk factors by improving their diet and lifestyle.

• Maintain a balanced and healthy diet. Stop smoking and drinking alcohol.
• Maintain a healthy weight and exercise regularly.
• Avoid exposure to viral sources during pregnancy.
• Consult a qualified registered Chinese medicine practitioner, doctors or pharmacist before using herbs or medications.

In addition, men's health is also important:

• Maintain a balanced and healthy diet. Quit smoking and reduce alcohol consumption before your wife's pregnancy
• Weight management

Lastly, it is important to maintain communication with your doctor or midwife. It is recommended that you ask your health care provider any questions about your pregnancy during your follow-up appointment.

There are three main ways to terminate your pregnancy:

• Expectant management of miscarriage: About 50% of the pregnant women can successfully pass out pregnancy tissues naturally. Some women may have to wait for a while before the bleeding starts, which may last for as long as three weeks Some women may have haemorrhage (extremely heavy bleeding) or abdominal pain. In cases of ongoing haemorrhage or severe abdominal pain, you or your partner may be hospitalized for medical or surgical treatments.
• Medical management of miscarriage: Some women may experience abdominal pain or discharge blood clots in the few hours after medication, which is similar to heavy menstrual bleeding. Analgesic drugs can be taken if necessary. Some women may also have diarrhea or nausea. Vaginal bleeding may also last for as long as three weeks.
• Surgical management of miscarriage: In case of signs of ongoing haemorrhage or infections, the surgery must be arranged as soon as possible. Despite the low risk of this minor operation, there is small chance of haemorrhage, infections or complications of the uterus. If pregnancy tissues remain, you or your partner may have to undergo another operation.

When comparing these termination methods, evidence have suggested that:

• There is a low probability of the risk of being infected or other harms for all 3 methods.
• They will not affect your next pregnancy.

We recommend that you have a discussion with your partner prior to visiting the hospital on the following topics:

• Do you and your partner wish to see your child? (If you or your partner have been pregnant for a while now, you may have chance to take photos with your baby or create something out of their footprint or fingerprint)
• Do you and your partner wish to conduct a post-mortem examination (Due to hygienic reasons, you will not be able to pick up the remains of your child)
• Click here to learn more about the options for funeral arragement.

Please note that the information provided above is for reference only, as each parent's situation is unique and hospital facilities or arrangements may differ. Please contact medical staff for detailed arrangement.

Source of information:

National Health Service

Miscarriage Association

Funeral rituals may help bereaved parents to process their grief. The following sections outline the funeral arrangements for different stages of pregnancy loss:

Procedure for handling pregnancy loss below 24 weeks:*

1. Let healthcare professionals know if you and your partner have your own arrangements for burying or cremating your baby.

2.You may be directed to the Patient Relationship Office for procedural explanation.

3.Fill in the application form and submit it to Patient Relationship Office.

4.Application will be reviewed by Hospital Dean and Hospital Authority. If your application is approved, you will be notified to collect the remains of your baby. Approval usually takes one month.

5. If your pregnancy ends before 24 weeks, you may consider in-ground burial (please click this link for related information: https://www.fehd.gov.hk/englis...) and abortus cremation. The following locations offer in-ground burial and abortus cremation services:

6. Confirm the date of burial (by undertaker or yourself)

Procedure for handling pregnancy loss at 24 weeks or above:*

1. Apply for documents related to funeral arrangements at the hospital (Form 13 “ Certificate of Still-birth”, Body Collection Form)

2. Apply for a cremation permit from the Department of Health.

3. Arrange a date for cremation

4. Attend the funeral

5. Apply for the recovery of cremated ashes, and scattering of cremated ashes

*Neither Birth Certificate nor Death Certificate will be issued. The baby will be named as “the child of XXX (the mother’s name)”.

Procedures for handling neonatal death:

1. Apply for a Birth Certificate.

2. Apply for documents related to funeral arrangements at the hospital ( Form 12 “ Certificate of Registration of Death”, Body Collection Form, Medical Certificate of the Cause of Death)

3. Arrange a date for cremation

4. Apply for Death Certificate.

5. Attend the funeral

6. Apply for the recovery of cremated ashes, and scattering of cremated ashes

Unclaimed bodies will be handled by the Hospital Authority according to the relevant law.

Source of information:

HKSAR Food and Environmental Hygiene Department Service for Keeping Abortuses

HKSAR Food and Environmental Hygiene Department Cemeteries and Crematoria

梁梓敦（2021）。《我永遠是你們的孩子 – 給天使爸媽的話》。香港：Dirty press。

As you wait for the outcome of your application you may:

• Choose a name for your baby
• Decorate a miscarriage casket for your baby (Contact YWCA’s acute psychological support services for casket decoration)
• Prepare quilts and clothes for your baby (please use cotton if possible)
• Prepare decomposable items such as dolls, letters or drawings for your baby.

• The Family Planning Association of Hong Kong (FPAHK), a non-profit making organization, advocates, promotes and provides information, education, medical and counselling services in Sexual and Reproductive Health for the community.
  https://www.famplan.org.hk/en
• Psychological Counselling Services - For Couples and Individuals Facing Fertility Issues and Undergoing Infertility Treatments. https://learning.hku.hk/ibms/home/services-and-training/infertility-counseling-services/