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Miscarriage

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Miscarriage refers to the death of an embryo or fetus before 28 weeks of gestation or when the fetus weighs less than 500 grams.

Cause
  1. Sixty percent of miscarriages (or approximately three out of four) occur due to abnormalities, generally chromosomal, in the fetus.
  2. Often there is no clear reason why a miscarriage occurred, but some risk factors include:
  • Being over 35 years old or younger than 15 years old puts the person at a higher risk of miscarriage than those between the ages of 16 and 34.
  • Previous miscarriage(s).
  • Previous dilation and curettage (D&C), making it harder for the embryo to implant and grow.
  • Drinking alcohol, smoking, and using drugs.
  • Chronic illness or abnormal immune system.
  • Existing medical conditions, such as hypertension, diabetes, hyperthyroidism, systemic lupus erythematosus (SLE), polycystic ovary syndrome (PCOS), lupus, or other infectious diseases, such as measles, rubella, malaria, and certain sexually transmitted infections.
  • Problems with the production of hormones in the ovaries, affecting the body’s ability to sustain a fetus. It has been found that when estrogen and progesterone levels are low, the uterine lining is not appropriate to support the embryo, leading to a miscarriage.
  • Rh incompatibility.
  • Cervical injury from a previous birth or unsafe termination/abortion, making it incompetent.
  • Problems with the uterus, such as congenital issues, abnormal structure of the uterus, uterine growth, or uterine septum.
  • Inflammation in the vagina and/or uterus, infection in the pelvis or other parts of the body, severe inflammation in the body, and/or extremely high fever.
  • Severe maternal infection that spreads to the fetus, causing death.
  • Certain types of medications, such as quinine used to treat malaria and which may cause the uterus to contract those used to treat cancer; exposure to lead or long-term exposure to industrial toxins through inhalation or direct contact.
  • Intentional use of medication to terminate pregnancy usually leads to miscarriage, but these medications must be prescribed by the doctor. Buying over-the-counter medication that supposedly aborts the fetus may not be successful.
  • Severe malnutrition, specifically the lack of folic acid and vitamin C.
  • Accident or injury, especially when the uterus is severely impacted, such as in a car accident, when falling, or due to strong impact to the abdomen.
  • Problems with the sperm.
  • No known cause.
Miscarriages often occur in early pregnancy. In approximately 95% of cases of miscarriage, there will be vaginal bleeding along with some abdominal cramping. Some women may notice some tissue/clots as well.
  1. Threatened abortion is vaginal bleeding that occurs during pregnancy and this happens in 10% of pregnancies. Half of these pregnancies will end in miscarriage and the other half will continue to term. There may be some slight vaginal bleeding or spotting, though the cervix will remain closed. There may or may not be abdominal pain. Symptoms can be confusing for the woman, especially if she does not know that she is pregnant.
  2. With an inevitable abortion the woman will experience heavier vaginal bleeding and more abdominal pain, and the cervix will be open due to the contractions of the uterus. Sometimes the amniotic sac (bag of waters) will also break. When the cervix has opened the pregnancy can no longer continue and the fetus will be expelled naturally or the doctor will need to manually remove the contents of the uterus to complete the miscarriage.
  3. Recurrent miscarriage, habitual abortion, or recurrent pregnancy loss (RPL) is defined by three or more miscarriages at the same gestational age. This can be due to cervical incompetence, hormonal imbalance, or chromosomal abnormalities.
  4. Complete abortion is the natural expulsion of the fetus and all uterine contents (confirmed by ultrasound). The process begins and ends on its own. The woman may experience abdominal cramping and pain and vaginal bleeding during the process that will stop on their own. (Tissue will be expelled and then the bleeding will stop.) No medical intervention is usually necessary.
  5. Incomplete abortion is the partial expulsion of the fetus or uterine contents and some parts still remain in the uterus. This type of miscarriage prevents the uterus from contracting efficiently and there is usually more pain and vaginal bleeding involved. If bleeding is excessive and uncontrolled, the woman can go into shock and require intravenous fluids and even a blood transfusion. Usually a dilation and curettage (D&C) is necessary to remove the contents of the uterus to stop the bleeding and prevent infection. Once the uterus is empty, it will contract efficiently and the bleeding will stop on its own.
  6. A missed abortion is when the fetus has died for more than eight weeks without the woman knowing because she has not shown any signs of a miscarriage. This is often diagnosed with an ultrasound where the fetus and placenta can be seen in the uterus, where they can remain for weeks and months without causing any symptoms. The body will eventually expel the contents of the uterus or medical intervention may be required. Without the removal of the fetus, the woman cannot get pregnant again.
  7. Septic abortion is a miscarriage along with an infection, causing fever, abdominal pain, and vaginal bleeding.
  • Vaginal bleeding in various amounts, from light spotting to heavy bleeding.
  • Abdominal pain.
  • Tissue expelled from the vagina.
  • Medical history, including menstrual history and any signs of an abnormal pregnancy, such as bleeding.
  • Internal examination to check the cervix.
  • Ultrasound to check the size and age of the fetus in case gestational age is unclear or unknown.
  • Blood test to check for pregnancy hormones.
If the fetus appears normal and symptoms are mild, the doctor may recommend that you return home to rest as a threatened miscarriage may resolve itself. If you experience severe vaginal bleeding, the doctor may decide to admit you into the hospital for monitoring. Treatment, if any, may include:
  1. If this is your first miscarriage, no testing is usually necessary. Most women who miscarry the first time will go on to have normal pregnancies. But if this is your second miscarriage (or more), additional testing may be carried out to discover the cause of these losses.
  2. If you have cervical incompetence and miscarriage occurs in the second trimester of pregnancy, the doctor may place a cerclage (stitch) to keep your cervix closed. If the miscarriage is attributed to a growth in your uterus, that growth will be removed.
  3. If the miscarriage is related to hormones, you may be prescribed progesterone.
  4. If the miscarriage cannot be avoided, the doctor may decide to perform a dilation and curettage (D&C) to remove the contents or your uterus or give you medication to ensure complete miscarriage.
  5. If the miscarriage is incomplete, a dilation and curettage (D&C) will be required.
  6. If any uterine contents are retained, a dilation and curettage (D&C) and/or medication to trigger contractions will be required.
Possible Complications
  1. Excessive vaginal bleeding can cause anemia or even shock and death.
  2. Infection may occur from prolonged vaginal bleeding or if any pregnancy content remains in the uterus for a long time.
  3. Patients who undergo a dilation and curettage (D&C) have the small risk of a uterine perforation.
If you are pregnant, maintain good health and begin prenatal care as soon as you discover you are pregnant. Most women (85%), even after multiple miscarriages, will go on to have healthy pregnancies.
  1. If you have experienced multiple miscarriages, talk to your doctor about thorough screenings of you, your partner, and/or the fetus(es) to discover the cause of the miscarriage.
  2. Start prenatal care as soon as you discover you are pregnant, especially if you have a history of problems with your cervix that put you at risk for miscarriage.
  3. Maintain good health by exercising, resting when you can, and maintaining a healthy weight. Avoid drinking and smoking. If you have any existing medical conditions, such as diabetes, make sure they are well managed.
  4. After a miscarriage you should start using birth control after two weeks.
  5. Eat a healthy diet from the five food groups. Take folic acid before conceiving. Avoid drinking alcohol and caffeinated drinks like tea and coffee.
  6. Take care of your mental health.
  7. See a doctor immediately if you notice any abnormal symptoms.
 
If you are pregnant and experience vaginal bleeding, abdominal pain, and/or notice tissue expelled from your vagina, come to the hospital immediately to see your doctor to prevent possible hemorrhage.
 

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