Miscarriage: Signs, Symptoms, Treatment and Prevention

Miscarriage, is a term used for a pregnancy that ends on its own. A miscarriage is the spontaneous loss of a fetus before the 20th week of pregnancy. Pregnancy losses after the 20th week are called stillbirths.

Miscarriage is the most common type of pregnancy loss. Studies reveal that anywhere from 10-25% of all clinically recognized pregnancies will end in miscarriage.

Why Do Miscarriages Occur?

The reason for miscarriage is varied, and most often the cause cannot be identified. During the first trimester, the most common cause of miscarriage is chromosomal abnormality – meaning that something is not correct with the baby’s chromosomes. Most chromosomal abnormalities are the cause of a damaged egg or sperm cell. Most miscarriages are caused by chromosome problems that make it impossible for the baby to develop. Usually, these problems are not related to the mother’s or father’s genes.

Other causes for miscarriage include (but are not limited to):

  • Hormonal problems, infections or maternal health problems
  • Lifestyle (i.e. smoking, drug use, malnutrition, excessive caffeine and exposure to radiation or toxic substances)
  • Implantation of the egg into the uterine lining does not occur properly
  • Maternal age
  • Maternal trauma

Factors that are not proven to cause miscarriage are sex, working outside the home (unless in a harmful environment) or moderate exercise.

Around half of all fertilized eggs die and are lost (aborted) spontaneously, usually before the woman knows she is pregnant. Among women who know they are pregnant, 15 to 20 out of every 100 will have a miscarriage. Most miscarriages occur during the first 7 weeks of pregnancy. The rate of miscarriage drops after the baby’s heartbeat is detected.

Chemical pregnancies may account for 50-75% of all miscarriages. This occurs when a pregnancy is lost shortly after implantation, resulting in bleeding that occurs around the time of her expected period. The woman may not realize that she conceived when she experiences a chemical pregnancy.

What are the chances of having a Miscarriage?

For women in their childbearing years, the chances of having a miscarriage can range from10-25%, and in most healthy women the average is about a 15-20% chance.

An increase in maternal age affects the chances of miscarriage for women

  • Under the age of 35 yrs old have about a 15% chance of miscarriage
  • Who are 35-45 yrs old have a 20-35% chance of miscarriage
  • Over the age of 45 can have up to a 50% chance of miscarriage

A woman who has had a previous miscarriage has a 25% chance of having another (only a slightly elevated risk than for someone who has not had a previous miscarriage)

What are the Warning signs of a  Miscarriage?

If you experience any or all of these symptoms, it is important to contact your health care provider or a medical facility to evaluate if you could be having a miscarriage:

  • Mild to severe back pain (often worse than normal menstrual cramps)
  • Weight loss
  • White-pink mucus
  • True contractions (very painful happening every 5-20 minutes)
  • Brown or bright red bleeding with or without cramps (20-30% of all pregnancies can experience some bleeding in early pregnancy, with about 50% of those resulting in normal pregnancies)
  • Tissue with clot like material passing from the vagina
  • Sudden decrease in signs of pregnancy

If you have the symptoms of a miscarriage, you’ll usually be referred to a hospital for tests. In most cases, an ultrasound scan can determine whether the pregnancy is ongoing or you’re having a miscarriage.

When a miscarriage is confirmed, you’ll need to talk to your doctor or nurse about the options for the management of the end of the pregnancy.

In the majority of cases, the pregnancy tissue will pass out naturally in a week or two. Sometimes medication to assist the passage of the tissue may be recommended, or you can choose to have minor surgery to remove it if you don’t want to wait.

The different types of Miscarriage:

Miscarriage is often a process and not a single event. There are many different stages or types of miscarriage. Most of the time all types of miscarriage are just called miscarriage, but you may hear your health care provider refer to other terms or names of miscarriage such as:

Threatened Miscarriage: Some degree of early pregnancy uterine bleeding accompanied by cramping or lower backache. The cervix remains closed. This bleeding is often the result of implantation.

Inevitable or Incomplete Miscarriage: Abdominal or back pain accompanied by bleeding with an open cervix. Miscarriage is inevitable when there is a dilation or effacement of the cervix and/or there is rupture of the membranes. Bleeding and cramps may persist if the miscarriage is not complete.

Complete Miscarriage: A completed miscarriage is when the embryo or products of conception have emptied out of the uterus. Bleeding should subside quickly, as should any pain or cramping. A completed miscarriage can be confirmed by an ultrasound or by having a surgical curettage (D&C) performed.

Missed Miscarriage: Women can experience a miscarriage without knowing it. A missed miscarriage is when embryonic death has occurred but there is not any expulsion of the embryo. It is not known why this occurs. Signs of this would be a loss of pregnancy symptoms and the absence of fetal heart tones found on an ultrasound.

Recurrent Miscarriage (RM): Defined as 3 or more consecutive first trimester miscarriages. This can affect 1% of couples trying to conceive.

Blighted Ovum: Also called an an embryonic pregnancy. A fertilized egg implants into the uterine wall, but fetal development never begins. Often there is a gestational sac with or without a yolk sac, but there is an absence of fetal growth.

Ectopic Pregnancy: A fertilized egg implants itself in places other than the uterus, most commonly the fallopian tube. Treatment is needed immediately to stop the development of the implanted egg. If not treated rapidly, this could end in serious maternal complications.

Molar Pregnancy: The result of a genetic error during the fertilization process that leads to growth of abnormal tissue within the uterus. Molar pregnancies rarely involve a developing embryo, but often entail the most common symptoms of pregnancy including a missed period, positive pregnancy test and severe nausea.

Treatment of Miscarriage:

The main goal of treatment during or after a miscarriage is to prevent hemorrhaging and/or infection. The earlier you are in the pregnancy, the more likely that your body will expel all the fetal tissue by itself and will not require further medical procedures. If the body does not expel all the tissue, the most common procedure performed to stop bleeding and prevent infection is a dilation and curettage, known as a D&C.

Drugs may be prescribed to help control bleeding after the D&C is performed. Bleeding should be monitored closely once you are at home; if you notice an increase in bleeding or the onset of chills or fever, it is best to call your physician immediately.

When a miscarriage occurs, the tissue passed from the vagina should be examined. This is done to determine if it was a normal placenta or a hydatidiform mole (a rare growth that forms inside the womb early in pregnancy). It is also important to determine whether any pregnancy tissue remains in the uterus.

If the pregnancy tissue does not naturally leave the body, you may be closely watched for up to 2 weeks. Surgery (suction curettage, D and C) or medicine may be needed to remove the remaining contents from your womb.

After treatment, women usually resume their normal menstrual cycle within 4 to 6 weeks. Any further vaginal bleeding should be carefully monitored. It is often possible to become pregnant immediately. It is recommended that you wait one normal menstrual cycle before trying to become pregnant again.

Possible Complications:

Complications of a complete miscarriage are rare.

An infected abortion may occur if any tissue from the placenta or fetus remains in the uterus after the miscarriage. Symptoms of an infection include fever, vaginal bleeding that does not stop, cramping, and a foul-smelling vaginal discharge. Infections can be serious and require immediate medical attention.

Women who lose a baby after 20 weeks of pregnancy receive different medical care. This is called premature delivery or fetal demise and requires immediate medical attention.

Prevention of Miscarriage:

Since the cause of most miscarriages is due to chromosomal abnormalities, there is not much that can be done to prevent them. One vital step is to get as healthy as you can before conceiving to provide a healthy atmosphere for conception to occur.

  • Exercise regularly
  • Eat healthy
  • Manage stress
  • Keep weight within healthy limits
  • Take folic acid daily
  • Do not smoke

Once you find out that you are pregnant, again the goal is to be as healthy as possible, to provide a healthy environment for your baby to grow in:

  • Keep your abdomen safe
  • Do not smoke or be around smoke
  • Do not drink alcohol
  • Check with your doctor before taking any over-the-counter medications
  • Limit or eliminate caffeine
  • Avoid environmental hazards such as radiation, infectious disease and x-rays
  • Avoid contact sports or activities that have risk of injury

Emotional Treatment:

Unfortunately, miscarriage can affect anyone. Women are often left with unanswered questions regarding their physical recovery, their emotional recovery and trying to conceive again. It is very important that women try to keep the lines of communication open with family, friends and health care providers during this time.

A miscarriage can be an emotionally and physically draining experience. You may have feelings of guilt, shock and anger.

You can try for another baby as soon as your symptoms have settled and you’ve had one period, although you should ensure you’re emotionally and physically ready first.

Having a miscarriage doesn’t necessarily mean you’ll have another if you get pregnant again. Most women are able to have a healthy pregnancy after a miscarriage, even in cases of recurrent miscarriages.

Sources: American Pregnancy NHS NLM

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