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Causes, Signs and Symptoms of Miscarriage

The natural loss of a fetus before the twentieth week of pregnancy is called miscarriage. It can occur due to abnormal development of the fetus. Miscarriage also known as a spontaneous abortion is not a commonly used term for surgical abortions or medical terminations of pregnancies. It is the most common cause of losing a pregnancy.

It is better to be aware of the issues surrounding miscarriage in the unforeseen circumstance that you experience a miscarriage, or a loved one loses the pregnancy.

Fast Facts about Miscarriage

  • Miscarriage is defined as the spontaneous loss of a fetus before the twentieth week of pregnancy.
  • Miscarriage is also called spontaneous abortion, incomplete abortion, missed abortion, infected abortion, etc.
  • Miscarriage is often caused due to chromosomal abnormalities. Other abnormalities that can cause miscarriage include drug and alcohol abuse, environmental toxin exposure, hormonal issues, infection, obesity, problems with mother’s reproductive organs, problems with immune response of the body, systemic diseases in the mother, e.g. controlled diabetes, thyroid disease, and smoking.
  • Women at risk for miscarriage are those with previous history of miscarriages, women over the age of 35, women with systemic diseases like thyroid disease and diabetes, and women who smoke, drink, or use drugs.
  • Signs of a miscarriage are vaginal expulsion of tissue and fluid, vaginal spotting and bleeding, and painful abdominal cramping.
  • Miscarriage is diagnosed by physical examination, blood tests, biopsy, and ultrasound.
  • Surgical D and C and Misoprostol are used to fully remove the fetal tissue from the uterus.
  • Steps should be taken to ensure that the woman gets complete prenatal care during pregnancy, avoids tobacco, alcohol, and drugs, and avoids exposure to environmental toxins.
  • Coping with a miscarriage is a painful emotional experience. Do not hesitate to get counseling, join support groups, and seek medical attention.

Types of Miscarriage

  • Complete abortion – involves expulsion of all fetal tissues
  • Incomplete abortion – partial removal of fetal tissues
  • Inevitable abortion – a miscarriage will happen and cannot be stopped
  • Infected abortion – also called septic abortion where the lining of the uterus and any remaining fetal tissues become infected
  • Missed abortion – the pregnancy is lost but the fetal tissues do not leave the body

Common Causes of Miscarriage

Under normal circumstances, a miscarriage is often caused by chromosome abnormalities making it difficult for the baby to develop normally. These genetic issues may be unrelated to the genes of either parent. Other common causes of miscarriage include:

  • Drug and alcohol abuse
  • Maternal trauma
  • Environmental toxin exposure
  • Hormonal issues
  • Infection
  • Obesity
  • Problems with the mother’s reproductive organs
  • Problems with the immune response of the body
  • Systemic diseases in the mother, e.g. controlled diabetes
  • Thyroid disease
  • Smoking

Almost half of fertilized eggs die and are aborted naturally, even before the woman is aware of her pregnancy. The rate of miscarriage in pregnant woman is about 15 to 20%. Miscarriage commonly occurs within 7 to 8 weeks of pregnancy.

Risk Factors for Miscarriage

These are the risk factors for miscarriage:

  • After the age of 35, women are at about 15% higher risk for miscarriage. The risk is greater after the age 45, when the risk can go up to 50%
  • Women with previous history of miscarriages are at about 25% higher risk of another miscarriage
  • Chronic medical conditions like diabetes or thyroid disease
  • Women who smoke, drink or use illicit drugs excessively increase their risk of miscarriage

Symptoms of Miscarriage

A miscarriage usually occurs between the 7th and 8th week of pregnancy, and in most cases before the 12th week of pregnancy. The typical signs and symptoms of a miscarriage are:

  • Vaginal spotting or bleeding
  • Painful abdominal cramping or lower back pain
  • Vaginal discharge of fluids or tissues

Not all vaginal spotting or heavy bleeding results in a miscarriage.

Diagnosing Miscarriage

  • A pelvic exam is performed to diagnose a miscarriage. The pelvic exam involves checking the cervical opening for dilatation
  • An abdominal ultrasound can monitor the baby’s development, and amount of bleeding
  • Blood tests performed include complete blood count (CBC), HCG (human chorionic gonadotropin) to confirm pregnancy, HCG quantitative done daily or weekly, blood type to check Rh incompatibility, and white blood cell and differential to rule out infective process
  • Tissue biopsy

Treatment Options for Miscarriage

In miscarriage, the tissue discharged from the vagina is examined to determine if it was a rare growth in the uterus or the normal placenta. The entire tissue must be removed from the uterus in a miscarriage. If the tissue is not expelled naturally, then a surgical procedure called D and C (Dilation and Curettage) is performed to remove the tissue. Drugs may be necessary to control bleeding after the D and C. Careful monitoring of bleeding is essential with a surgical D and C. Misoprostol is sometimes required to expel all the uterine contents from the miscarriage. Normal menstruation begins in 4 to 6 weeks after pregnancy. During this period, any further vaginal bleeding must be closely monitored. Doctors recommend that women wait for one normal menstrual cycle before trying to get pregnant again.

Prevention of Miscarriage

Pregnant women must contact their prenatal healthcare provider immediately if they notice any signs of vaginal bleeding or spotting in order to avoid the risks of miscarriage. Early, comprehensive prenatal care can prevent miscarriages. Exposure to environmental hazards like drugs, alcohol, caffeine, infections, and x-rays must be avoided. Some miscarriages result due to systemic diseases like diabetes, which must be managed and controlled before becoming pregnant.

Coping with Miscarriage

In a miscarriage, the physical process is easier than the emotional healing. It can be a heart-wrenching experience for the parents, and people around you may not understand the depth of your emotions. You must give yourself sufficient time to grieve the loss of your pregnancy, and not hesitate to seek help from those who love you and support you.

Join a support group or get counseling if you feel overwhelmed with emotions and mental anguish. In cases of extreme mood swings, women can get clinically depressed and must seek medical attention to deal with the situation. Be positive and after some time, you will be able to get pregnant again if you have no other medical issues. Talk to your doctor to discuss and better cope with the situation.

Where to Find More Information: American Pregnancy Association