Miscarriage

Definition
Miscarriage is the spontaneous loss of a pregnancy before the fetus can survive outside the uterus (before the 20th week of pregnancy). The medical term for a miscarriage is a spontaneous abortion. Miscarriage can take a heavy emotional toll on everyone involved.

Causes/associated factors
A miscarriage can happen at any time during the first half (20 weeks) of a pregnancy, but it's most common during the first 12 weeks. Many miscarriages occur before a woman realizes she is pregnant.
Although there may be other factors involved, an estimated 60 percent of miscarriages are related to an abnormally developed embryo. In these cases, miscarriage is inevitable because the embryo would not be able to survive outside the womb. The abnormal development is often related to problems with chromosomes (the structures inside the cells that contain information about inherited characteristics). Most of these chromosomal abnormalities are not inherited and do not recur in later pregnancies.

Other causes of miscarriage may be associated with the mother's health. For example, infections in the uterus, hormonal imbalances, uncontrolled diabetes, high blood pressure, problems with the immune system, defects in the uterus or cervix, and the mother's exposure to diethylstilbestrol (DES, a synthetic estrogen used to treat certain medical conditions) before she was born may all be factors.

The risk of miscarriage increases with smoking, heavy alcohol use, drug use and, possibly, high caffeine consumption. It also increases with exposure to certain chemicals (such as arsenic, lead, formaldehyde, benzene and ethylene oxide). Parents who conceive at an older age and women who become pregnant within three months of delivering a baby also have a higher risk of miscarriage.

If you've had repeated miscarriages, a medical problem may be to blame. You may want to consult a specialist. Even after repeated miscarriages, many women go on to deliver healthy babies.


Signs/symptoms
The most common symptom of an impending miscarriage is vaginal bleeding that may continue for several days. This type of bleeding in the first half of pregnancy is called a threatened abortion. It may be accompanied by lower abdominal cramping and/or a lower backache.
It's important to remember that 20 to 25 percent of pregnant women experience some degree of vaginal spotting or bleeding during the first three months of pregnancy. Only about half of these women actually miscarry. For the rest, the bleeding stops and the pregnancy continues. If you're spotting or bleeding, don't assume that you're having a miscarriage. Do report the symptom to your doctor right away, however. During this time, it's normal to feel frightened and anxious about possibly losing your pregnancy.

If you do have a miscarriage, the fetus and associated tissue are likely to pass from your vagina. If possible, save the tissue so that your doctor can examine it. Your doctor will also want to make sure no tissue remains in your uterus.

After a miscarriage, you will have vaginal spotting for about eight to 10 days. You may also experience very intense -- but normal -- feelings of grief and loss. You may feel guilty, angry, sad, lonely and depressed. You may want to place blame on yourself or others. You may also find it difficult to concentrate. You may even have physical problems, such as appetite loss, inability to sleep or fatigue.


Diagnosis
Your doctor will probably want to do a physical exam to check the size of the uterus and determine if the cervix (the neck of the uterus) has opened. If the miscarriage is not certain, the doctor may also do a pregnancy test or ultrasound (using sound waves to create images of internal body parts) to verify the fetus is still alive.

Treatment
If you have the symptoms of a miscarriage, your doctor may recommend limiting your activity and avoiding sex until the symptoms subside. Limiting activity will not prevent miscarriage, but it may help decrease your symptoms. Hospitalization may be necessary if the bleeding and pain are severe.
It's important to evaluate your bleeding and any tissue that passes from your vagina. Bleeding and pain may continue if part of the tissue from the pregnancy is not passed from the uterus, a condition known as an incomplete miscarriage. Prompt treatment is necessary to prevent a serious infection. To clean out your uterus, the doctor may recommend a dilation and curettage (commonly referred to as a D & C) or a suction extraction of the remaining tissue. Antibiotics are sometimes prescribed after the procedure.

In some cases, the fetus may not survive but still remain in the uterus. This is known as a missed abortion or missed miscarriage. Although the symptoms of pregnancy will disappear, you may have no bleeding or pain. Your doctor may suspect a missed miscarriage if your uterus stops growing. In this case, a D & C may be necessary. If you miscarry and have Rh-negative blood, you'll be given Rh immune globulin (such as RhoGAM) to help prevent Rh incompatibility with the fetus in any future pregnancies.

After a miscarriage, avoid using tampons for at least two to four weeks. Ask your doctor when you can resume intercourse. Generally, you may be asked to wait until you stop bleeding. Because you may ovulate as early as two weeks after a miscarriage, use contraception if you have sex. If you want to get pregnant again, talk to your doctor about time frames. To give your body time to recover, the doctor may suggest having two or three normal menstrual cycles before trying to conceive.

Grief following a miscarriage is normal. To begin the healing process, it's important for you and your partner to share your feelings with someone who understands and can provide the support you need. You may find it helpful to talk to your doctor, a counselor or someone who has experienced a similar loss. Remember that it's normal to be unsure of the best way to talk to your friends and loved ones about your miscarriage. You may feel awkward, and others may feel the same way. Again, finding someone who can provide the support you need is the best way to begin the healing process.


Complications
Various complications are possible after a miscarriage, including:
infection, indicated by fever, chills, foul-smelling vaginal discharge or increased abdominal pain
hemorrhaging, defined in this case as soaking one sanitary pad or more with blood or blood clots within an hour
internal blood clotting problems, indicated by unexplained bruising or bleeding from parts of your body other than the vagina

Prevention
Most miscarriages cannot be avoided. You can help ensure the best possible outcome for your pregnancy, however, by seeking early and regular prenatal care and eating a well-balanced diet. Don't smoke, drink alcohol, use recreational drugs, or consume large amounts of caffeine. Also, take only medications that are recommended by your doctor.