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Miscarriage
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Miscarriage Overview
Miscarriage refers to the premature end of a pregnancy before the developing baby is able to survive outside the womb. Miscarriage can occur during the first or second trimester, before 20 weeks. Most occur in the first 12 weeks of pregnancy and most miscarriages are unexpected and isolated events. About 15%-20% of recognized pregnancies end this way.
Symptoms
Symptoms include some or all of the following: vaginal bleeding; pink or brown discharge; cramping; discharge of the products of conception; fever.
Causes
Some miscarriages cannot be explained. Miscarriages often occur for the following reasons: chromosomal abnormality (advancing maternal age); uterine defects; fibroids ; scar tissue from a past surgery; insufficient progesterone (a female hormone needed to support pregnancy); infection in the genital tract; immunologic factors that may cause blood-clotting problems or rejection of the fetus.
Diagnosis
Diagnosis is based on symptoms, the length of the pregnancy, and a physical and pelvic exams. Tests may include ultrasound testing–to assess the health of the fetus or detect an ectopic pregnancy; tissue Examination–to examine tissue that has been expelled and check for chromosome defects; other tests check the degree of blood loss and for fetal and maternal blood type.
Treatment
Immediate care usually involves observation only, especially in early or first trimester miscarriages. Medication may be indicated in the event of heavy bleeding or cramping. A dilation and evacuation may be needed if all uterine contents are not spontaneously expelled. The goal of long-term treatment is to prevent future miscarriages.
Medications to decrease the chance of miscarriage may include antibiotics for infection, progesterone supplements (if this hormone is believed to be suboptimal), aspirin and other medications to treat blood-clotting problems caused by immunologic disorders
Many physical abnormalities can be corrected by surgery to decrease the chance of another miscarriage.
Support services by a professional counselor often help women deal with their loss. Some people benefit from participating in a support group.
Prevention
Before starting to plan a next pregnancy, consider the following regarding health: is diet ready to support another pregnancy? Are there habits to change prior to another pregnancy? What medications taken that can affect a pregnancy? Are there issues to be resolved before trying another pregnancy?
Complications
Recurrent Miscarriage
While miscarriage usually is a one-time occurrence, up to one in twenty couples experience two miscarriages in a row, and one in one hundred have three or more. In some cases, these couples have an underlying problem that is causing the losses. Couples who have experienced two or more miscarriages should have a complete medical evaluation to learn the cause of the miscarriages, and how they can prevent another one. Testing can reveal the cause of repeat miscarriages in at least 75 percent of couples.
Risks
Risk factors that increases the chance of getting miscarriage include: advancing maternal age; smoking; drinking alcohol at a level beyond two drinks per day; using illicit drugs (street drugs); exposure to certain environmental toxins; infection, such as cytomegalovirus (CMV) and HIV ; chronic maternal illness, eg, autoimmune diseases, such as lupus and insulin-dependent diabetes with uncontrolled blood sugar.
Recovery
After one miscarriage early in the pregnancy, the risk is not increased for subsequent miscarriages. If multiple miscarriages (at least three), t is important to consult a health professional and benefit from a medical evaluation to determine the cause.