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Miscarriage
Abortion - spontaneous; Spontaneous abortion; Abortion - missed; Abortion - incomplete; Abortion - complete; Abortion - inevitable; Abortion - infected; Missed abortion; Incomplete abortion; Complete abortion; Inevitable abortion; Infected abortionA 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 a naturally occurring event, unlike medical or surgical abortions.
A miscarriage may also be called a "spontaneous abortion." Other terms for the early loss of pregnancy include:
- Complete abortion: All of the products (tissue) of conception leave the body.
- Incomplete abortion: Only some of the products of conception leave the body.
- Inevitable abortion: Symptoms cannot be stopped and a miscarriage will happen.
- Infected (septic) abortion: The lining of the womb (uterus) and any remaining products of conception become infected.
- Missed abortion: The pregnancy is lost and the products of conception do not leave the body.
Your health care provider may also use the term "threatened miscarriage." The symptoms of this condition are abdominal cramps with or without vaginal bleeding. They are a sign that a miscarriage may occur.
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Causes
Most miscarriages are caused by chromosome problems that make it impossible for the baby to develop. In rare cases, these problems are related to the mother's or father's genes.
Other possible causes of miscarriage may include:
- Drug and alcohol abuse
- Exposure to environmental toxins
- Hormone problems
- Infection
- Overweight
- Physical problems with the mother's reproductive organs
- Problem with the body's immune response
- Serious body-wide (systemic) diseases in the mother (such as uncontrolled diabetes)
- Smoking
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, few women 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.
The risk of miscarriage is higher:
- In women who are older -- The risk increases after 30 years of age and becomes even greater between 35 and 40 years, and is highest after 40.
- In women who have had previous miscarriages.
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Symptoms
Possible symptoms of miscarriage may include:
- Low back pain or abdominal pain that is dull, sharp, or cramping
- Tissue or clot-like material that passes from the vagina
- Vaginal bleeding, with or without abdominal cramps
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Exams and Tests
During a pelvic exam, your provider may see that your cervix has opened (dilated) or thinned out (effacement).
Abdominal or vaginal ultrasound may be done to check the baby's development and heartbeat, and the amount of your bleeding.
The following blood tests may be performed:
- Blood type (if you have an Rh-negative blood type, you would require a treatment with Rh-immune globulin).
- Complete blood count (CBC) to determine how much blood has been lost.
- HCG (qualitative) to confirm pregnancy.
- HCG (quantitative) done every several days or weeks.
- White blood count (WBC) and differential to rule out infection.
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Treatment
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 find out whether any pregnancy tissue remains in the uterus. If you have passed tissue, ask your provider if the tissue should be sent for genetic testing. This can be helpful to determine if a treatable cause of miscarriage is present.
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 suggested that you wait one normal menstrual cycle before trying to become pregnant again.
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Possible Complications
In rare cases, complications of miscarriage are seen.
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 need 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. This needs immediate medical attention.
After a miscarriage, women and their partners may feel sad. This is normal. If your feelings of sadness do not go away or get worse, seek advice from family and friends as well as your provider.
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When to Contact a Medical Professional
Call your provider if you:
- Have vaginal bleeding with or without cramping during pregnancy.
- Are pregnant and notice tissue or clot-like material that passes through your vagina. Collect the material and bring it to your provider for examination.
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Prevention
Early, complete prenatal care is the best prevention for complications of pregnancy, such as miscarriage.
Miscarriages that are caused by systemic diseases can be prevented by detecting and treating the disease before pregnancy occurs.
Miscarriages are also less likely if you avoid things that are harmful to your pregnancy. These include x-rays, recreational drugs, alcohol, high caffeine intake, and infectious diseases.
When a mother's body has difficulty keeping a pregnancy, signs such as slight vaginal bleeding may occur. This means there is a risk of miscarriage. But it does not mean one will definitely occur. A pregnant woman who develops any signs or symptoms of threatened miscarriage should contact her prenatal provider instantly.
Taking a prenatal vitamin or folic acid supplement before you become pregnant can greatly lower the chances of miscarriage and certain birth defects.
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References
Catalano PM. Obesity in pregnancy. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 41.
Ellenson LH, Pirog EC. The female genital tract. In: Kumar V, Abbas AK, Aster JC, eds. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 22.
Hobel CJ, Williams J. Antepartum care. In: Hacker NF, Gambone JC, Hobel CJ, eds. Hacker & Moore's Essentials of Obstetrics and Gynecology. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 7.
Kippenhan M. Disorders of early pregnancy. In: Adams JG, ed. Emergency Medicine. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 119.
Moore KL, Persaud TVN, Torchia MG. Discussion of clinically oriented problems. In: Moore KL, Persaud TVN, Torchia MG, eds. Developing Human, The. 10th ed. Philadelphia, PA: Elsevier; 2016:503-512.
Nussabaum RL, McInnes RR, Willard HF. Principles of clinical cytogenetics and genome analysis. In: Nussabaum RL, McInnes RR, Willard HF, eds. Thompson & Thompson Genetics in Medicine. 8th ed. Philadelphia, PA: Elsevier; 2016:chap 5.
Reddy UM, Spong CY. Stillbirth. In: Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore TR, Greene MF, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 45.
