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Miscarriage(1)
Miscarriage, is a term used for Early pregnancy loss , it is the loss of a
pregnancy before 24 weeks
incidence
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. Chemical pregnancies may account for 50% 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
Most miscarriages occur during the first 13 weeks of pregnancy.
For women in their childbearing years, the chances of having a miscarriage can
range from 10-25%, and in most healthy women the average is about a 15-20%
chance
An increase in maternal age affects the chances of miscarriage
Women under the age of 35 yrs old have about a 15% chance of miscarriage
Women who are 35-45 yrs old have a 20-35% chance of miscarriage
Women 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
one.
Causes
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. The majority of miscarriages are believed to be
caused by genetic problems in the embryo that would
prevent a baby from developing normally and surviving.
Other causes for miscarriage include:-
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
In other cases, certain illnesses or medical conditions can
cause miscarriage and may increase the risk of miscarriage.
disease are at
thyroid
or
diabetes
Mothers who have
increased risk of miscarriage. Infections that spread to the
placenta, including some viral infections, can also increase
the risk of miscarriage.
In general, risk factors for miscarriage include the following:
●
Older maternal age
●
(>10 cigarettes/day)
smoking
Cigarette
●
consumption
alcohol
Moderate to high
●
to the uterus
Trauma
●
exposure
Radiation
●
Previous miscarriage
●
either below 18.5 or
BMI
Maternal weight extremes (
above 25 kg/m2)
●
Anatomical abnormalities of the uterus
●
Illicit drug use
Women who had one miscarriage have an incidence of
miscarriage of about 20%, whereas women who have three
or more consecutive miscarriages may have a risk as high as
43%
Symptoms and signs
Vaginal bleeding and pelvic pain are the hallmark symptoms of miscarriage. All
vaginal bleeding during pregnancy should be investigated, although not all
instances of bleeding result from a miscarriage. Bleeding in the first trimester of
pregnancy is very common and does not typically signify a miscarriage. The pain
tends to be dull and cramping, and it may come and go or be present constantly.
Sometimes, there is passage of fetal or placental tissue. This material may appear
whitish and covered with blood. Blood clots may also be present in the vaginal
bleeding. The degree of bleeding does not necessarily correlate with the severity
of the situation, and miscarriage may be associated with bleeding that ranges
from mild to severe
Mild to severe back pain often worse than normal menstrual cramps
White-pink mucus
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
Types of miscarriage
Some degree of early pregnancy uterine bleeding
Threatened Miscarriage:
accompanied by cramping or lower backache. The cervix remains closed. This
bleeding is often the result of implantation
Sometimes not all the products of conception are
-
Incomplete miscarriage:
passed from the womb. This situation is called an incomplete miscarriage. Usually,
when the woman is admitted to hospital an ultrasound scan will be carried out. If
there are remains of tissue present then the woman will usually be taken to
theatre for an ERPC.
Sometimes if a woman has been threatening to
-
An inevitable miscarriage:
miscarry, the inevitable will occur, ie. the cervix starts to dilate and open up. Once
this occurs it is unlikely that the pregnancy will be preserved. Bleeding and pain
are common symptoms of this. The pain is due to contraction of the womb as it
tries to evacuate the pregnancy. Sometimes there can be nausea and vomiting.
The woman may notice large pieces of tissue, which appear like blood clots, being
passed from the vagina. This can be a very frightening experience. An inevitable
miscarriage will either progress to an incomplete or a complete miscarriage.
A completed miscarriage is when the embryo or products
carriage:
Complete Mis
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.
Women can experience a miscarriage without knowing it. A
Missed Miscarriage:
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.
Defined as 3 or more consecutive first trimester
Recurrent Miscarriage (RM):
miscarriages. This can affect 1% of couples trying to conceive.
he fetal and
a miscarriage in which there is infection in t
Septic miscarriage:
pregnancy material before or after a miscarriage
Also called an anembryonic pregnancy. A fertilized egg implants
Blighted Ovum:
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
Diagnosis
An ultrasound examination is typically performed if a woman has symptoms of a
miscarriage. The ultrasound can determine if the pregnancy is intact and if a fetal
heartbeat is present. Ultrasound examination can also reveal whether the
pregnancy is an ectopic pregnancy (located outside of the uterus, typically in the
Fallopian tube), which may have similar symptoms and signs as miscarriage. Other
tests that may be performed include blood tests for pregnancy hormones, blood
counts to determine the degree of blood loss or to see whether infection is
present, and a pelvic examination. The mother's blood type will also be checked
at the time of a miscarriage, so that Rh-negative women can receive an injection
of anti-D immune globulin to prevent problems in future pregnancies
What happens after a miscarriage
There are no specific treatments that can stop a miscarriage, although women
who are at risk and have not yet miscarried may be advised to rest in bed, abstain
from sexual activity, and restrict all activity until any warning signs are no longer
present. Once a miscarriage occurs, there is no treatment available. In many
cases, the miscarriage will take its course, and unless there is severe pain and
cramping or severe blood loss, no treatment is required. If a miscarriage does not
completely clear the pregnancy tissue from the uterus, a procedure known as a
dilatation and curettage (D&C) can be performed to remove the remaining
pregnancy material. This treatment is used in the case of a missed abortion, for
example, when the pregnancy material is not expelled from the uterus
As mentioned above, women who are Rh-negative will receive a dose of anti-D
immune globulin to prevent complications in future pregnancies
If a miscarriage is due to infection, antibiotic treatment will be given
Miscarriage is such a common occurrence that typically, unless known risk factors
are present, no special testing is performed. For couples who have experienced
more than two miscarriages, diagnostic studies to detect genetic, hormonal, or
anatomical problems may be recommended. Some doctors recommend
evaluation of the couple after the second miscarriage, particularly if the woman is
over 35 years of age
What is the outlook for future pregnancies after a miscarriage?
Most women who miscarry go on to have a successful pregnancy. The likelihood
of a miscarriage in a future pregnancy increases with the number of miscarriages
a woman has had. In general, the risk of a second miscarriage in women who have
had a previous miscarriage is about 15%. The risk is about 30% in women who
have had two miscarriages. Most women will have their menstrual period within 4
to 6 weeks after a miscarriage