Pregnancy and Miscarriage

A miscarriage is the loss of a fetus before the 20th week of pregnancy. The medical term for a miscarriage is spontaneous abortion, but “spontaneous” is the key word here because the condition is not an abortion in the common definition of the term.

According to the March of Dimes, as many as 50% of all pregnancies end in miscarriage — most often before a woman misses a menstrual period or even knows she is pregnant. About 15-25% of recognized pregnancies will end in a miscarriage.

More than 80% of miscarriages occur within the first three months of pregnancy. Miscarriages are less likely to occur after 20 weeks gestation; these are termed late miscarriages.

Symptoms of a miscarriage include:

If you experience the symptoms listed above, contact your obstetric health care provider right away. He or she will tell you to come in to the office or go to the emergency room.

Most miscarriages happen when the unborn baby has fatal genetic problems. Usually, these problems are unrelated to the mother.

Other causes of miscarriage include:

A woman has a higher risk of miscarriage if she:

Cervical Insufficiency

A miscarriage sometimes happens because there is a weakness of the cervix, called an incompetent cervix, which cannot hold the pregnancy. A miscarriage from an incompetent cervix usually occurs in the second trimester.

There are usually few symptoms before a miscarriage caused by cervical insufficiency. A woman may feel sudden pressure, her “water” may break, and tissue from the fetus and placenta may be expelled without much pain. An incompetent cervix can usually be treated with a “circling” stitch in the cervix in the next pregnancy, usually around 12 weeks. The stitch holds the cervix closed until it is pulled out around the time of delivery. The stitch may also be placed even if there has not been a previous miscarriage if cervical insufficiency is discovered early enough, before a miscarriage does occur.

Your health care provider will perform a pelvic exam, an ultrasound test and bloodwork to confirm a miscarriage. If the miscarriage is complete and the uterus is empty, then no further treatment is usually required. Occasionally, the uterus is not completely emptied, so a dilation and curettage (D&C) procedure is performed. During this procedure, the cervix is dilated and any remaining fetal or placental tissue is gently removed from the uterus. As an alternative to a D&C, certain medications can be given to cause your body to expel the contents in the uterus. This option may be more ideal in someone who wants to avoid surgery and whose condition is otherwise stable.

Blood work to determine the amount of a pregnancy hormone (hCG) is checked to monitor the progress of the miscarriage.

When the bleeding stops, usually you will be able to continue with your normal activities. If the cervix is dilated, you may be diagnosed with an incompetent cervix and a procedure to close the cervix (called cerclage) may be performed if the pregnancy is still viable. If your blood type is Rh negative, your doctor may give you a blood product called Rh immune globulin (Rhogam). This prevents you from developing antibodies that could harm your baby as well as any of your future pregnancies.

Blood tests, genetic tests, or medication may be necessary if a woman has more than two miscarriages in a row (called recurrent miscarriage). Some diagnostic procedures used to evaluate the cause of repeated miscarriage include pelvic ultrasound, hysterosalpingogram (an X-ray of the uterus and fallopian tubes), and hysteroscopy (a test in which the doctor views the inside of the uterus with a thin, telescope-like device inserted through the vagina and cervix).

Bleeding and mild discomfort are common symptoms after a miscarriage. If you have heavy bleeding with fever, chills, or pain, contact your health care provider right away. These may be signs of an infection.

Yes. At least 85% of women who have miscarriages have subsequent normal pregnancies and births. Having a miscarriage does not necessarily mean you have a fertility problem. On the other hand, about 1%-2% of women may have repeated miscarriages (three or more). Some researchers believe this is related to an autoimmune response.

If you’ve had two miscarriages in a row, you should stop trying to conceive, use a form of birth control, and ask your health care provider to perform diagnostic tests to determine the cause of the miscarriages.

Discuss the timing of your next pregnancy with your health care provider. Some health care providers recommend waiting a certain amount of time (from one menstrual cycle to 3 months) before trying to conceive again. To prevent another miscarriage, your health care provider may recommend treatment with progesterone, a hormone needed for implantation and early support of a pregnancy in the uterus.

Taking time to heal both physically and emotionally after a miscarriage is important. Above all, don’t blame yourself for the miscarriage. Counseling is available to help you cope with your loss. Pregnancy loss support groups may also be a valuable resource to you and your partner. Ask your health care provider for more information about these resources.

Usually a miscarriage cannot be prevented and often occurs because the pregnancy is not normal. If a specific problem is identified with testing, then treatment options may be available.

Sometimes, treatment of a mother’s illness can improve the chances for a successful pregnancy.

SOURCES: 

The March of Dimes.

National Institutes of Health.

American Pregnancy Organization.

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