About Miscarriage
A miscarriage, also known as a spontaneous abortion, is the term used to describe the loss of a fetus (unborn baby) before it’s able to survive outside of the womb. It typically occurs before the 20th week of pregnancy. Signs of a miscarriage may include spotting or bleeding, cramping, and back pain.
Unfortunately, miscarriages are relatively common, with around one-quarter of all pregnancies ending in miscarriage. Most miscarriages happen during the first few months of pregnancy, with an estimated 85 percent occurring before week 12. It's important to note that a woman may have a miscarriage before she even knows she is pregnant. If a pregnancy loss occurs after 20 weeks, it is referred to as a stillbirth. While miscarriage is common, it can be an extremely traumatic and devastating experience for those who go through it.
The exact cause of most miscarriages remains unknown. However, researchers have identified several factors that may increase the risk of this unfortunate event.
Potential causes of miscarriage include:
- Abnormal genetics in the fetus
- Viral or bacterial infections
- Blood-clotting disorders
- Structural abnormalities of the uterus
- Exposure to certain medicines or chemicals
Non-modifiable risk factors for miscarriage are factors that can’t be changed, including:
- Maternal age: Advanced maternal age is a non-modifiable risk factor for miscarriage. The older a person is during pregnancy, the greater their risk for fetal chromosomal problems and pregnancy loss.
- Genetic factors: Abnormal chromosomal rearrangements in parents or abnormal genotypes or karyotypes in the embryo can also be non-modifiable risk factors.
Modifiable risk factors for miscarriage are factors that can be influenced or changed, including:
- Lifestyle factors: Some modifiable risk factors for miscarriage include smoking, alcohol consumption, and excessive intake of caffeine during pregnancy.
- Underlying health conditions: Conditions like high blood pressure and polycystic ovary syndrome (PCOS) can also increase the risk of miscarriage.
- Body weight: Obesity is another modifiable risk factor for miscarriage.
It's important to note that most miscarriages occur because the fertilized egg in the uterus isn't developing normally, not because of anything an individual did. Miscarriages are not caused by exercise, stress, or sex.
The most common early symptoms of a miscarriage include:
- Vaginal bleeding and/or spotting
- Back pain
- Diarrhea
- Nausea
- Pelvic cramping (may feel like getting your period)
- Severe abdominal pain
- Fluid coming from the vagina
- Tissue coming from the vagina
- Unexplained weakness
- Disappearance of other pregnancy symptoms, such as breast soreness or morning sickness
In later stages, or with progression or higher severity of a miscarriage, additional symptoms may occur. These include:
- Passing large fluids, such as blood clots or tissue, through the vagina
- Cramping in the abdomen or lower back (which may start out like period cramps but worsen over time)
- Passing larger-than-normal blood clots or tissue from the vagina
- Weight loss
- Fluid or mucus discharge from the vagina
- Decrease in signs of pregnancy, such as breast tenderness, nausea, and vomiting
It's important to note that spotting or light bleeding during early pregnancy isn't always a sign of a miscarriage. If you experience any unusual symptoms or are unsure if your bleeding levels are normal, it's recommended to call your doctor for guidance.
To diagnose a miscarriage, doctors use a variety of examinations, tests, and procedures. These include:
- Ultrasound scans: This involves using a small probe placed either in the vagina or on the abdomen to check for the presence of a fetal heartbeat. Transvaginal ultrasounds are commonly used and may be preferred by some women due to their comfort level.
- Blood tests: These tests are helpful in determining the levels of beta-human chorionic gonadotropin (hCG) and progesterone, which are hormones associated with a healthy pregnancy. Abnormal levels may indicate a miscarriage.
- Pelvic exams: These exams are performed to assess the condition of the cervix. Thinning out or opening of the cervix can be an indication of miscarriage.
In addition to these diagnostic tests, doctors may also perform additional examinations, tests, and procedures to determine the stage or severity of a miscarriage. These may include:
- Vaginal ultrasound and pelvic exam: These tests can provide more detailed information about the condition of the uterus and any remaining fetal tissue.
- Fetal heart scanning: If the dates of the pregnancy indicate that a fetal heartbeat should be detectable, doctors may conduct this test to confirm whether there is still a heartbeat.
- Hormone level testing: Doctors may test hormone levels, such as human chorionic gonadotropin (hCG), to monitor changes over time. Declining hCG levels may indicate a miscarriage.
- Tissue examination: If you have passed any pregnancy tissue, your doctor may examine it to confirm the miscarriage.
It's important to seek medical help immediately if you suspect you're having a miscarriage. Any vaginal bleeding or pelvic pain should be evaluated by a healthcare professional. They will perform the necessary examinations and tests to determine if a miscarriage has occurred and provide appropriate care based on your specific situation.
The goals of treatment for miscarriage are to prevent bleeding and infection. There are several treatment options available, depending on the type of miscarriage and the individual's specific situation. Treatments for miscarriage include:
- Expectant Management: This approach involves waiting for the remaining tissue to pass naturally out of the body. It is typically recommended when there is no pregnancy tissue left in the body (complete miscarriage). The risk of complications from this treatment option is very small.
- Medical Management: In this approach, medications are prescribed to help the individual pass the remaining tissue. These medications can be taken orally or vaginally. They work by stimulating contractions in the uterus, which helps expel the tissue. Treatment is usually effective within 24 hours.
- Surgical Management: If there is still some tissue present in the body, a surgical procedure may be necessary to remove it. This procedure is called dilation and curettage (D & C). During a D & C, a doctor opens the cervix and uses a thin instrument to remove the remaining tissue from the uterus. This procedure can be discussed as the first treatment, or performed if medication does not successfully remove all the tissue.
It's important to note that not all miscarriages require medical intervention or treatment, especially if all the tissue passes naturally on its own. This is particularly common with early losses in pregnancy.
In addition to these treatments, there are also certain health behavior changes that may be recommended to reduce the risk of infection following a miscarriage:
- Avoid inserting anything into the vagina for a short period of time.
- Rest and limit activity until pain and bleeding stop.
- Avoid having sex or using tampons for at least two weeks after a miscarriage.
It's best to consult with a healthcare provider to determine which treatment option is most suitable based on individual circumstances. They can provide guidance on managing symptoms, monitoring recovery, and addressing any concerns or questions that may arise during this time.
The natural progression of a miscarriage can vary from person to person. In many cases, the body expels the fetal tissue on its own. This means that the contents of the uterus are passed without any medical interventions such as surgery or medication. However, it's important to remember that not all miscarriages can be managed naturally. In some situations, medical interventions may be necessary.
Complications of a miscarriage can include:
- Hemorrhaging (bleeding): Excessive bleeding may occur during or after a miscarriage. This can be a serious complication and may require medical attention.
- Infection: There is a risk of infection following a miscarriage, especially if the uterus is not completely emptied of fetal tissue.
- Emotional impact: Miscarriage can have significant emotional effects on individuals and their partners. It is important to seek support from loved ones or professionals during this time.
Treatment for a miscarriage aims to prevent hemorrhaging and infection.
It's important to remember that every situation is unique, so it's essential to consult with a healthcare provider for personalized advice and guidance. They will be able to provide appropriate recommendations based on individual circumstances.