Miscarriage

Miscarriage refers to the 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 Miscarriages are isolated events.

Causes

Some miscarriages cannot be explained. Miscarriages often occur for the following reasons:
  • Chromosomal abnormality (Advancing maternal and paternal age increases the risk.)
  • 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

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Advancing maternal/or and paternal age
  • Conception within 3 months of delivering a baby
  • Smoking
  • Drinking three or more cups of coffee per day
  • Drinking alcohol
  • Using illicit drugs
  • Exposure to certain environmental toxins
  • Diabetes, with poorly controlled blood sugar
  • Infection, such as herpes simplex virus, HIV or Group B streptococcus
  • Autoimmune disease, such as lupus
After one miscarriage early in the pregnancy, you are not at increased risk for subsequent Miscarriages. If you've had multiple Miscarriages, you may benefit from a medical evaluation to determine the cause.

Symptoms

Symptoms include some or all of the following:
  • Vaginal bleeding
  • Pink or brown discharge
  • Cramping
  • Discharge of the products of conception
  • Fever

Diagnosis

You will be asked about your symptoms, the length of your pregnancy, and when you first noticed a change in your condition. The doctor will perform physical and pelvic exams.
Tests may include:
Ultrasound Testing – to assess the health of the fetus or detect an ectopic pregnancy (a pregnancy in which development occurs outside the uterus)
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 types:
Blood Tests – to check for a chromosomal error in the man or the woman or to check hormone and antibody levels.
Imaging Tests – x-rays or an ultrasound to identify a problem with your uterus
Endometrial Biopsy – reveals the suitability of your uterine lining to accept and sustain an embryo
Hysteroscopy – looking inside your uterus, using a thin, lighted fiberoptic instrument. The hysteroscope is inserted in your vagina and passed through your cervix. The doctor can check for problems with the shape or size of your uterus and examine and sample the endometrial lining. During the procedure, the doctor also may be able to correct a uterine problem.

Treatment

Immediate care generally calls for controlling bleeding with medication. A dilation and evacuation (D&E) is needed if all uterine contents have not been expelled. During a D&E, the doctor dilates the cervix, inserts a tool into the uterus and suctions out remaining material. Women may need professional counseling to recover emotionally from the loss.
The goal of long-term treatment is to prevent future miscarriages. This is geared toward whatever caused past losses.
Medications
Medications may include:
  • Antibiotics for infection
  • Progesterone supplements (if this hormone is in low supply)
  • Aspirin and other medications to treat blood-clotting problems caused by immunologic disorders
Surgery
Many physical abnormalities can be corrected to decrease the chance of another miscarriage. If the cervix is weak, the doctor can place a stitch early in the next pregnancy to keep it closed until you are ready to deliver. If fibroids are a contributing factor, removing them may prevent another loss.
Support Services
Talking with a professional counselor often helps women deal with their loss. Some people benefit from participating in a support group.

Prevention

Often nothing can prevent a Miscarriage. However, there are ways a woman can decrease the risk, including:
  • Do not smoke.
  • Do not drink alcohol.
  • Do not use illegal drugs.
  • Limit coffee and caffeine intake.
  • Consult a specialist if:
    • You have had two or more miscarriages and are over 35
    • You have a medical condition that may make it difficult to carry a baby to term