A miscarriage is the spontaneous loss of a pregnancy withing the first 20 weeks of gestation. The term stillbirth refers to the death of a fetus after 20 weeks’ gestation. Miscarriage is sometimes referred to as spontaneous abortion, because the medical term abortion means the ending of a pregnancy, whether intentional or unintentional. Most miscarriages occur in the first trimester of pregnancy, from seven to twelve weeks after conception.
How common is miscarrying?
Miscarriage is believed to be the most common type of pregnancy loss. It has been revealed that anywhere from 10-25% of all clinically recognized pregnancies will end in miscarriage. Chemical pregnancies may account for 50-75% of all miscarriages. This occurs when a pregnancy is lost shortly after implantation, resulting in bleeding that occurs around the time of the expected period.
As many or even most miscarriages occur so early in pregnancy that a woman does not even realize that she is pregnant, it is difficult to estimate how frequently miscarriages occur.
Women who had one miscarriage have a risk of miscarriage of about 20%, whereas women who have three or more consecutive miscarriages may have a risk as high as 43%.
What causes miscarriage?
After having a miscarriage, you may blame yourself and wonder what you could have done to prevent the loss. Understand that most miscarriages happen for reasons beyond your control.
Miscarriage is caused by the separation of the fetus and placenta form the uterine wall. The majority of miscarriages are believed to be caused by genetic problems within the embryo that would prevent a baby form developing normally and surviving after birth. These fatal genetic errors are not usually related to genetic problems in the mother.
In other cases, certain illnesses or medical conditions can cause miscarriage or may increase the risk of miscarriage. For example, mothers who have diabetes or thyroid disease are at increased risk of miscarriage. Infections that spread to the placenta, including some viral infections, can also increase the risk of miscarriage. Other causes may include hormonal problems, immune system responses, uterine abnormalities.
In general, risk factors for miscarriage include the following:
. Older maternal age
. Cigarette smoking and moderate to high alcohol consumption
. Trauma to the uterus
. Radiation exposure
. Previous miscarriage
. Maternal weight extremes( BMI either below 18.5 or above 25kg/m2)
. Illicit drug use
. Use of non-steroidal anti-inflammatory drugs(NSAIDS) around the time of conception may increase the risk of miscarriage.
A miscarriage sometimes happens because there is a weakness of the cervix, called an incompetent cervix, which cannot hold the pregnancy. This usually occur in the second trimester.
Miscarriage warning signs
There are signs and symptoms that should be recognized and shouldn’t be ignored during pregnancy.
The most common signs to look out for include:
. Mild to severe back pain
. Weight loss
. White-pink mucus
. True contractions(very painful happening every 5-20 minutes)
. Brown or bright red bleeding with or without cramps.
. Tissue with clot like material passing form the vagina
.sudden decrease in signs of pregnancy
If you were to experience any or all of these symptoms, it is to contact your doctor or a medical facility to evaluate if you could be having a miscarriage.
Miscarriage signs and symptoms
Women experience miscarriage symptoms of varying degrees, with some not displaying symptoms at all. Bleeding in the first trimester does not always signify a miscarriage.
Common signs of miscarriage:
.no heartbeat in a transvaginal ultrasound(after 6weeks)
.presence of extra or missing chromosomes
.high blood levels of antiphospholipid(aPL) antibody and lupus anticoagulant
Common symptoms of miscarriage:
. vaginal bleeding or spotting
.unusual or brown vaginal discharge
.intense cramping that feels like a period
.pain in lower abdomen(dull ache to severe pain)
Types of miscarriage
Miscarriage is often a process and not as single event. There are many different stages or types of miscarriage. Most of the time all types of miscarriage are just called a miscarriage, but you may hear your doctor refer to other terms or names according to what is experienced.
. Threatened miscarriage: some degree of early pregnancy uterine bleeding accompanied by cramping or lower backache. The cervix remains closed and loss of the pregnancy has not yet occurred. With observation and sometimes medical attention, you may be able to continue the pregnancy.
This bleeding is often the result of implantation.
. Inevitable or incomplete miscarriage: abdominal or back pain accompanied by bleeding with an open cervix. Miscarriage is inevitable when there is a dilatation or effacement of the cervix and/or there is rupture of the membranes. Bleeding and cramps may persist if the miscarriage is not complete.
. Complete miscarriage: it occurs when the embryo or products 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(Dilation &Curettage ) performed.
. Missed miscarriage: women can experience a miscarriage without knowing it. A missed miscarriage is when embryonic death has occurred but there is not any expulsion of the placenta and embryonic tissue. It is not known why this occurs. Signs of it would be a loss of pregnancy symptoms and the absence of fetal heart tones found on an ultrasound.
If you ignore a possible miscarriage you could develop septic miscarriage, which is a serious uterine infection. Signs of this complication include fever, chills, abdominal tenderness, and foul-smelling vaginal discharge.
In some cases, miscarriage can be diagnosed based upon the woman’s symptoms and the physical exam. For instance, with inevitable miscarriage, the cervix is open and pregnancy tissue may be seen in the cervix.
However, many cases of vaginal bleeding in early pregnancy require further examination and testing. Among those, the most commonly used are:
.Ultrasound- ultrasound is used to establish a diagnosis, and/or to help determine if the pregnancy is “viable”, that is, whether it is capable of progressing to term. In addition, it is important to make sure that the pregnancy is in the uterus and not outside. Ultrasound uses sound waves to visualize the structures inside the uterus. In early pregnancy, the ultrasound exam is often done through the vagina. Ultrasound can help identify a complete miscarriage(no pregnancy sac or embryo seen) or non-viable pregnancy( pregnancy sac can be seen but abnormal or no embryo present).
If an embryo is present, it is measured and its size compared to the normal expected embryo’s size at the woman’s stage of pregnancy.
. Fetal heartbeat- at about 6 weeks after the last menstrual period, the motion of the fetal heart should be visible on ultrasound. If the pregnancy has progressed to the stage where a heartbeat should be present, the failure to detect a heartbeat during an ultrasound exam indicates that the pregnancy has likely ended. Your doctor will also evaluate the rate of the fetal heart. A fetal heart beat that is less than 100 to 120 beats per minute can indicate that a miscarriage is likely.
.Blood work to determine the amount of a pregnancy hormone(hCG) is checked to monitor the progress of the miscarriage.
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, may be necessary if a woman has more than two miscarriages in a row-recurrent miscarriage- include pelvic ultrasound, hysterosalpingogram( an X-ray of the uterus and fallopian tubes), and hysteroscopy( a test to view inside the uterus using a thin telescope-like device inserted through the vagina and the cervix).
Miscarriage treatment options
Unfortunately, there is no way to stop most miscarriages once they have started. When a miscarriage is inevitable or is already occurring, several options are available, depending upon the stage of the miscarriage, the condition of the mother, and other factors.
The three main options are:
Observation: some women with complete miscarriage require little treatment. Women who miscarry at less than 12 weeks of pregnancy and have stable vital signs and no signs of infection can often be managed without medical or surgical treatment.
In time, the contents of the uterus will pass, usually within two weeks, although sometimes as long as 3 to 4 weeks later. Once the contents have been passed, an ultrasound is done to ensure that the miscarriage is complete.
Medical treatment: in some cases, medications can be give to stimulate the uterus to pass the pregnancy tissue. The medicine can administered orally or vaginally, and works over several days.
Surgical treatment: the conventional treatment for early miscarriage is a surgical procedure called dilatation and curettage, or D&C. The cervix is dilated, and an instrument is inserted that uses suction and/or gently scraping motion to remove the contents of the uterus. D&C is generally recommended for women who do not want to wait for spontaneous passage of the tissue, and in women with heavy bleeding or infection.
Emotional treatment: women and couples are left with unanswered questions regarding their physical recovery, their emotional recovery and trying to conceive again. It is very important that you try to keep the lines of communications open with family, friends and health care providers during this time.
Following a miscarriage women are advised to avoid having sex or putting anything into the vagina, such as douche or tampon, for two weeks.
Pregnancy after a miscarriage
You may wonder if you can get pregnant after a miscarriage, and the answer is ,yes. At least 85% percent 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. This might be related to autoimmune response.
If you have had two miscarriages in a row, you should ask your doctor to perform diagnostic tests to try and determine the cause of the miscarriages.
Your doctor or midwife may recommend waiting a certain amount of time before trying to conceive again. Some health care providers recommend waiting from one menstrual cycle to 3 months. To prevent another miscarriage, your doctor 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.
Thought you may be physically ready to get pregnant again, you may not feel ready emotionally. Some women cope best by turning their attention toward trying for new pregnancy as soon as possible. Others find that months or more go by before they are ready to try to conceive again. Take the time to examine your feelings, and do what feels right for you and your partner.
Since the main cause of miscarriages is chromosomal abnormalities, there is not much that can be done to prevent them. One vital step is to get and/or stay as healthy as you can before conceiving or during pregnancy to provide a healthy atmosphere for conception and pregnancy period.
You can do so, by:
.Keep weight withing healthy limits
.Keeping your abdomen safe
.Not smoking or be in a smoking environment
.Not drinking alcohol
.Limiting or eliminating caffeine
.Checking with your doctor before taking any medication
.Avoiding environmental hazards such as radiation, infectious diseases, and X-rays
The above article serves only as reference. Kindly refer to your primary care provider for complete consultation and treatment.
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