For Physicians
Sign Up 0    

Miscarriage

Overview

Miscarriage is the spontaneous loss of pregnancy before the fetus has developed enough to survive, usually before the gestation period of 20 weeks. The incidence of miscarriages keeps increasing, and about 10 to 20% of known pregnancies end from a miscarriage. In certain cases, a miscarriage can occur even before the pregnancy gets identified. Apart from causing physical pain and discomfort, a miscarriage can cause psychological or emotional damage to a woman. Unfortunately, it is difficult to predict a miscarriage or prevent it from occurring. However, a few lifestyle modifications can help in completing a pregnancy. 

Causes

The majority of miscarriages occur during the first trimester of pregnancy. The most well-known reason is chromosomal abnormalities found in the developing embryo. These abnormalities happen on their own, and they have got no link with the parents’ genetics. Any embryo that develops chromosomal abnormalities before 13 weeks of pregnancy is likely to end in a miscarriage. The risk of these genetic abnormalities increases with age. Older women over the age of 35 have a greater risk than younger women.

Some other causes of miscarriage can be associated with maternal health. Some medical conditions that may lead to a miscarriage include progesterone deficiency, uterine malformation, fibroids, or cervical issues. Uncontrolled diabetes, thyroid issues, or severe infections can also cause a miscarriage. Incidence of miscarriage is also higher among women who smoke, drink alcohol, or use illegal drugs during pregnancy. 

Types

Miscarriages can be divided into the following types:

Inevitable miscarriage: In this case, the fetal heartbeat stops, and the cervix gets dilated. Bleeding and cramping occur, indicating the end of pregnancy.

Threatened miscarriage: Early bleeding occurs, but the cervix is not dilated. It is likely that the pregnancy will continue to its full term.

Complete miscarriage: All the pregnancy tissues get eliminated from your body.

Incomplete miscarriage: Some pregnancy tissues leave your body, but some of them remain inside.

Missed miscarriage: It occurs when the embryo dies early inside the uterus, but the tissues are never expelled. It is also called a delayed miscarriage.

Recurrent miscarriage: In this case, three or more pregnancies are lost during the first trimester in a row. It is a rare condition to occur. 

Risk Factors And Epidemiology

As mentioned above, the risk of miscarriage is higher in older females. It is high during your 30s and is highest if you conceive during your 40s. Women who have underlying medical conditions, especially those associated with their hormones, uterus, and cervix, are also a risk. Uncontrolled diabetes, thyroid issues, or a weakened immune system can also put you at risk of a miscarriage. Some females who have had two or more miscarriages in the past have a higher risk. Smoking, alcohol intake, and drug abuse during early pregnancy can also lead to miscarriage.

The exact prevalence of miscarriage is difficult to identify because many cases occur even before the female knows that she is pregnant. The incidence is higher among older women. 

Signs And Symptoms

Symptoms of miscarriage can vary among different women depending on the duration and type of their pregnancy. One of the common symptoms is vaginal bleeding that starts light and continues as heavy bleeding for a few days. You may also notice fluid or tissue in vaginal bleeding that looks like a blood clot. These symptoms are accompanied by cramps, abdominal pain, back pain, and generalized weakness. In some cases, females develop fever and appetite issues. 

Diagnosis

Your doctor will need a brief history before a physical examination is done. If your pregnancy is known, you will need to tell your doctor about its duration. A physical examination follows this. The first step will be a pelvic examination to check if your cervix has dilated. An ultrasound is done to determine fetal heartbeat. If the test is difficult to perform, it needs to be repeated after a week. Blood tests are also done to measure the levels of human chorionic gonadotropin (HCG) hormone. An abnormal level of this hormone can indicate an underlying issue. If you are passing tissues from your vagina, your doctor may take a sample to confirm the diagnosis of miscarriage and rule out other possible causes. In cases of repetitive miscarriages, your doctor may recommend a chromosomal test to determine if there is any genetic issue from the parents’ side. 

Differential Diagnosis

The symptoms of a miscarriage are apparent but can be mistaken for another condition if the pregnancy is not known. Some of these conditions include ectopic pregnancy, vaginal trauma, ovarian torsion, cervical polyps, or acute appendicitis. The differentiation can be made based on lab tests and ultrasounds. 

Treatment

Treatment depends on the type of miscarriage. If you experience a threatened miscarriage, your doctor will ask you to rest and avoid strenuous physical activity. Your symptoms will likely get better within a few days, and your pregnancy will continue as normal. If an actual miscarriage occurs, the management will depend on your symptoms. In case of no infection, it is better to let the miscarriage complete naturally through bleeding. You will need to rest and take care of yourself during this period as it can be very emotionally challenging. If you have severe pain or want to speed up the process, your doctor will prescribe medications to clear your pregnancy. If you develop the risk of infection, surgical removal of pregnancy tissues by suction dilation and curettage (D&C) would be the treatment of choice.

Medication

Misoprostol is the drug of choice if medication is necessary to speed up the process of a miscarriage. It is a prostaglandin. Medications should only be taken if the process of natural bleeding does not occur or has complications. 

Prognosis

In majority of the cases that occur naturally, females will recover within two to six weeks after a miscarriage. However, psychological and emotional damage can be much more than physical. Consult a therapist if you are unable to go through this period of grief by yourself. 

Prevention

It is difficult to prevent a miscarriage as it occurs spontaneously without warning signs. If you have a known pregnancy, you should follow advice from your doctor and maintain a healthy lifestyle for yourself and your baby to reduce the risk of a miscarriage. Eat a nutritious diet, keep yourself hydrated, exercise well and sleep on time. Avoid smoking, alcohol intake, or drug abuse during pregnancy.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 07, 2023.

 

References

https://www.nhs.uk/conditions/miscarriage/

https://www.sciencedirect.com/science/article/abs/pii/S0140673621006826

Related Blogs