Miscarriage

Types
Symptoms
Causes And Risk Factors
Prevention
Diagnosis
Treatment
Prognosis
References

All
News
Photos

Miscarriage or abortion is the spontaneous termination of a pregnancy before 20 weeks of gestation. It is a traumatic experience that can have psychological as well as physical consequences for the mother-to-be. Disappointment, resentment and anger are some of the natural reactions.

Types

Miscarriage is of the following types.

Complete miscarriage: This occurs when there is complete emptying out of the embryo and its related tissues from the uterus. Cramping and bleeding may occur, which gets resolved within a week.

Incomplete or inevitable miscarriage: In this type of miscarriage, only a part of the embryo or its surrounding tissue may be expelled, leading to persistent bleeding and pain.

Missed miscarriage: As the name suggests, one may be unaware of the embryo’s death until the pregnancy symptoms cease or no heartbeat is detected during an ultrasound check.

Threatened miscarriage: In this case, there may be a threat of miscarriage, and it may not definitely occur. Bleeding and cramping may occur, but the cervix does not open.

Recurrent miscarriage: Occurrence of three or more miscarriages in the first trimester of pregnancy is termed as recurrent miscarriage.

Other types of miscarriage are as follows.

Chemical pregnancy: This type of miscarriage occurs during the early weeks after conception. Normal development of the embryo may be hampered by chromosomal abnormalities. This chemical pregnancy may go undetected as the tissue may be passed out during the time of a normal menstrual cycle. The woman may be unaware that she was pregnant.

Blighted Ovum: In this type of miscarriage, or embryonic pregnancy, the foetus fails to develop due to implantation of the fertilized egg in the uterine wall.

Ectopic pregnancy – Miscarriage may occur due to implantation of the fertilized egg in a place other than the uterus (like the fallopian tube). As this is quite a dangerous situation for the mother, surgical intervention may be required.

Molar pregnancy – This rare type of miscarriage may occur due to a genetic error, which causes failure of the embryo’s growth. Though this is not a viable pregnancy, the woman may still experience pregnancy symptoms.[1]

Symptoms

Vaginal bleeding with the passing of clots accompanied by abdominal cramps during pregnancy;

Weight loss;

Discharge of white to pinkish mucus from the vagina;

Severe back pain;

Contractions s occurring every 5 to 20 minutes;

Passage of clot-like tissues from the vagina;

Abrupt cessation of pregnancy symptoms.

On suspecting a miscarriage

If you experience any of the above symptoms, call your gynaecologist immediately. Vaginal bleeding and cramping may not always mean it is a miscarriage. So, your doctor will be the best judge to tell you if it is one. Till you see a doctor, use a sanitary napkin to absorb the bleeding. It is advisable not to use tampons as they may increase the chance of an infection.

Causes And Risk Factors

Causes

- Blighted Ovum or Anembryonic Pregnancy: A fertilized egg attaches itself to the uterine wall, and conception occurs, but it doesn’t develop into an embryo as the pregnancy progresses. In such instances, the woman may experience signs of pregnancy and will still get a positive pregnancy test result because the placenta produces human chorionic gonadotropin.
- Chromosomal Abnormalities: These abnormalities are found in the baby in most miscarriages occurring in the first trimester. This may have nothing to do with the parents’ genetic condition. However, when repeated spontaneous abortions occur, there may be a genetic angle to it.
- Progesterone Deficiency: Progesterone is a key hormone that helps support a developing embryo. Progesterone is responsible for maintaining the uterine lining and reducing the chances of the mother’s immune system attacking the foetus as a foreign substance. Decreased progesterone during pregnancy can cause recurrent miscarriages.

Other possible reasons: Infections, hormonal problems, malnutrition, smoking(including second-hand smoke), drug and alcohol abuse, uncontrolled diabetes, problems in the reproductive organs, obesity, exposure to environmental toxins, Polycystic Ovary Syndrome, etc.

Risk Factors

Miscarriages can happen to any woman, but some are more likely to have them. Some of the risk factors are:

Age: Miscarriages increase steadily with maternal age because the chances of chromosomal abnormality are greater. The risk may also arise with the father’s age.

Problems in the reproductive organs: Scar tissues in the uterus, cervical insufficiency (premature dilating of the narrow tubular structure at the upper end of the vagina), etc., increase the risk of miscarriages.

Infections: Certain infections like mumps, measles, rubella, listeria, cytomegalovirus, gonorrhoea, etc., may increase the risk of miscarriage.

Lifestyle: Smoking, alcohol consumption and using drugs during pregnancy can increase the risk of miscarriage. High levels of caffeine consumption and an increased risk of miscarriage have been linked in some studies.

Medications: It’s best to know the safety of any medications taken during the pregnancy and even before conception. Some drugs have been linked to an increased risk of miscarriage.

Obesity: It has been associated with an increased risk of pregnancy complications – from miscarriage to complications in advanced pregnancy. Also, women with Polycystic Ovarian Syndrome (PCOS) are more likely to be overweight.

Chronic diseases: Uncontrolled diabetes, Polycystic Ovary Syndrome, blood clotting disorders, autoimmune disorders, etc., could increase the risk of miscarriage.

Environmental factors: Exposure to lead, benzene, arsenic, formaldehyde, and large doses of radiation are some of the risk factors. According to some studies, even the father being exposed to lead, mercury, industrial chemicals, and pesticides may be linked to a greater risk of miscarriage.

History of miscarriages: Most of those who have experienced up to two or three losses may go on to have a successful pregnancy the next time. But having recurrent miscarriages in a row increases the chances to miscarry again.

Congenital Disability in the child from a previous pregnancy: Research has shown that women who have a child with a congenital disability are at an increased risk of miscarriage or giving birth to another baby with such disability. The chances of subsequent chromosomal abnormalities in the foetus increase, particularly in women who are above 35 years of age.

Genetic abnormality in the family

Prenatal diagnostic tests: There is a very low risk of miscarriage due to prenatal diagnostic genetic testing like amniocentesis and Chorionic villus sampling (CVS).

Prevention

Though miscarriage cannot be prevented, there are many ways to lower the risk of it happening.

Avoid smoking while pregnant.

Avoid consumption of alcohol and narcotics during pregnancy.

Consume a balanced diet rich in fruits and vegetables.

Take precautions against infections like rubella (German measles) when pregnant.

Maintain a healthy pre-pregnancy weight. Though there is no evidence which links the loss of weight during pregnancy and decrease in miscarriage risk, consuming a healthy diet and exercising are beneficial to pregnant women.

In cases where an individual was not leading an active lifestyle pre-pregnancy, it would be advisable to get an exercise regimen from the treating physician before starting exercises.

Avoid foods that may harm you or your baby when pregnant.

Get treatment for Antiphospholipid Syndrome (APS), or Hughes Syndrome, in which blood clots are formed. Research has proven that women with this condition can be treated with a combination of heparin and aspirin (medications to prevent clotting of blood) to improve pregnancy.

In the case of a weakened cervix, or cervical insufficiency, a surgery involving the closing of the cervix by stitching a strong thread around it can be performed within the first 12 weeks of the pregnancy.

Diagnosis

The gynaecologist may perform pelvic exams, foetal heart scan, ultrasound scan and HCG level (human chorionic gonadotropin) testing to confirm the miscarriage. An ultrasound can also show the empty pregnancy sac of a blighted ovum.

Blood tests may be performed to determine the blood type or rule out infection. In the case of repeated miscarriages, other tests may be done.

For ruling out chromosomal abnormalities, genetic testing is done. If any abnormalities in the endometrium (inner lining of the uterus) are suspected, an endometrial biopsy is done.

Hysterosalpingogram may be done to rule out any structural abnormality of the uterus, uterine fibroids, or adhesions, which may cause miscarriage.

If the uterus needs to be further probed for issues, a hysteroscope or laparoscope is inserted through the vagina into the uterus.

Treatment

Treatment aims to avoid heavy bleeding and infection. With no treatment, in most of these cases, nature takes its course. The tissue will pass naturally within two to six weeks. No further treatment is usually required if the miscarriage is complete and the uterus is empty. Sometimes, to encourage completion of the process, specific medicines may be prescribed. If that doesn’t help, surgery may be needed to remove the remaining contents from the womb.

Dilatation and Curettage (D&C) is a minor surgical procedure done under local, spinal or general anaesthesia. The remaining pregnancy tissue is removed through the cervix. The procedure takes five to ten minutes. The normal menstrual cycle should resume within four to six weeks.

Suppose any tissue from the foetus remains in the uterus after the miscarriage. In that case, there are chances of infection with symptoms like fever, cramping, foul-smelling vaginal discharge and vaginal bleeding that does not stop. It needs immediate medical care. The risk of complications from D&C includes injury to the cervix and uterus and potential scarring of the intrauterine lining.

Vacuum aspiration may be done under local anaesthesia in the doctor’s office. This procedure involves suctioning the pregnancy tissue from the uterus via insertion of a thin tube into the uterus.

It takes time to heal both physically and emotionally. Physical recovery from miscarriage may take a few hours to a couple of days. Though the WHO recommends waiting for at least six months before trying to conceive again, some researchers suggest that the sooner one starts trying, the better. One need not wait to conceive after miscarriage if she is healthy and emotionally ready. If she has had repeated miscarriages, it is recommended to get tests done to determine the cause before attempting another pregnancy.

Prognosis

After a miscarriage, it may be possible to have another normal pregnancy and birth. Though it is not recommended to wait before trying to conceive again, it would be better to discuss with one’s physician. Identifying the cause of the miscarriage can prevent reoccurrences. Individuals deal differently with a miscarriage. Some may want to have a memorial service in remembrance of the loss of their pregnancy. Others may go through a period of bereavement, which may last for several weeks. The emotional impact of a miscarriage may exhibit physical signs like loss of appetite, tiredness, emotional symptoms like shock, guilt, or anger towards other women who have had positive pregnancies. It may also be beneficial to counsel the father too. Receiving support via support groups or counselling can help get over this loss.