Miscarriage
Miscarriage is the loss of a pregnancy without obvious cause before the 20th week. About 15 percent of known pregnancies end in miscarriage, according to the American College of Obstetricians and Gynecologists (ACOG). But the actual number is probably much higher because many miscarriages occur so early in pregnancy that a woman doesn't even know she's pregnant.
Most miscarriage occurs before the 12th week of pregnancy. Signs and symptoms include:
- Vaginal spotting or bleeding
- Pain or cramping in your abdomen or lower back
- Fluid or tissue passing from your vagina
Causes
Most miscarriages occur because the fetus isn't developing normally. Problems with the baby's genes or chromosomes are typically the result of errors that occur by chance as the embryo divides and grows — not problems inherited from the parents.
In a few cases, a mother's health condition — such as uncontrolled diabetes, thyroid disease, infections, blood-clotting problems, or problems with the uterus or cervix — may lead to miscarriage.
Routine activities — such as exercising, having sex, working or lifting heavy objects — can't provoke a miscarriage. Nausea and vomiting in early pregnancy, even if it's severe, won't cause a miscarriage. And a fall or other injury is unlikely to cause a miscarriage, unless the injury is serious enough to threaten your own life.
Risk Factors
Various circumstances increase the risk of miscarriage, including:
- Age. Women older than age 35 have a higher risk of miscarriage than do younger women. Paternal age also may play a role. In a 2006 study, women whose partners were age 40 or older had a higher risk of miscarriage than did women whose partners were younger than age 25.
- Previous miscarriages. The risk of miscarriage is higher in women with a history of two or more previous miscarriages. After one miscarriage, your risk of miscarriage is the same as that of a woman who's never had a miscarriage.
- Chronic conditions. Women with certain chronic conditions, such as diabetes or thyroid disease, have a higher risk of miscarriage.
- Uterine or cervical problems. Certain uterine abnormalities or a weak or unusually short cervix may increase the risk of miscarriage.
- Smoking, alcohol and illicit drugs. Women who smoke or drink alcohol during pregnancy have a greater risk of miscarriage than do nonsmokers and women who avoid alcohol during pregnancy. Illicit drug use also increases the risk of miscarriage.
- Caffeine. The evidence linking caffeine consumption and miscarriage is inconclusive. Because of the unknowns, your doctor may recommend limiting caffeine intake to less than 200 milligrams a day.
- Invasive prenatal tests. Some prenatal genetic tests, such as chorionic villus sampling and amniocentesis, carry a slight risk of miscarriage.
In the vast majority of cases, there's nothing you can do to prevent a miscarriage. Simply focus on taking good care of yourself and your baby. Seek regular prenatal care, and avoid known risk factors — such as smoking and drinking alcohol. If you have a chronic condition, work with your health care team to keep it under control.
Preliminary research suggests that treatment with aspirin or another blood thinner to prevent blood clots may improve the chances of a successful pregnancy for women with unexplained recurrent miscarriages. If you've had three or more miscarriages without an identifiable cause, ask your doctor if this might be an option for you.
Treatment
If you're having a threatened miscarriage, your doctor may recommend resting until the bleeding or pain subsides. You may be asked to avoid exercise and sex as well. It's also a good idea to avoid traveling — especially to areas where it would be difficult to receive prompt medical care.
In the case of an inevitable miscarriage — or after a miscarriage occurs — you may have various treatment options.
- Expectant management. If an ultrasound reveals a miscarriage before you have any signs or symptoms, you may choose to let the miscarriage progress naturally. Usually this happens within a few weeks of determining that the embryo has died.
- Medical treatment. If a miscarriage is inevitable and you'd prefer to speed the process, medication can cause your body to expel the pregnancy tissue and placenta. Although you can take the medication by mouth, your doctor may recommend applying the medication vaginally to increase its effectiveness and minimize side effects, such as nausea, vomiting, cramping and diarrhea. The miscarriage will likely happen at home. The specific timing may vary.
- Surgical treatment. If your cervix is dilated and you're bleeding or in pain — or you've had a miscarriage but some of the pregnancy tissue or placenta remains in your uterus — you may need a minor surgical procedure called dilation and curettage (D and C). During this procedure, the doctor dilates your cervix and gently suctions the tissue out of your uterus. Sometimes a long metal instrument with a loop on the end (curet) is used after the suction to scrape the uterine walls. Complications are rare, but may include damage to the connective tissue of your cervix or the uterine wall.
Informations obtained from National Institute of Health.