Miscarriage

measurement of the blood pressureLosing a pregnancy or miscarriage is one of the most common complications in the first trimester and can be a very difficult time for women. In the United States this is defined as a loss of pregnancy less than 20 weeks old. The World Health Organization defines a miscarriage as a loss of a pregnancy/fetus that weighs less than 500gm. Most miscarriages will occur before 12 weeks and up 25% of women will experience a miscarriage.

Causes

Reasons for miscarriages are often unclear, but the majority of miscarriages is caused due to a genetic problem and stops developing and growing, often these pregnancies would not have resulted in a normal healthy pregnancy. Sometimes the mother has a different shaped uterus or fibroids this can contribute to having a miscarriage. When a mother has structural conditions in the genital tract, this can interfere with implantation of development of the fetus and lead to a miscarriage. Some medical conditions can contribute to miscarriages, such as progesterone deficiency, lupus and uncontrolled diabetes. Other times infections such: Listeria monocytogenes, Toxoplasma Gondi, parvovirus B19, rubella, herpes simplex, cytomegalovirus, lymphocytic choriomeningitis virus can cause a miscarriage. Lower hormonal levels can also contribute to miscarriages. As a woman ages here risks for having a miscarriage also increases. Other environmental and external factors can also contribute to having a miscarriage these include heavy alcohol consumption and heavy smoking and recreational drug use such as cocailne.

Reducing risk

There is no way to make sure that you will not have a miscarriage. But you can reduce your chances of having a miscarriage by reducing some of the risks associated with having one.

  • Stop using recreational drugs, such as cocaine.
  • Stop smoking more than 10 cigarettes a day. Women who smoke more than 10 cigarettes a day have a greater risk of miscarriages. It is believed that smoking this much can cause constriction (squeezing) of the blood vessels that interferes with a healthy pregnancy.
  • Stop drinking more than 3 drinks per week when you are pregnant.  Women who drink more than 3 drinks per week when they are pregnant are at an increased risk for pregnancy in the first 12 weeks.
  • Achieve a BMI that is within normal limits. Women whose BMI is less than 18.5 or more than 25 are at risk for miscarriage.

Symptoms

Bleeding

Most women will have vaginal bleeding. The amount of vaginal bleeding can range in amount and color. Sometimes there will be scant amounts of bleeding and other times you can pass blood clots, especially if you are further along in the pregnancy. Most often it will be red or bright red but it can also be a brownish color. You can also pass tissue which looks different than blood clots and may be a whitish color. The bleeding will usually last a few days.

Pain

The abdominal pain and cramping in a miscarriage can range from minimal and mild cramping to intense pain similar to pain during labor. You may need pain relief medication such as over the counter Tylenol and Ibuprofen.

Tissue

In some cases, women will pass tissue, especially in the early weeks. This may appear to be whitish in color or for women further along you may pass a developed embryo.

In some cases of miscarriage there are no symptoms. The fetus stops developing and remains in the uterus and usually not found until you have your routine ultrasound.

Testing

If your healthcare provider suspects that you are having a miscarriage you will most likely undergo some testing. This can include:

  • Ultrasound—which will help determine a heartbeat and the health of the fetus
  • Blood test—to check your blood type and the  hCG hormone level (human chorionic gonadotropin), in some cases to check your blood level to make sure you have not loss too much blood
  • Gynecological/pelvic exam—to check the vagina and cervix and to see if tissue has passed.

Treatment

Most often your body will pass the tissue and you will return to your pre-pregnant state. Other times you may need a procedure, especially if your body is unable to pass the tissue. This procedure is called a dilation and evacuation is done by a medical doctor. Other times medications can be given to help with passing tissue

Blood Type

It is extremely important to know your blood type. If you have a negative blood type, such as “O negative”, you will most likely need a special injection, Rhogam. If you do not get this injection, then this can create many problems for your future pregnancies.

Emotions

Most women will experience some grief with a miscarriage. It is normal to feel sad or anxious after you have a miscarriage. But some women become truly depressed. If you think you might be depressed, mention it to your healthcare provider. There are treatments and coping strategies that can help.

For some women they may have mixed emotions, many pregnancies are unplanned and a pregnancy loss is not always a period of grief for a woman. It is normal to have these emotions too. Each women experience pregnancy loss differently and it is normal to have varying ranges of emotions.

 

When to call your Healthcare Provider

Not all pelvic or vaginal pain with bleeding will result in a miscarriage is it important to notify your healthcare provider.

  • Anytime you are pregnant and bleeding
  • Anytime you are pregnant and are having vaginal or pelvic pain
  • Anytime you pass tissue or blood clots from your vagina
  • Anytime you develop a fever greater than 100.4

 

 

Common questions

What do I do after a miscarriage?  You should rest after you have had a miscarriage. , you should not have sex or put anything in your vagina until you have follow-up with your healthcare provider. Most times your healthcare provider will monitor some of your blood tests to make sure that you return to the pre-pregnant state.

Will I be able to have a normal pregnancy after a miscarriage?  Most women who have a miscarriage go on to have healthy pregnancies. However, your healthcare provider might suggest that you wait 2 or 3 months before trying to become pregnant again so that your body has time to health and rebuild healthy tissue for another pregnancy. Unfortunately, women who have had a miscarriage are more likely than those who have not to have other miscarriages and women that have had more than 3 should seek the advice of their doctor for further testing to understand better the reason for having miscarriages.

 

References:

  1. Regan L, Rai R. Epidemiology and the medical causes of miscarriage. Baillieres Best Pract Res Clin Obstet Gynaecol 2000; 14:839.
  2. Boklage CE. Survival probability of human conceptions from fertilization to term. Int J Fertil 1990; 35:75, 79.
  3. Armstrong BG, McDonald AD, Sloan M. Cigarette, alcohol, and coffee consumption and spontaneous abortion. Am J Public Health 1992; 82:85.
  4. Chen, B. A., & Creinin, M. D. (2007). Contemporary management of early pregnancy failure. Clinical obstetrics and gynecology, 50(1), 67-88