Miscarriage

Miscarriage

A miscarriage is the spontaneous loss of a fetus before the 20th week of pregnancy. (Pregnancy losses after the 20th week are called preterm deliveries.)

A miscarriage may also be called a "spontaneous abortion." This refers to naturally occurring events, not medical abortions or surgical abortions.

Other terms for the early loss of pregnancy include:

• Complete abortion: All of the products of conception exit the body
• Incomplete abortion: Only some of the products of conception exit the body
• Inevitable abortion: The symptoms cannot be stopped, and a miscarriage will happen
• Infected (septic) abortion: The lining of the womb, or uterus, and any remaining products of conception become infected
• Missed abortion: The pregnancy is lost and the products of conception do not exit the body

See also: Threatened miscarriage

Causes, incidence, and risk factors

Most miscarriages are caused by chromosome problems that make it impossible for the baby to develop. Usually, these problems are unrelated to the mother or father's genes.

Other possible causes for miscarriage include:

• Drug and alcohol abuse
• Exposure to environmental toxins
• Hormone problems
• Infection
• Obesity
• Physical problems with the mother's reproductive organs
• Problem with the body's immune response
• Serious body-wide ( systemic) diseases in the mother (such as uncontrolled diabetes)
• Smoking

It is estimated that up to half of all fertilized eggs die and are lost (aborted) spontaneously, usually before the woman knows she is pregnant. Among those women who know they are pregnant, the miscarriage rate is about 15-20%. Most miscarriages occur during the first 7 weeks of pregnancy. The rate of miscarriage drops after the baby's heart beat is detected.

The risk for miscarriage is higher in women:

• Older age, with increases beginning by 30, becoming greater between 35 and 40, and highest after 40
• Who have had previous miscarriages

Symptoms

Possible symptoms include:

• Low back pain or abdominal pain that is dull, sharp, or cramping
• Tissue or clot-like material that passes from the vagina
• Vaginal bleeding, with or without abdominal cramps

Signs and tests

During a pelvic exam, your health care provider may see the cervix has opened (dilated) or thinned out (effacement).

Abdominal or vaginal ultrasound may be done to check the baby's development, heart beat, and amount of bleeding.

The following blood tests may be performed:

• Blood type (if you have an Rh-negative blood type, you would require a treatment with Rh-immune globulin. See: Rh incompatibility)
• Complete blood count (CBC) to determine how much blood has been lost
• HCG (qualitative) to confirm pregnancy
• HCG (quantitative) done every several days or weeks
• WBC and differential to rule out infection

Treatment

When a miscarriage occurs, the tissue passed from the vagina should be examined to determine if it was a normal placenta or a hydatidiform mole. It is also important to determine whether any pregnancy tissue remains in the uterus.

If the pregnancy tissue does not naturally exit the body, the woman may be closely watched for up to 2 weeks. Surgery (D and C) or medication (such as misoprostol) may be needed to remove the remaining contents from the womb.

After treatment, the woman usually resumes her normal menstrual cycle within 4 - 6 weeks. Any further vaginal bleeding should be carefully monitored. It is often possible to become pregnant immediately. However, it is recommended that women wait one normal menstrual cycle before trying to become pregnant again.

Complications

An infected abortion may occur if any tissue from the placenta or fetus remains in the uterus after the miscarriage. Symptoms of an infection include fever, vaginal bleeding that does not stop, cramping, and a foul-smelling vaginal discharge. Infections can be serious and require immediate medical attention.

Complications of a complete miscarriage are rare. However, many mothers and their partners feel very sad. Seemingly helpful advice like "you can try again," or "it was for the best" can make it harder for mothers and fathers to recover because their sadness has been denied.

Women who lose a baby after 20 weeks of pregnancy receive different medical care. This is called premature delivery or fetal demise and requires immediate medical attention.

Calling your health care provider

Call your health care provider if vaginal bleeding with or without cramping occurs during pregnancy.

Call your health care provider if you are pregnant and notice tissue or clot-like material passed vaginally (any such material should be collected and brought in for examination).

Prevention

Early, comprehensive prenatal care is the best prevention available for all complications of pregnancy.

Many miscarriages that are caused by body-wide (systemic) diseases can be prevented by detecting and treating the disease before pregnancy occurs.

Miscarriages are less likely if you receive early, comprehensive prenatal care and avoid environmental hazards (such as x-rays, drugs and alcohol, high levels of caffeine, and infectious diseases).

When a mother's body is having difficulty sustaining a pregnancy, signs (such as slight vaginal bleeding) may occur. This means there is a possibility of miscarriage, but it does not mean one will definitely occur. A pregnant woman who develops any signs or symptoms of threatened miscarriage should contact her prenatal provider immediately.

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Smoking during pregnancy

Smoking during pregnancy
Like drinking too much alcohol or doing drugs, smoking is also very harmful to your health. It can cause serious health conditions including cancer, heart disease, stroke and gum disease. It can also cause eye diseases that can lead to blindness. Smoking can make it harder for a woman to get pregnant.

Smoking and your baby

Not only is smoking harmful to you, it's also harmful to your baby during pregnancy. When you smoke during pregnancy, your baby is exposed to dangerous chemicals like nicotine, carbon monoxide and tar. These chemicals can lessen the amount of oxygen that your baby gets. Oxygen is very important for helping your baby grow healthy. Smoking can also damage your baby's lungs.

Women who smoke during pregnancy are more likely to have:

• An ectopic pregnancy
• Vaginal bleeding
• Placental abruption (placenta peels away, partially or almost completely, from the uterine wall before delivery)
• Placenta previa (a low-lying placenta that covers part or all of the opening of the uterus)
• A stillbirth

Babies born to women who smoke during pregnancy are more likely to be born:

• With birth defects such as cleft lip or palate
• Prematurely
• At low birthweight
• Underweight for the number of weeks of pregnancy

Babies born prematurely and at low birthweight are at risk of other serious health problems, including lifelong disabilities (such as cerebral palsy, mental retardation and learning problems), and in some cases, death. 

Secondhand smoke

Breathing in someone else's smoke is also harmful. Secondhand smoke during pregnancy can cause a baby to be born at low birthweight. Secondhand smoke is also dangerous to young children. Babies exposed to secondhand smoke:

• Are more likely to die from SIDS (Sudden Infant Death Syndrome)
• Are at greater risk for asthma, bronchitis, pneumonia, ear infections, respiratory symptoms
• May experience slow lung growth

Thirdhand smoke

New research shows that thirdhand smoke is another health hazard. Thirdhand smoke is made up of the toxic gases and particles left behind from cigarette or cigar smoking. These toxic remains, which include lead, arsenic and carbon monoxide, cling to things like clothes, hair, couches and carpets well after the smoke from a cigarette or cigar has cleared the room. That's why you often can tell a smoker by the smell of cigarettes or cigars that linger on his clothing or in his home or car. Things like cracking the car window down while you smoke or smoking in another room aren't enough to keep others away from the harm caused by cigarettes or cigars.

Breathing in these toxins at an early age (babies and young children) may have devastating health problems like asthma and other breathing issues, learning disorders and cancer. It's important that expecting moms and their children do their best to keep away from places where people smoke.

Reasons to quit

The sooner you quit smoking during pregnancy, the healthier you and your baby will be. It's best to quit smoking before getting pregnant. But if you're pregnant, this would be a great opportunity to kick the habit.

Some women may mistakenly think that switching to "light" or "mild" cigarettes are a safer choice during pregnancy. Other pregnant women may want to cut down on smoking rather than quitting altogether. It's true that the less you smoke, the better off baby will be. But quitting smoking is the best way to help ensure a healthy pregnancy and healthy baby.

Besides, when you quit smoking, you'll never again have to go outside and look for a place to smoke. You'll also have:

• Cleaner teeth
• Fresher breath
• Fewer stain marks on your fingers
• Fewer skin wrinkles
• A better sense of smell and taste
• More strength and ability to be more active

Tips to quit

• Write down your reasons for quitting. Look at the list when you are tempted to smoke.
• Choose a "quit day." On that day, throw away all your cigarettes or cigars, lighters and ashtrays.
• Drink plenty of water.
• Keep your hands busy using a small stress ball or doing some needlework.
• Keep yourself occupied, too. Try going for a walk or doing chores to keep your mind off of cravings.
• Snack on some raw veggies or chew some sugarless gum to ease the need to have something in your mouth.
• Stay away from places, activities or people that make you feel like smoking.
• Ask your partner or a friend to help you quit. Call that person when you feel like smoking.
• Ask your health care provider about quitting aids such as patches, gum, nasal spray and medications.
• Don't start using these without your health care provider's okay, especially if you're pregnant.
• Don't get discouraged if you don't quit completely right away. Keep trying. If you can't quit, cut back as much as you can.
• Ask your employer to see what services are offered or covered by insurance.
• Learn about smoking cessation programs in your community or from your employer. You can get more information from you health care provider, hospital or health department.

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