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by Wood D

Miscarriage

(Spontaneous Abortion)

Definition

Miscarriage is the end of a pregnancy before the baby is able to survive outside the uterus. Miscarriage can occur during the first or second trimester, before 20 weeks. Most happen in the first 12 weeks of pregnancy. They often are unexpected and isolated events.
Fetus in First Trimester
Nucleus image
Copyright © Nucleus Medical Media, Inc.

Causes

Miscarriages often occur for the following reasons:
  • Problems in the chromosomes (common cause)
  • Abnormal structure or issues in the uterine tract, such as fibroids
  • Problem with hormones, such as not having enough hormone (progesterone) to support pregnancy
  • Immune system related problems, such as blood-clotting problems or rejection of the fetus
  • Trauma
For some, the cause of miscarriage is unknown.

Risk Factors

Miscarriages are more common in women 35 years and older. Other things that may increase the chance of a miscarriage are:
  • Infection
  • Smoking , drinking alcohol , or using drugs during pregnancy
  • Certain medicine
  • Exposure to certain environmental toxins
  • Autoimmune disorders, such as systemic lupus erythematosus
  • High-dose radiation therapy on the ovaries, uterus, or the pituitary gland during treatment of childhood cancers

Symptoms

Miscarriage may cause:
  • Vaginal bleeding
  • Pink or brown discharge
  • Cramping
  • Passing the fetus, placenta, and surrounding membranes through the vagina
  • Fever

Recurrent Miscarriage

Miscarriage is often a one-time occurrence. Couples who have 2 or more miscarriages should have a complete medical exam. It may help to understand the cause. This may prevent another miscarriage.

Diagnosis

The doctor will ask about symptoms, length of pregnancy, and when changes happened. Physical and pelvic exams will be done. Passed tissue may be examined. The uterus may also be examined with:
  • Ultrasound
  • Hysteroscopy —to examine the inside of the uterus

Treatment

Early or first trimester miscarriages may only need observation. Medicine may be needed if there is heavy bleeding or cramping.
A dilation and evacuation (D&E) may be needed if all tissue does not pass through the vagina. The doctor will remove remaining tissue.

Support Services

Miscarriage carries emotional challenges as well. Many women have grief, anger, guilt, and more. A counselor or support group may help.

Prevention

Treatment may help prevent future miscarriages if a specific cause was found.

RESOURCES

The American Congress of Obstetricians and Gynecologists
http://www.acog.org
March of Dimes
http://www.marchofdimes.org

CANADIAN RESOURCES

The Society of Obstetricians and Gynaecologists of Canada
https://sogc.org
Women's Health Matters
http://www.womenshealthmatters.ca

References

First trimester pregnancy loss. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/first-trimester-pregnancy-loss . Updated January 24, 2020. Accessed March 19, 2020.
Jurkovic D, Overton C, Bender-Atik R. Diagnosis and management of first trimester miscarriage. BMJ. 2013 Jun 19;346.
Miscarriage. American Pregnancy Association website. Available at: http://americanpregnancy.org/pregnancy-complications/miscarriage. Updated MAy 2, 2017. Accessed March 19, 2020.
Miscarriage. March of Dimes website. Available at: http://www.marchofdimes.com/loss/miscarriage.aspx. Updated July 2012. Accessed March 19, 2020.
Second trimester pregnancy loss. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T904101/Second-trimester-pregnancy-loss . Updated May 10, 2017. Accessed March 19, 2020.
Recurrent pregnancy loss. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/second-trimester-pregnancy-loss . Updated January 24, 2020. Accessed March 19, 2020.

Revision Information

  • Reviewer: EBSCO Medical Review Board Mary-Beth Seymour, RN
  • Review Date: 09/2019
  • Update Date: 03/19/2020
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