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General Illness Information

Common Name:

Miscarriage (Spontaneous abortion)

Medical Term:

Spontaneous abortion

Description:

Spontaneous termination of pregnancy within 20 weeks of fetal age. At this stage. the fetus is considered to be unable to survive outside the uterus. About 20% of recognized pregnancies terminate in spontaneous abortions and 75% of these occur before the 8th week. Frequently the miscarriage occurs so early in pregnancy that the woman is not aware that she is pregnant.

Causes:

60% of spontaneous abortions result from chromosomal defects due to maternal or paternal factors. 15% are caused by maternal trauma, infections, diabetes mellitus, dietary deficiencies, hypothyroidism or uterine abnormalities eg. fibroids; cervical incompetence. In 25% of cases, the cause in unknown.

There is no evidence that miscarriage can be caused by psychological factors such as stress, anxiety, fright or grief.

Prevention:

During pregnancy:

Obtain regular checkups, eat a normal, well-balanced diet. Don't drink alcohol, smoke cigarettes, or use drugs. Don't use any medications, including non-prescription drugs, without medical advice. Start folic acid prior to or at onset of pregnancy.

Signs & Symptoms

	Vaginal bleeding ranging from slight to heavy bleeding. Usually accompanied by passage of clots.
	Lower abdominal pain caused by uterine cramps.
	If examination reveals that the cervix is dilated then miscarriage is considered inevitable.
	Many miscarriages are only "threatened", and the pregnancy continues to term. However symptoms may be the same for threatened miscarriage as for those in spontaneous abortion.

Risk Factors

	History of previous spontaneous abortions.
	Infections.
	Diabetes.
	Multiple pregnancies.
	Smoking.
	Drug abuse. Alcohol abuse.

Diagnosis & Treatment

The diagnosis is made on clinical examination. Ultrasound examination and laboratory blood studies (B-HCG) may be needed to confirm the diagnosis.

General Measures:

For a threatened miscarriage, follow doctor's orders.

Bed rest at home is often enough to stabilize the pregnancy. Do not use hormones, douches or tampons.

If bleeding is severe, hospitalization and blood transfusion may be required.

After a miscarriage:

Expect a small amount of vaginal bleeding or spotting for 8 to 10 days. Don't use tampons for 2 to 4 weeks.

Wait through 2 or 3 normal menstrual cycles before attempting to become pregnant.

Occasionally dilatation and curettage is necessary to remove any remaining tissue.

Psychotherapy or grief counseling for patient and her partner may be helpful.

Medications:
	For a threatened miscarriage: medications are usually not necessary. Don't take any medication without medical advice.
	After a miscarriage, antibiotics may be prescribed to fight infection.
	Blood transfusions for severe blood loss.
	Rh negative female may be given RhD (immune globulin).

Activity:

For a threatened miscarriage: Rest in bed until symptoms disappear. Avoid sexual intercourse until the outcome is known.

After a miscarriage: Reduce activity and rest often during the next 3-4 days.

Diet:
	For a threatened miscarriage: Drink fluids only, if bleeding and cramping severe.
	After miscarriage: No special diet.

Possible Complications :
	Uterine infection, signaled by fever, chills, and aching.
	Hemorrhage from the uterus, and rarely from other areas of the body.
	Anemia from excessive blood loss.
	"Incomplete" abortion, in which some placental or fetal tissue remains in the uterus.
	"Missed" abortion, in which the fetus dies but remains in the uterus.

Prognosis

With treatment, a miscarriage is not a life-threatening condition. It does not affect a woman's ability to carry a healthy baby to term in the future.

Feelings of loss and grief are common. Feelings of guilt may also be present. If these persist, seek emotional help.

Other

Nothing Specified.