Miscarriage

General Illness Information

Medical Term: Spontaneous Abortion

Common Name: Miscarriage (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 e.g.. 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 (BHCG) 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 an injection of 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.