A miscarriage is defined as the spontaneous loss of a fetus before it is viable, which in the United States is the 20th week of pregnancy. The medical term for miscarriage is "spontaneous abortion."
Miscarriage is one of the most common complications associated with early pregnancy. Sadly, around one-quarter of all pregnancies result in miscarriage.
Most miscarriages occur during the first few months of pregnancy. An estimated 85 percent of miscarriages happen before week 12. A woman may have a miscarriage before she knows she is pregnant.
Although miscarriage is relatively common, it can be an extremely traumatic and devastating experience.
The main sign of miscarriage is vaginal spotting or bleeding, which can vary from slight brownish discharge to very heavy bleeding.
Other symptoms include:
- cramping and pain in the abdomen
- mild to severe back pain
- weight loss
- fluid discharge from the vagina
- tissue or clotted discharge from the vagina
- feeling faint or light-headed
If you are pregnant and experience any of these symptoms, contact your doctor, midwife, or antenatal clinic immediately.
Ectopic pregnancy and miscarriage
An ectopic pregnancy is when the fertilized egg settles and grows outside the inner lining of the uterus, instead of inside.
Around 1–2 percent of all pregnancies are ectopic. If left untreated, they can be fatal because of internal bleeding, and the risk of losing the baby is increased.
Symptoms of an ectopic pregnancy are:
Shoulder tip pain - where the shoulder ends and the arm begins; this is more evident when the woman is lying down; also:
- severe abdominal pain
- feeling light-headed
There are a variety of terms that doctors use when discussing miscarriage, these include:
Threatened miscarriage: Some bleeding in early pregnancy with lower backache. Cervix stays closed. In this case, the pregnancy continues.
Inevitable or incomplete miscarriage: Abdominal or back pain, bleeding, and an open cervix. If the cervix is open, the miscarriage is considered inevitable.
Complete miscarriage: The embryo empties out of the uterus. Bleeding and pain subside quickly.
Missed miscarriage: The embryo has died, but there are no other symptoms, such as bleeding or pain.
Recurrent miscarriage: This is defined as three or more miscarriages during the first trimester.
The aim of treatment following or during a miscarriage is to prevent hemorrhaging (bleeding) and infection. Normally, the body expels the fetal tissue on its own, especially earlier in the pregnancy. However, if it does not, a doctor may perform a dilation and curettage (D and C).
During a D and C, a doctor opens the cervix and inserts a thin instrument into the uterus to remove tissue. After the procedure, drugs may be prescribed to control bleeding.
Miscarriage can happen for a range of reasons.
Placental problems: If the placenta develops abnormally, blood supply from the mother to the baby is interrupted.
Chromosome problems: Sometimes, a fetus can receive the wrong number of chromosomes, causing abnormal development of the fetus. Miscarriages that occur during the first trimester are mainly related to chromosomal abnormalities in the baby.
Womb structure abnormalities: Abnormally shaped wombs and the development of fibroids (non-cancerous growths) in the womb can put a developing fetus at risk.
Polycystic ovary syndrome (PCOS): This occurs when the ovaries are too big, causing a hormonal imbalance.
Weakened cervix: The cervix is the neck of the womb. When the muscles of the cervix are weak, they can open up too early during pregnancy, resulting in miscarriage.
Lifestyle factors: Habits such as smoking, drinking alcohol, or using illegal drugs can lead to miscarriage.
Underlying health conditions
Underlying health conditions among pregnant woman that are associated with miscarriage include:
- high blood pressure
- coeliac disease
- kidney disease
- thyroid gland problems
Being overweight or underweight
Women with a low body mass index before they become pregnant are also at a heightened risk of miscarriage. Research published in the International Journal of Obstetrics and Gynaecology reported that underweight women were 72 percent more likely to suffer a miscarriage during their first 3 months of pregnancy, compared with women whose weight was healthy.
Be aware of current medications
It is crucial to check with a doctor which medications are safe to take during pregnancy. Medicines that should be avoided (if possible) while pregnant include:
A meta-analysis published in the European Journal of Epidemiology combined data from 60 studies and concluded:
"Greater caffeine intake is associated with an increase in spontaneous abortion, stillbirth, low birth weight, and SGA, but not preterm delivery."
The World Health Organization (WHO) advises that women who consume more than 300 milligrams (mg) of caffeine per day should reduce their intake.
There are many misconceptions regarding miscarriage. Many people believe that having sex and/or exercising can result in miscarriage, but there is no evidence to suggest this. However, some types of exercise would not be suitable for a woman who is 8 months pregnant. If you are pregnant, ask your doctor which exercises are appropriate.
In many cases, a miscarriage has no apparent cause.
The tests used to diagnose miscarriage are:
Ultrasound scans: Transvaginal ultrasounds involve placing a small probe into the vagina to check for the heartbeat of the fetus. Some women may choose to undergo an external abdominal ultrasound instead to avoid discomfort.
Blood tests: These are useful because they can determine if levels of beta-human chorionic gonadotropin (hCG) and progesterone are normal - both of these hormones are associated with a healthy pregnancy.
Pelvic exams: These determine whether the cervix has thinned out or opened.