Miscarriage – causes, symptoms and diagnosis

What is a miscarriage?

A miscarriage is the spontaneous loss of the fetus from conception to the twentieth week of pregnancy. If the pregnancy has lasted more than 20 weeks, the term is no longer a miscarriage, but a stillbirth.

However, the term abortion is used not only for the spontaneous loss of the fetus, but also for the intentional termination of pregnancy at the mother’s will.

Most miscarriages occur in the first trimester of pregnancy, between the 7th and 12th week of pregnancy.

How common is abortion?

Abortion is very common. Between 10 and 20% of test- or research-proven pregnancies end in abortion. However, experts warn that the percentage is much higher.

According to most doctors, approximately 50% of pregnancies end in abortion, but this happens at a very early stage of pregnancy and the mother does not even realize it. In many cases, the fertilized egg has not even managed to implant yet.

What causes an abortion?

In most cases, an abortion occurs because the fetus has some genetic defect that would prevent it from surviving and developing normally.

Usually, this damage to the fetus has nothing to do with genetic problems in the mother. Other causes of miscarriage can be diabetes or thyroid disease in the mother, as well as some viral infections that have reached the placenta .

What are the risk factors?

In general, risk factors for miscarriage include the following:
Older maternal age
Cigarette smoking (>10 cigarettes per day)
Moderate to heavy alcohol consumption
Uterine trauma
Radiation exposure
Previous miscarriage
Extremes in maternal weight
Anatomical abnormalities of the uterus
Drug use

What’s the risk?

Usually, women’s risk of having a miscarriage is estimated to be less than 20%, but if they’ve had a previous miscarriage, especially more than one, the rate rises to about 43%.

What are the types of miscarriage?

Spontaneous abortions are sometimes referred to by specific names to reflect the type and characteristics of the abortion.

– Danger of abortion: a woman may experience vaginal bleeding or other signs of abortion, but not have a miscarriage;

– Incomplete abortion: only the fetus or the placenta is expelled from the uterus;

– Complete abortion: all parts of the pregnancy tissue are discarded;

– Missed abortion: the fetus does not develop, so it is not a viable pregnancy, but the placental tissue is still in the uterus;

– Septic abortion: spontaneous abortion in which there is infection of the fetus and the pregnancy;

What are the signs and symptoms of a miscarriage?

Vaginal bleeding and pelvic pain are some of the hallmark symptoms of a miscarriage. Any vaginal bleeding during pregnancy should be investigated and its origin determined, although not all cases of bleeding are the result of miscarriage.

Bleeding in the first trimester of pregnancy is possible and does not necessarily mean miscarriage.

The pain tends to be in the form of cramping and may come and go or be constant. Sometimes there is expulsion of fetal or placental tissue. A whitish and blood-covered material may appear.

Blood clots may also be present in vaginal bleeding. The degree of bleeding does not necessarily correspond to the severity of the condition. A condition with the same bleeding can vary from mild to severe.

How is a miscarriage diagnosed?

If a woman has symptoms of a miscarriage, an ultrasound is usually done. Ultrasound can determine if everything is fine with the pregnancy if fetal tones are present.

Ultrasound can also reveal whether the pregnancy is ectopic (whether the fetus is outside the uterus, usually in the fallopian tubes), which can cause similar symptoms and signs as a miscarriage.

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Other tests that may be performed include blood tests for hormones, blood cell counts to determine the extent of blood loss or whether an infection is present, a pelvic exam, and more.

The mother’s blood type will also be checked in case of miscarriage. Rh-negative women can receive an injection of Rho-D immunoglobulin (RhoGam) to prevent problems in future pregnancies.

What happens after a miscarriage?

There is no specific treatment that can possibly stop a miscarriage that has already started, although women who are at risk may be advised to rest on bed, abstain from sexual activity, and limit all activities until all warning signs have resolved.

If the miscarriage has already occurred, nothing can be done. In most cases, if there is no severe pain and cramping or heavy blood loss, no treatment is necessary. Sometimes after an abortion it is necessary to perform a short procedure to remove the remaining materials from the aborted pregnancy.

As mentioned above, women who are Rh-negative receive a dose of Rho-D immunoglobulin to prevent complications in future pregnancies.

If the miscarriage is due to an infection, antibiotic treatment may be required.

Abortion is a common occurrence. For couples who have had more than two miscarriages, diagnostic tests may be recommended to detect genetic, hormonal or anatomical problems.

Some doctors recommend testing the couple after a second miscarriage, especially if the woman is over 35 years of age.

What is the outlook for future pregnancies after an abortion?

Most women who experience a miscarriage go on to have a successful pregnancy. The likelihood of miscarriage in a future pregnancy increases with the number of miscarriages a woman has had.

Overall, the risk of a second miscarriage in women who have had one miscarriage averages about 15% (ranging from 10 to 20%). The risk increases in women who have had two miscarriages.

Most women will have a period again within 4 to 6 weeks after an abortion. Your doctor can advise you when you can start trying to conceive again.

Although it is possible to get pregnant again after menstruation has returned, some doctors advise women to wait longer, such as another menstrual cycle or more, to allow enough time for the mother-to-be to recover physically and emotionally.

Can miscarriage be prevented?

There is no evidence that bed rest can help prevent miscarriage, but women who have vaginal bleeding during pregnancy are often advised to rest more and limit sexual activity until potential signs of abortion disappear.

Some risk factors for miscarriage may be minimized by maintaining a normal weight and by avoiding the use of alcohol, drugs, or tobacco products.

Getting tested for all sexually transmitted infections can also reduce the risk of miscarriage. Avoiding certain sports, such as horse riding or skiing, can reduce the risk of trauma to the uterus.

In most cases, however, the cause of a miscarriage is beyond the woman’s control.