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MiscarriageBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/pregnancy-loss-miscarriage/DS01105
Miscarriage is the spontaneous loss of a pregnancy before the 20th week. About 15 to 20 percent of known pregnancies end in miscarriage. But the actual number is probably much higher because many miscarriages occur so early in pregnancy that a woman doesn't even know she's pregnant. Most miscarriages occur because the fetus isn't developing normally.
Miscarriage is a relatively common experience — but that doesn't make it any easier. Take a step toward emotional healing by understanding what can cause a miscarriage, what increases the risk and what medical care might be needed.
Most miscarriages occur before the 12th week of pregnancy. Signs and symptoms include:
- Vaginal spotting or bleeding (although spotting or bleeding in early pregnancy is fairly common)
- Pain or cramping in your abdomen or lower back
- Fluid or tissue passing from your vagina
In most cases, women who experience light bleeding in the first trimester go on to have successful pregnancies. Sometimes even heavier bleeding doesn't result in miscarriage.
When to see a doctor
Call your doctor if you experience:
- Bleeding, even light spotting
- A gush of fluid from your vagina without pain or bleeding
- Passing of tissue from the vagina
You may bring any tissue that is passed into your doctor's office in a clean container. It's unlikely that any testing would define a cause, but confirming the passage of placental tissue helps your doctor determine that your symptoms aren't related to a tubal (ectopic) pregnancy.
Abnormal genes or chromosomes
Most miscarriages occur because the fetus isn't developing normally. Problems with the baby's genes or chromosomes are typically the result of errors that occur by chance as the embryo divides and grows — not problems inherited from the parents. Some examples of abnormalities include:
- Blighted ovum. Blighted ovum occurs when a fertilized egg develops a placenta and membrane but no embryo. Blighted ovum is common — the cause of about half of all miscarriages that occur in the first 12 weeks.
- Intrauterine fetal demise. In this situation the embryo is present but has died before any symptoms of pregnancy loss have occurred. This situation may also be due to genetic abnormalities within the embryo.
- Molar pregnancy. A molar pregnancy, also called gestational trophoblastic disease, is less common, occurring in about 1 in 1,000 pregnancies. It is an abnormality of the placenta caused by a problem at fertilization. In a molar pregnancy, the early placenta develops into a fast-growing mass of cysts in the uterus. This mass may or may not contain an embryo. If it does contain an embryo, the embryo will not reach maturity.
A mother's health conditions
In a few cases, a mother's health condition may lead to miscarriage. Examples include:
- Uncontrolled diabetes
- Thyroid disease
- Hormonal problems
- Uterus or cervix problems
What does NOT cause miscarriage
Routine activities such as these don't provoke a miscarriage:
- Lifting or straining
- Having sex
- Working, provided you're not exposed to harmful chemicals
Various factors increase the risk of miscarriage, including:
- Age. Women older than age 35 have a higher risk of miscarriage than do younger women. At age 35, you have about a 20 percent risk. At age 40, the risk is about 40 percent. And at age 45, it's about 80 percent. Paternal age also may play a role. Some studies indicate that the chance of miscarriage is higher if a woman's partner is age 35 or older, with the chance increasing as men age.
- Previous miscarriages. The risk of miscarriage is higher in women with a history of more than one previous miscarriage. After one miscarriage, your risk of miscarriage in a future pregnancy is about the same as women who have never had a miscarriage — 20 percent. After two miscarriages, your risk increases to about 28 percent.
- Chronic conditions. Women with certain chronic conditions, such as diabetes or thyroid disease, have a higher risk of miscarriage.
- Uterine or cervical problems. Certain uterine abnormalities or a weak or unusually short cervix may increase the risk of miscarriage.
- Smoking, alcohol and illicit drugs. Women who smoke or drink alcohol during pregnancy have a greater risk of miscarriage than do nonsmokers and women who avoid alcohol during pregnancy. Illicit drug use also increases the risk of miscarriage.
- Invasive prenatal tests. Some prenatal genetic tests, such as chorionic villus sampling and amniocentesis, carry a slight risk of miscarriage.
Some women who miscarry develop a uterine infection, also called a septic miscarriage. Signs and symptoms of this infection include:
- Body aches
- Thick, foul-smelling vaginal discharge
Preparing for your appointment
You're likely to start by talking with your obstetrics care provider. He or she will tell you whom you need to see and when. In some circumstances, you may be instructed to go to a hospital emergency room immediately. If you haven't yet seen an obstetrics doctor, make an appointment with one in the next 24 hours or go to an emergency room.
You'll likely need to see your doctor fairly quickly. Here's some information to help you get ready, and what to expect from your doctor.
What you can do
If there's time before you see your doctor:
- Write down any symptoms you're experiencing, including when they first started and how they've changed over time.
- Write down key personal information, such as allergies, prior medical and surgical history, and blood type, if you know it.
- Make a list of all medications, as well as any vitamins or supplements, that you're taking.
- Take a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot, and may also provide emotional support.
- Write down questions to ask your doctor.
Preparing a list of questions will help you make the most of your time with your doctor. For miscarriage, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- What kinds of tests do I need?
- What needs to be done now?
- What treatment approach do you recommend?
- Do I need to follow any restrictions?
- What emergency signs and symptoms should I watch for at home?
- What are my chances for a successful future pregnancy?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When was your last menstrual period?
- Were you using any contraceptive methods at the time you likely conceived?
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous, or occasional?
- Compared with your heaviest days of menstrual flow, is your bleeding more, less or about the same?
- What chronic conditions, if any, do you have?
- Have you had a miscarriage before?
Tests and diagnosis
Your doctor may do a variety of tests:
- Pelvic exam. Your doctor will check to see if your cervix has begun to dilate.
- Ultrasound. This helps your doctor check for a fetal heartbeat and determine if the embryo is developing normally.
- Blood tests. If you've miscarried, measurements of the pregnancy hormone, beta HCG, can occasionally be useful in determining if you've completely passed all placental tissue.
- Tissue tests. If you have passed tissue, it can be sent to the laboratory to confirm that a miscarriage has occurred — and that your symptoms aren't related to another cause of pregnancy bleeding.
Possible diagnoses include:
- Threatened miscarriage. If you're bleeding but your cervix hasn't begun to dilate, there is a threat of miscarriage. Such pregnancies often proceed without any further problems.
- Inevitable miscarriage. If you're bleeding, your uterus is contracting and your cervix is dilated, a miscarriage is inevitable.
- Incomplete miscarriage. If you pass some of the fetal or placental material but some remains in your uterus, it's considered an incomplete miscarriage.
- Missed miscarriage. The placental and embryonic tissues remain in the uterus, but the embryo has died or was never formed.
- Complete miscarriage. If you have passed all the pregnancy tissues, it's considered a complete miscarriage. This is common for miscarriages occurring before 12 weeks.
- Septic miscarriage. If you develop an infection in your uterus, it's known as a septic miscarriage. This can be a very severe infection and demands immediate care.
Treatments and drugs
If you're having a threatened miscarriage, your doctor may recommend resting until the bleeding or pain subsides. You may be asked to avoid exercise and sex as well. Although these steps haven't been proved to reduce the risk of miscarriage, they may reduce bleeding and improve your comfort.
It's also a good idea to avoid traveling — especially to areas where it would be difficult to receive prompt medical care.
With ultrasound, it is now much easier to determine whether the embryo has died or was never formed. Either finding means that a miscarriage will definitely occur. In this situation there are several choices to consider:
- Expectant management. You may choose to let the miscarriage progress naturally. Usually this happens within a couple of weeks of determining that the embryo has died. Unfortunately it may take up to three or four weeks. This can be an emotionally difficult time.
- Medical treatment. If, after a diagnosis of certain pregnancy loss, you'd prefer to speed the process, medication can cause your body to expel the pregnancy tissue and placenta. Although you can take the medication by mouth, your doctor may recommend applying the medication vaginally to increase its effectiveness and minimize side effects such as nausea, stomach pain and diarrhea. For about 70 percent of women, this treatment works within 24 hours. If treatment doesn't work within 24 hours, you may experience the miscarriage within several days to weeks.
Surgical treatment. Another option is a minor surgical procedure called suction dilation and curettage (D and C). During this procedure, the doctor dilates your cervix and gently suctions the tissue out of your uterus. Sometimes a long metal instrument with a loop on the end (curet) is used after the suction to scrape the uterine walls. Complications are rare, but they may include damage to the connective tissue of your cervix or the uterine wall.
In the case of an inevitable miscarriage, surgical treatment may be necessary to stop the bleeding.
Lifestyle and home remedies
Physical recovery from miscarriage in most cases will take only a few hours to a couple of days. Expect your period to return within six weeks. In the meantime, call your doctor if you experience heavy bleeding, fever, chills or severe pain. These signs and symptoms could indicate an infection. Avoid having sex or putting anything in your vagina — such as a tampon or douche — for two weeks after a miscarriage.
It's possible to become pregnant during the menstrual cycle immediately after a miscarriage. But if you and your partner decide to attempt another pregnancy, make sure you're physically and emotionally ready. Your doctor may recommend waiting at least one menstrual cycle, if not longer.
If you experience multiple miscarriages, generally more than three in a row, consider testing to identify any underlying causes - such as uterine abnormalities, coagulation problems or chromosomal abnormalities. In some cases your doctor may suggest testing after two consecutive losses, but two losses are still often due to chance and not to an underlying medical cause. If the cause of your miscarriages can't be identified, don't lose hope. Even without treatment, about 70 percent of women with repeated miscarriages go on to have successful pregnancies.
Coping and support
Emotional healing may take much longer than physical healing. Miscarriage can be a heart-wrenching loss that others around you may not fully understand. Your emotions may range from anger to despair. Give yourself time to grieve the loss of your pregnancy, and seek help from those who love you. Keeping the loss to yourself isn't necessary.
You'll likely never forget your hopes and dreams surrounding this pregnancy, but in time acceptance may ease your pain. Talk to your doctor if you're feeling profound sadness or depression.
In the vast majority of cases, there's nothing you can do to prevent a miscarriage. Simply focus on taking good care of yourself and your baby. Seek regular prenatal care, and avoid known risk factors — such as smoking and drinking alcohol. If you have a chronic condition, work with your health care team to keep it under control.
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