Definition & Overview

A miscarriage is described as a loss of a pregnancy within the first 20 weeks of gestation. Most miscarriages occur between the 7th and 12th week of pregnancy, otherwise referred to as the first trimester.

Miscarriages are a common occurrence mainly because some women aren’t even aware that they’re pregnant. Those who are aware of their condition, on the other hand, have 10% to 20% risk of experiencing miscarriage.

For women who want to conceive a child, a miscarriage is an unfortunate event. Most miscarriages are beyond the woman’s control, thus cannot be prevented. If the miscarriage is a result of an abnormal development of the fetus, it is impossible to prevent the miscarriage.

However, if the fetus is healthy, there is a possibility that stress and trauma may prevent the pregnancy from progressing. If this occurs after the 20th week of gestation, the condition is referred to as a “late miscarriage” or a “still birth”.

Although often times, healthcare providers may simply tell you that the mother experienced a miscarriage, there are actually different types, which are listed as follows:

  • Complete Miscarriage: A complete miscarriage occurs when both the embryo and other products of conception have been removed from the body. This stops the bleeding and other symptoms of the miscarriage. This can be confirmed by performing an ultrasound or a D&C (dilatation & curettage).

  • Missed Miscarriage: If the embryo dies but not removed from the uterus, the condition is referred to as a missed miscarriage. The condition is usually identified by the absence of a fetal heartbeat in an ultrasound.

  • Recurrent Miscarriage: If the woman experiences a miscarriage three or more times consecutively, it is referred to as recurrent miscarriage.

  • Blighted Ovum: This is sometimes referred to as an embryonic pregnancy. It is when the fertilized egg is implanted in the uterus, but fails to develop.

  • Ectopic Pregnancy: If the fertilized egg is implanted anywhere else than the uterus, the condition is called an ectopic pregnancy. The egg needs to be surgically removed as soon as possible to prevent it from developing and posing risk to the patient.

  • Molar Pregnancy: This condition occurs when a genetic error results in the formation of an abnormal tissue instead of an embryo in the uterus.

Cause of Condition

While the majority of miscarriages are caused by a genetic problem in the embryo, the condition can be caused by other factors as well.

Some of the most common risk factors of a miscarriage are:

  • Trauma or injuries to the uterus
  • Previous miscarriage
  • Smoking more than 10 cigarettes a day
  • Obesity
  • Drug use
  • Non-steroidal anti-inflammatory drugs (NSAIDS)
  • Abnormalities of the uterus
  • Alcohol consumption
  • Exposure to radiation
  • Age

If the woman has already had a miscarriage, the risk of it happening again increases with every subsequent miscarriage. Patients who experience such are encouraged to seek treatment, which starts with the identification of the underlying condition/s. Doing such will increase the patient’s chances of a successful pregnancy in the future.

Key Symptoms

Pregnant women should be mindful of what is happening to their body during this period because the signs and symptoms of a miscarriage can be subtle. In fact, some women are not even aware that they have already miscarried.

However, the symptoms that will normally indicate the possibility of a miscarriage are as follows:

  • Weight loss

  • True contractions – if the pregnancy is still within the first trimester and you start experiencing contractions, there is a possibility of a miscarriage.

  • Bleeding with contractions – Bleeding within the first trimester is not a definite sign of a miscarriage, but if it is accompanied by contractions, you need to consult your doctor immediately.

  • Back pains – mild to severe back pains can be a sign of a miscarriage.

If you experience any of the above symptoms, make sure that you visit your doctor. You will likely need to undergo an ultrasound or other tests to determine the condition of your pregnancy.

Who to See & Types of Treatment Available

Before you visit your doctor, it’s important to remember that the doctor will not be able to prevent the miscarriage if there is an abnormal development of the embryo. The best the doctor can do is to ensure your safety and that the chances of you becoming pregnant again are still high.

The doctor will diagnose your condition and confirm whether or not you experienced a miscarriage. The first examination will likely be an ultrasound to determine the presence of a fetal heartbeat. An ultrasound will also reveal if the embryo was implanted outside of the uterus (ectopic pregnancy).

You may also need to undergo other tests, such as a blood test to identify the presence of pregnancy hormones, measure the degree of blood loss, and determine if there is an infection. Some doctors may also perform blood typing so that the mother can be injected with rho-D immune globulin that can help prevent future pregnancy problems.

If the symptoms of a miscarriage are present, but the doctor determines that a miscarriage hasn’t occurred, you’ll likely be advised to return home and rest. Otherwise, your doctor will provide the required treatment.

In complete miscarriages, treatment may not be necessary. However, if pregnancy tissue is still in the uterus, you’ll need to undergo a procedure called dilatation & curettage (D&C) to remove any remaining contents in the uterus.

The doctor will also attempt to identify the cause of the miscarriage so that the condition can be treated. For instance, if an infection caused the miscarriage, you’ll be provided with antibiotics to cure the infection. However, if your last pregnancy resulted in a miscarriage, the doctor may ask you to undergo different examinations to pinpoint the problem. Some hormonal and anatomical problems can be treated, which will help increase the chances of a successful pregnancy in the future.

References:

  • American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 462: Moderate caffeine consumption during pregnancy. ObstetGynecol. 2010;116(2 Pt 1):467-8.

  • Katz VL. Spontaneous and recurrent abortion: etiology, diagnosis, treatment. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 16.

  • Laurino MY, Bennett RL, Saraiya DS, et al. Genetic evaluation and counseling of couples with recurrent miscarriage: Recommendations of the National Society of Genetic Counselors. J Genet Couns. June 2005;14(3). Reaffirmed April 2010.

  • Simpson JL, Jauniaux ERM. Pregnancy loss. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 26.

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