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| Miscarriage is the most common complication of early pregnancy. About 15 to 20 percent of known pregnancies end in miscarriage, and more than 80 percent of these losses happen before 12 weeks.Miscarriage is the natural or spontaneous end of a pregnancy at a stage where the embryo or the fetus is incapable of surviving.If you lose a baby after 20 weeks of pregnancy, it's called a stillbirth. |
 What causes a miscarriage?
Between 50 and 70 percent of first trimester miscarriages are thought to be random events caused by chromosomal abnormalities in the fertilized egg. Most often, this means that the egg or sperm had the wrong number of chromosomes, and as a result, the fertilized egg can't develop normally.
In other cases, a miscarriage is caused by problems that occur during the delicate process of early development — for example, when an egg doesn't implant properly in the uterus or an embryo has structural defects that don't allow it to continue developing. Since most healthcare practitioners won't do a full-scale workup after a single miscarriage, it's usually impossible to tell why the pregnancy was lost. And even when a detailed evaluation is performed — say after you've had two or three consecutive miscarriages — the cause still remains unknown in about half of cases.
Once your baby has a heartbeat — usually visible on ultrasound at around 6 weeks — your odds of having a miscarriage drop significantly. |
What are common risks for miscarriage?
| Though any woman can miscarry, some are more likely to miscarry than others. Here are the most common risk factors:
• Age: Older women are more likely to conceive babies with chromosomal abnormalities, and to miscarry them as a result. In fact, 40-year-olds are about twice as likely to miscarry as 20-year-olds.
• A history of miscarriages: Women who have had two or more miscarriages in a row are more likely than other women to miscarry again.
• A history of birth defects or genetic problems: Having had a child with a birth defect, or a family history (or a partner with a family history) of genetic problems.
• Smoking, drinking, and using drugs: Smoking a lot, drinking muchalchol, and using drugs like cocaine and ecstasy during pregnancy can all increase your risk for miscarriage. And some studies show an association between drinking four or more cups of coffee a day and a higher risk of miscarriage, so avoid smoking, alcohol, caffeine and drugs.
• Certain chronic diseases or disorders: Poorly controlled diabetes, certain inherited blood clotting disorders, certain autoimmune disorders (such as lupus), and certain hormonal disorders (such as polycystic ovary syndrome).
• Uterine or cervical problems: Having certain uterine abnormalities or a weak or abnormally short cervix (known as cervical insufficiency).
• Certain infections: Research has shown a somewhat higher risk for miscarriage if you have listeria, mumps, rubella, measles, cytomegalovirus, parvovirus, gonorrhea, HIV, and certain other infections.
• Taking certain medications: Some medications have been linked to increased risk of miscarriage, so it's important to ask your physician or pharmacist about the safety of any medications you're taking even while you're trying to conceive. This goes for prescription and over-the-counter drugs, including nonsteroidal anti-inflammatory drugs (NSAIDs) like ketoprofen ,ibuprofen and aspirin.
• Exposure to environmental toxins: Environmental factors that might increase your risk include lead; arsenic; some chemicals, like formaldehyde, benzene, and ethylene oxide; and large doses of radiation or anesthetic gases.
• Partner factors: Little is known about how the father's condition may contribute to a couple's risk for miscarriage, though the risk increases with the father's age. Researchers are studying the extent to which sperm could be damaged by environmental toxins but still manage to fertilize an egg. Some studies have found a greater risk of miscarriage when the father has been exposed to mercury, lead, and some industrial chemicals and pesticides.
Your risk of miscarriage also rises with each child you bear and if you get pregnant within three months after giving birth.
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What are the signs of miscarriage?
Vaginal spotting or bleeding is usually the first sign of miscarriage. Keep in mind, though, that up to 1 in 4 pregnant women have some bleeding or spotting (finding spots of blood on your underpants or toilet tissue) in early pregnancy, and half of these pregnancies don't end in miscarriage.
You may also have abdominal pain, which usually begins after you first have some bleeding. It may feel crampy or persistent, mild or sharp, or may feel more like low back pain or pelvic pressure. If you have both bleeding and pain, the chances of your pregnancy continuing are much lower.
It's very important to be aware that vaginal bleeding, spotting, or pain in early pregnancy can also signal an ectopic or a molar pregnancy. If you have any of these symptoms, call your doctor to be dealt with immediately. Also, if your blood is Rh-negative, you may need a shot of Rh immune globulin within two or three days after you first notice bleeding, unless the baby's father is Rh-negative as well.
Some miscarriages are first suspected during a routine prenatal visit, when the doctor can't hear the baby's heartbeat or notices that your uterus isn't growing as it should be. (Often the embryo or fetus stops developing a few weeks before you have symptoms, like bleeding or cramping.) If your doctor suspects that you've had a miscarriage, he'll order an ultrasound to see what's going on in your uterus and possibly do a blood test. |
What should i do if i suspect a miscarriage?
Call your doctor as fast as you can, if you ever notice unusual symptoms such as bleeding or cramping during pregnancy. He will examine you to see if the bleeding is coming from your cervix and check your uterus. He may also do a blood test to check for the pregnancy hormone hCG and repeat it in two to three days to see if your levels are rising as they should be.
If you're having bleeding or cramping and your doctor has even the slightest suspicion that you have an ectopic pregnancy, you'll have an ultrasound right away. If there's no sign of a problem but you continue to spot, you'll have another ultrasound at about 7 weeks.
At this point, if the sonographer sees an embryo with a heartbeat, you have a viable pregnancy and your risk of miscarrying is now much lower. If the sonographer sees an embryo of a certain size but no heartbeat, that means the embryo didn't survive.
If you're showing signs of a possible miscarriage, your doctor may prescribe bedrest in hopes of reducing your chances of miscarrying — but there's no evidence that bedrest will help. He may also suggest you not have sex while you're having bleeding or cramping. Sex doesn't cause miscarriage, but it's a good idea to stop if you're having these symptoms.
You may have light bleeding and cramping for a few weeks. You can wear sanitary pads but no tampons during this time and take paracetamol for the pain. If you are miscarrying, the bleeding and cramping will likely get worse shortly before you pass the "products of conception" — that is, the placenta and the embryonic or fetal tissue, which will look grayish and may include blood clots.
If you can, save this tissue in a clean container because your doctor may want to examine it or send it to a lab for investigation to try to find out why you miscarried. In any case, He'll want to see you again at this point, so call him to let him know what's happened. |
What happens after miscarriage?
Whether you miscarry on your own or have the tissue removed, you'll have mild menstrual-like cramps afterward for up to a day or so and light bleeding for a week or two. Use pads instead of tampons and take ibuprofen or paracetamol for the cramps. Avoid sex, swimming, douching, and using vaginal medications for at least a week or two and until your bleeding stops.
If you begin to bleed heavily (soaking a sanitary pad in an hour), have any signs of infection (such as fever, or foul-smelling vaginal discharge), or feel excessive pain, call your doctor immediately or go to the emergency room. |
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