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Miscarriage

From Simple English Wikipedia, the free encyclopedia

Amiscarriageis the natural death of anembryoor fetus in thewomb,before it is old enough to live on its own, outside the mother.[1]The medical words for a miscarriage arespontaneous abortion.( "Spontaneous" means something that a person did not expect to happen).

Miscarriage
Other namesspontaneous abortion,early pregnancy loss
Anultrasoundshowing agestational saccontaining ayolk sacbut noembryo
Medical specialtyObstetrics and Gynaecology,Neonatology,Pediatrics
SymptomsVaginal bleedingwith or without pain[2]
ComplicationsInfection,bleeding,[3]sadness,anxiety,guilt[4]
Usual onsetBefore 20 weeks of pregnancy[5]
CausesChromosomal abnormalities,[2][6]uterine abnormalities[7]
Risk factorsBeing an older parent, previous miscarriage, exposure totobacco smoke,obesity,diabetes,autoimmune diseases,drug or alcohol use[8][9][10]
Diagnostic methodPhysical examination,human chorionic gonadotropin,ultrasound[11]
Differential diagnosisEctopic pregnancy,implantation bleeding.[2]
PreventionPrenatal care[12]
TreatmentExpectant management,vacuum aspiration,emotional support[9][13]
Medicationmisoprostol
Frequency10–50% of pregnancies[2][8]

An "abortion"is when a pregnancy ends early, before birth.

Among women who know they are pregnant, about 15-20% have miscarriages. (This means that up to 1 in every 5 women who know they are pregnant miscarries.)[1]It is the most common complication (serious problem) that happens inearly pregnancyinhumans.[14][15]

Miscarriage vs. Stillbirth[change|change source]

In the United States, if a fetus dies after it is 20 weeks old, its death is no longer called a miscarriage. Its death is called astillbirth,afetal demise,or afetal death.( "Demise" means "death." ) Different countries have different ways ofdefiningthe difference between a miscarriage and a fetal death. For example:[16][17][18]

In This Country: Miscarriage Is: Fetal Death Is:
Norway Death of a fetus under 16 weeks old Death of a fetus over 16 weeks old
Australia Death of a fetus under 20 weeks old Death of a fetus over 20 weeks old
United Kingdom Death of a fetus under 24 weeks old Death of a fetus over 24 weeks old
Italy Death of a fetus under 26 weeks old Death of a fetus over 26 weeks old
Spain Death of a fetus under 26 weeks old Death of a fetus over 26 weeks old

Causes of miscarriage[change|change source]

Nobody knows all of the reasons why a woman may miscarry. However, some common causes include:

The most common causes of miscarriage change depending on whattrimesterthe mother is in. (Each trimester lasts about three months.)

First trimester (Weeks 1-12)[change|change source]

This is what a human embryo looks like about eight weeks afterconception

Most miscarriages happen during the first trimester. Some studies say that two-thirds (two out of three) to three-quarters (three out of four) of all miscarriages happen during this trimester.[22][23]About 30% to 40% (3 to 4 in every 10) of allfertilizedeggsmiscarry, often before a woman knows she is pregnant.[24]

In more than half ofembryosmiscarried in the first 13 weeks of pregnancy, the embryo haschromosomesthat are not normal.[25]These chromosomal problems may happen because of problems as the embryo grows and itscellsmake copies of themselves.It is also possible for chromosomal problems to happen because of a problem with a parent'sgenes.However, this is more likely to happen in women who have had other miscarriages, or if one of the parents has a child or other relatives withbirth defects.[26]Genetic problems are more likely to happen with older parents; this may be why miscarriages are more common in older women.[27]

Another cause may be the mother not having enoughprogesterone.If a woman is diagnosed with low progesterone levels in the second half of hermenstrual cycle(theluteal phase), she may be prescribed progesterone, to take during the first trimester of her pregnancy.[26]However, when a woman might already be miscarrying, there is noevidencethat first-trimester progesterone pills decrease the risk of having a miscarriage.[28]Scientists have even questioned whether problems with the luteal phase really can cause miscarriages.[29]

Second trimester (Weeks 13-27)[change|change source]

Common causes of miscarriage during the second trimester are:[22]

  • Uterinemalformation (when the mother's uterus is not shaped normally)
  • Growths in the mother's uterus (these are called fibroids)
  • Problems with the mother'scervix

These problems can also causepremature birth(when a baby is born earlier than expected).[22]One study found that 19% of second-trimester miscarriages were caused by problems with theumbilical cord.The fetus getsbloodandoxygenthrough the umbilical cord. Every part of the body needs blood and oxygen to survive. If the babycannot get enough oxygenbecause of a problem with the cord, it can die.[30]Problems with theplacentamay also cause second-trimester miscarriages.[30]Nutrientsand blood pass through the placenta in order to get from the mother to the umbilical cord. The placenta also helps filter out some things that could hurt the fetus. If there is a problem with the placenta, the fetus could die because it did not get enough nutrients and oxygen, or because the placenta did not filter out harmful things.

Diagnosis[change|change source]

Miscarriage is usuallydiagnosedwhen a pregnant woman notices that she is having certainsymptomsand goes to see a doctor. The most common symptom of a coming miscarriage isbleedingduring early pregnancy. The woman may not have any pain.[31]

Usually, if a pregnant woman is bleeding or having pain, anultrasoundshould be done. The ultrasound can show that the fetus'sheartis not beating, which means that the fetus has miscarried. If this happens, special tests should be done to make sure the woman does not have anectopic pregnancy,which can kill a woman.[32][33]

Not all light bleeding during early pregnancy means a woman is having a miscarriage. But any woman having light bleeding during pregnancy should see her doctor. If the bleeding is heavy, the woman is having a lot of pain, or she has afever,she should go to anEmergency Roomor call anambulanceto take her to thehospital.[32]

If a woman has bleeding during her pregnancy, she may be diagnosed with a "threatened miscarriage." In the past, if a doctor thought a pregnancy might miscarry in the future, they would suggest bed rest for the mother (lying in bed for most of the time). Today, most doctors and scientists think that bed rest does not help.[34]

Treatment[change|change source]

There are a few different types of miscarriage:[35]

  • In acomplete miscarriage,the fetus has totally left the mother's body. So has the placenta. There are no pieces of fetal or placentaltissueleft in the uterus.
  • In amissed miscarriage,the fetus has miscarried but is still inside the mother's body. This often happens when the mother does not realize she had a miscarriage (which is common when the pregnancy is very early on).
  • In anincomplete miscarriage,parts of the fetus or the placenta are still in the uterus.

The treatment is different for each kind of miscarriage.

Complete miscarriage[change|change source]

If a woman has a complete miscarriage, she usually does not need any medical treatment.[35]

Incomplete or missed miscarriage[change|change source]

If a woman has an incomplete miscarriage or a missed miscarriage, there are three different choices for treatment:

  • Watchful Waiting means that a doctor will keep checking on the woman, but will not give any treatment unless a problem happens. With watchful waiting, most of these miscarriages will pass naturally in two to six weeks. This means that the tissue left in the woman will leave her body, through thevagina,without any treatment.

With no treatment (watchful waiting), most of these cases (65–80%) will pass naturally within two to six weeks.[36]This path avoids the side effects and complications possible from medications and surgery,[37]but increases the risk of mild bleeding, need for unplanned surgical treatment, and incomplete miscarriage.

  • Medical Management means thatmedicineis given. Usually, a medicine calledmisoprostolis given. Misoprostol makes the uterus contract (get tighter) to push out whatever is inside. In about 95% of cases (95 out of 100), the fetal or placental tissue that is left in the uterus will leave the woman's body within a few days.[37]
  • Surgery is the fastest way to complete a miscarriage. It also makes bleeding less heavy and makes it not last as long. Also, the woman will not have to go through the physical pain of the miscarriage.[36]Most often, one of two surgeries are used to complete the miscarriage:
  • Vacuum aspiration, sometimes calleddilation and evacuation(D&E). In a D&E, a tube attached to a pump sucks the tissue left in the uterus out through thecervix.
  • Dilation and curettage(D&C). In a D&C, the cervix is widened, and the tissue left in the uterus is scraped and scooped out ( "curettage" ). Compared to giving medications, D&C has a higher risk of causing problems. For example, the cervix or uterus may beinjured.Because of this, some women prefer not to have a D&C because they want to have children in the future and want to lower the chances of problems during future pregnancies. However, if a woman has had more than one miscarriage, D&C is the most convenient way to get tissue samples, which can be studied to see if a reason for the miscarriages can be found.

Which treatment should be used?[change|change source]

The choice of which treatment to use depends on many things, including what the mother wants. However, there are guidelines that doctors use to suggest what treatment to use.

Missed Miscarriage

The most important things that help doctors decide what to do are the age and size of theembryo,and the size of thegestational sac(the fluid around theembryo.[38]

  • For embryos that were less than 7 weeks old, and the smallest gestational sacs, watchful waiting is the best choice, because the embryo will often leave the mother's body naturally.
  • For embryos that were 7–9 weeks old with larger sizes and gestational sacs, medicine is suggested, but either watchful waiting or surgery might be used depending on the situation.
  • For the embryos that were over 9 weeks old, with the largest gestational sacs, surgery is suggested because the mother is likely to have a lot of pain and bleeding when she miscarries.

Incomplete Miscarriages

  • For an incomplete miscarriage, the size of the tissue left in the uterus is the most important thing that helps doctors decide what to do. Ultrasound is used to find out how large the tissue is.[38]
  • If the tissue left is smaller than 15mm (millimeters): Watchful waiting is usually the best choice because it is likely that the tissue will leave the mother's body on its own.
  • If the tissue is between 15 and 20mm: Medical or expectant management is suggested. Surgery is chosen only if there is a specific reason why the mother needs it.
  • If the tissue is over 35 to 50mm, these things are suggested:
  • Giving misoprostol to make the tissue left in the uterus leave the mother's body on its own more quickly.
  • Having the mother stay in the hospital to be watched for a few hours or overnight. She should stay until most of the tissue left in her uterus has passed, and she has stopped bleeding.
  • If misoprostol has not worked, surgery may be needed.

Risk factors[change|change source]

Arisk factorfor miscarriage is something that makes a woman more likely to miscarry. There are many risk factors for miscarriage. For example:[39]

Related pages[change|change source]

References[change|change source]

  1. ↑1.01.1Susan Storck and A.D.A.M. Inc."Miscarriage".American Accreditation HealthCare Commission.
  2. ↑2.02.12.22.3Cite error: The named referenceJohn20122was used but no text was provided for refs named (see thehelp page).
  3. ↑"Spontaneous Abortion – Gynecology and Obstetrics".Merck Manuals Professional Edition.Archived fromthe originalon December 4, 2020.Retrieved5 May2018.
  4. ↑Cite error: The named referencePregnancy losswas used but no text was provided for refs named (see thehelp page).
  5. ↑Cite error: The named referenceNIH2013Defwas used but no text was provided for refs named (see thehelp page).
  6. ↑Cite error: The named referenceVai2015was used but no text was provided for refs named (see thehelp page).
  7. ↑Chan YY, Jayaprakasan K, Tan A, Thornton JG, Coomarasamy A, Raine-Fenning NJ (October 2011)."Reproductive outcomes in women with congenital uterine anomalies: a systematic review".Ultrasound in Obstetrics & Gynecology.38(4): 371–382.doi:10.1002/uog.10056.PMID21830244.S2CID40113681.
  8. ↑8.08.1Cite error: The named referenceNIH2013Epi2was used but no text was provided for refs named (see thehelp page).
  9. ↑9.09.1Cite error: The named referenceOl2014was used but no text was provided for refs named (see thehelp page).
  10. ↑Cite error: The named referenceCarpSelmi2012was used but no text was provided for refs named (see thehelp page).
  11. ↑Cite error: The named referenceNIH2015Diagwas used but no text was provided for refs named (see thehelp page).
  12. ↑Cite error: The named referenceNIH2013Prewas used but no text was provided for refs named (see thehelp page).
  13. ↑Cite error: The named referenceNIH2013Txwas used but no text was provided for refs named (see thehelp page).
  14. ↑National Coordinating Centre for Women's and Children's Health (UK) (December 2012)."Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage".NICE Clinical Guidelines, No. 154.Royal College of Obstetricians and Gynaecologists.PMID23638497.Retrieved4 July2013.
  15. ↑"Abortion Guide".
  16. ↑Mohangoo AD, Blondel B, Gissler M, Velebil P, Macfarlane A, Zeitlin J (2013)."International comparisons of fetal and neonatal mortality rates in high-income countries: should exclusion thresholds be based on birth weight or gestational age?".PLOS ONE.8(5): e64869.Bibcode:2013PLoSO...864869M.doi:10.1371/journal.pone.0064869.PMC3658983.PMID23700489.{{cite journal}}:CS1 maint: multiple names: authors list (link)
  17. ↑Li, Z; Zeki, R; Hilder, L; Sullivan, EA (2012)."Australia's Mothers and Babies 2010".Perinatal statistics series no. 27. Cat. no. PER 57.Australian Institute of Health and Welfare National Perinatal Statistics Unit, Australian Government.Retrieved4 July2013.
  18. ↑Royal College of Obstetricians and Gynaecologists UK (April 2001)."Further Issues Relating to Late Abortion, Fetal Viability and Registration of Births and Deaths".Royal College of Obstetricians and Gynaecologists UK. Archived fromthe originalon 16 July 2014.Retrieved4 July2013.
  19. ↑Terry Hassold; Heather Hall; Patricia Hunt, 'The origin of human aneuploidy: where we have been, where we are going',Human Molecular GeneticsVolume 16, Review Issue 2 (22 August 2007), p. R203
  20. ↑Tabor A, Alfirevic Z (2010). "Update on procedure-related risks for prenatal diagnosis techniques".Fetal Diagnosis and Therapy.27(1): 1–7.doi:10.1159/000271995.PMID20051662.S2CID25228648.
  21. ↑Agarwal K, Alfirevic Z (August 2012). "Pregnancy loss after chorionic villus sampling and genetic amniocentesis in twin pregnancies: a systematic review".Ultrasound in Obstetrics & Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology.40(2): 128–34.doi:10.1002/uog.10152.PMID22125091.S2CID23379631.
  22. ↑22.022.122.2Rosenthal, M. Sara (1999)."The Second Trimester".The Gynecological Sourcebook.WebMD.RetrievedDecember 18,2006.
  23. ↑Francis O (1959). "An analysis of 1150 cases of abortions from the Government R.S.R.M. Lying-in Hospital, Madras".Journal of Obstetrics and Gynaecology of India.10(1): 62–70.PMID12336441.
  24. ↑The Johns Hopkins Manual of Gynecology and Obstetrics(4 ed.). Lippincott Williams & Wilkins. 2012. pp. 438–439.ISBN9781451148015.
  25. ↑Kajii T, Ferrier A, Niikawa N, Takahara H, Ohama K, Avirachan S (1980). "Anatomic and chromosomal anomalies in 639 spontaneous abortuses".Human Genetics.55(1): 87–98.doi:10.1007/BF00329132.PMID7450760.S2CID2133855.{{cite journal}}:CS1 maint: multiple names: authors list (link)
  26. ↑26.026.1"Miscarriage: Causes of Miscarriage".HealthCentral.com.RetrievedJuly 26,2012.taken word-for-word from pp. 347–9 of:"What To Do When Miscarriage Strikes".The PDR Family Guide to Women's Health and Prescription Drugs.Montvale, NJ: Medical Economics. 1994. pp.345–50.ISBN1-56363-086-9.
  27. ↑"Pregnancy Over Age 30".MUSC Children's Hospital.Archived fromthe originalon November 13, 2006.RetrievedDecember 18,2006.
  28. ↑Wahabi HA, Fayed AA, Esmaeil SA, Al Zeidan RA (2007). Wahabi, Hayfaa A (ed.)."Progestogen for treating threatened miscarriage".Cochrane Database of Systematic Reviews(12): CD005943.doi:10.1002/14651858.CD005943.pub2.PMID22161393.{{cite journal}}:CS1 maint: multiple names: authors list (link)
  29. ↑Bukulmez O, Arici A (2004)."Luteal phase defect: Myth or reality".Obstetrics and Gynecology Clinics of North America.31(4): 727–44, ix.doi:10.1016/j.ogc.2004.08.007.PMID15550332.
  30. ↑30.030.1Peng HQ, Levitin-Smith M, Rochelson B, Kahn E (2006). "Umbilical Cord Stricture and Overcoiling Are Common Causes of Fetal Demise".Pediatric and Developmental Pathology.9(1): 14–9.doi:10.2350/05-05-0051.1.PMID16808633.S2CID20887175.{{cite journal}}:CS1 maint: multiple names: authors list (link)
  31. ↑Gracia CR, Sammel MD, Chittams J, Hummel AC, Shaunik A, Barnhart KT (2005). "Risk Factors for Spontaneous Abortion in Early Symptomatic First-Trimester Pregnancies".Obstetrics & Gynecology.106(5, Part 1): 993–9.doi:10.1097/01.AOG.0000183604.09922.e0.PMID16260517.S2CID44600202.{{cite journal}}:CS1 maint: multiple names: authors list (link)
  32. ↑32.032.1Yip SK, Sahota D, Cheung LP, Lam P, Haines CJ, Chung TK (2003). "Accuracy of Clinical Diagnostic Methods of Threatened Abortion".Gynecologic and Obstetric Investigation.56(1): 38–42.doi:10.1159/000072482.PMID12876423.S2CID24451895.{{cite journal}}:CS1 maint: multiple names: authors list (link)
  33. ↑Condous G, Okaro E, Khalid A, Bourne T (2005)."Do we need to follow up complete miscarriages with serum human chorionic gonadotrophin levels?".BJOG.112(6): 827–9.doi:10.1111/j.1471-0528.2004.00542.x.PMID15924545.S2CID7546943.{{cite journal}}:CS1 maint: multiple names: authors list (link)
  34. ↑Tien JC, Tan TY (2007). "Non-surgical interventions for threatened and recurrent miscarriages".Singapore Medical Journal.48(12): 1074–90, quiz 1090.PMID18043834.
  35. ↑35.035.1"Miscarriage: Signs, Symptoms, Treatment, and Prevention".American Pregnancy Association. August 2015.RetrievedDecember 13,2015.
  36. ↑36.036.1Kripke C (2006)."Expectant management vs. surgical treatment for miscarriage".American Family Physician.74(7): 1125–6.PMID17039747.
  37. ↑37.037.1Tang OS, Ho PC (2006). "The use of misoprostol for early pregnancy failure".Current Opinion in Obstetrics and Gynecology.18(6): 581–6.doi:10.1097/GCO.0b013e32800feedb.PMID17099326.S2CID23354454.
  38. ↑38.038.1Clinical Practice Guideline: Miscarriage: ManagementArchived2011-03-12 at theWayback MachinefromRoyal Women's Hospital.Publication date: 7 October 2010.
  39. ↑39.039.139.239.3"Miscarriage - Risk Factors".American Pregnancy Association. July 9, 2013.RetrievedDecember 13,2015.
  40. ↑"Complications in a Multiples Pregnancy".American Pregnancy Association. July 2015.RetrievedDecember 13,2015.
  41. ↑Mills JL, Simpson JL, Driscoll SG, Jovanovic-Peterson L, Van Allen M, Aarons JH, Metzger B, Bieber FR, Knopp RH, Holmes LB (1988). "Incidence of Spontaneous Abortion among Normal Women and Insulin-Dependent Diabetic Women Whose Pregnancies Were Identified within 21 Days of Conception".New England Journal of Medicine.319(25): 1617–23.doi:10.1056/NEJM198812223192501.PMID3200277.{{cite journal}}:CS1 maint: multiple names: authors list (link)
  42. ↑van den Boogaard E, Vissenberg R, Land JA, van Wely M, van der Post JA, Goddijn M, Bisschop PH (2011). "Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: A systematic review".Human Reproduction Update.17(5): 605–19.doi:10.1093/humupd/dmr024.PMID21622978.{{cite journal}}:CS1 maint: multiple names: authors list (link)
  43. ↑43.043.143.2"Miscarriages - Causes".NHS Choices. May 21, 2015.RetrievedDecember 13,2015.
  44. ↑44.044.1Ness RB, Grisso JA, Hirschinger N, Markovic N, Shaw LM, Day NL, Kline J (1999). "Cocaine and Tobacco Use and the Risk of Spontaneous Abortion".New England Journal of Medicine.340(5): 333–9.doi:10.1056/NEJM199902043400501.PMID9929522.{{cite journal}}:CS1 maint: multiple names: authors list (link)
  45. ↑Venners SA, Wang X, Chen C, Wang L, Chen D, Guang W, Huang A, Ryan L, O'Connor J, Lasley B, Overstreet J, Wilcox A, Xu X (2004). "Paternal Smoking and Pregnancy Loss: A Prospective Study Using a Biomarker of Pregnancy".American Journal of Epidemiology.159(10): 993–1001.doi:10.1093/aje/kwh128.PMID15128612.{{cite journal}}:CS1 maint: multiple names: authors list (link)
  46. ↑"Miscarriage: An Overview".Armenian Medical Network. 2005.RetrievedSeptember 19,2007.
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