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Spontaneous Abortion - Miscarriage

Overview, Causes, & Risk Factors

A miscarriage occurs when a woman is pregnant and her womb expels the fetal tissue. It results from natural causes within the first 20 weeks of pregnancy.

What is going on in the body?

A miscarriage takes place after the fetus and placenta stop growing. This makes pregnancy hormone levels fall. The following symptoms of pregnancy may no longer appear:

breast tenderness

nausea

fatigue

A miscarriage starts when the womb begins to contract. This causes cramping and discomfort. It may also cause vaginal spotting or bleeding. A miscarriage is complete when the contents of the womb are expelled. When no fetal tissue remains, the cervix will close. The uterus will shrink in size. The bleeding will slow and then stop.

What are the causes and risks of the condition?

A fetus that fails to develop or is abnormal in some way is the most likely cause of a miscarriage that occurs in the first trimester of pregnancy.

Miscarriages in the second trimester are most often caused by factors linked to the mother, such as:

an abnormal-shaped uterus

autoimmune disorders, in which the woman's body creates antibodies to its own tissue, including fetal tissue

bacterial infections, such as the sexually transmitted disease Chlamydia trachomatis\. Sexually transmitted disease refers to any contagious disease transmitted from one person to another during sexual contact. ',CAPTION,'Chlamydia');" onmouseout="return nd();"> chlamydia

certain diseases and conditions, including diabetes or hypothyroidism

cervical incompetence, a condition in which the cervical opening from the womb does not stay closed through the whole pregnancy

cocaine use

drinking liquids, such as coffee, or eating foods, such as chocolate, that contain caffeine

exposure to pesticides, chemicals, or other toxins

noncancerous tumors in the uterus, which are also called fibroids

hormonal disorders, such as a low level of the female hormone progesterone

polycystic ovary syndrome, a condition in which abnormal hormone levels cause growths within the ovary

posttraumatic stress disorder, also called PTSD, which may occur after a major traumatic event

toxoplasma infection, also called toxoplasmosis \ \other infections, such as hepatitis B, syphilis, and herpes zoster, the virus that causes chickenpox \ \ rubella, the virus that causes German measles\ \ cytomegalovirus, or CMV\ \ herpes simplex virus, the cause of genital herpes \ ',CAPTION,'TORCH Infections');" onmouseout="return nd();">TORCH infections in the first trimester of pregnancy

Herbal remedies can cause birth defects as well as a miscarriage. The March of Dimes recommends that pregnant women avoid all of the following unless recommended by their doctors:

dietary supplements

over-the-counter medicines

prescription medicines

Symptoms & Signs

What are the signs and symptoms of the condition?

A pregnant woman having a miscarriage may experience these signs or symptoms:

low back pain

passage of some tissue or clots from the vagina

pelvic or abdominal cramping

vaginal bleeding or spotting

Diagnosis & Tests

How is the condition diagnosed?

A blood or urine test will be done to confirm that a pregnancy exists. The level of the pregnancy hormone HCG may be checked several times over a period of days or weeks. Rising levels suggest that the fetus is growing. Levels that fall or stay steady suggest a malformed or dying fetus.

Other tests can include the following:

a complete blood count, called CBC, if the woman is bleeding heavily

a pelvic exam to see if the cervix is open and whether there is any fetal tissue in the vagina or the cervix

a pregnancy ultrasound to check for any fetal movement and heartbeat and to rule out an ectopic pregnancy, which occurs when the egg implants outside the uterus

a progesterone level to find out if enough of the hormone is being made to maintain the pregnancy

a white blood cell count to rule out infection

Prevention & Expectations

What can be done to prevent the condition?

Not all miscarriages can be prevented. But taking certain actions can help. Several months before pregnancy and during the entire pregnancy, a woman should follow these guidelines.

Avoid alcohol and caffeine.

Stay away from pesticides, and chemical solvents such as paint thinners

Avoid all medicines unless recommended by the doctor. This includes those sold over-the-counter, prescriptions, and herbal remedies.

Eat a diet rich in folic acid and take multivitamins.

Maintain good control of diseases such as diabetes and hypothyroidism

Notify the doctor of any other risk factors, such as PTSD.

Report any symptoms of sexually transmitted disease to the doctor

Stop smoking

If a woman has had infertility tests for imbalanced hormones, the doctor may screen her for hormone problems in the first trimester. If a problem is found, hormone pills can be prescribed.

What are the long-term effects of the condition?

The long-term effects of a miscarriage vary. There are many myths about what causes miscarriage. A woman may feel anxiety, fear, and guilt if she believes she did something to cause the miscarriage. She should discuss feelings or worries such as these with her doctor.

What are the risks to others?

A miscarriage is not catching. It poses no risk to others.

Treatment & Monitoring

What are the treatments for the condition?

Some providers suggest that a woman try to collect any tissue that passes from her vagina so it can be checked.

Other treatments for miscarriage include:

antibiotics to prevent infection

dilation and curettage, or D & C, a procedure to remove any fetal tissue remaining in the uterus

medicines to help the uterus contract so that bleeding stops

Rh immune globulin, if the mother's blood is Rh-negative

Sometimes, the woman may have an incomplete miscarriage. This means some fetal tissue stays in the uterus. To avoid infection, a procedure called a D & C will be done. The D & C helps empty the uterus.

What are the side effects of the treatments?

A D & C may cause bleeding, infection, and allergic reaction to anesthesia. Antibiotics and medicines to help the uterus contract may cause rash, upset stomach, abdominal cramps, and allergic reaction.

What happens after treatment for the condition?

If a woman has a complete miscarriage without abnormal bleeding, she is sent home to get better. If a woman has a D & C for an incomplete miscarriage, she is usually able to go home within a few hours. She should rest in bed for 1 to 2 days. A woman should contact her doctor if she has any of these symptoms:

any other new or worsening symptoms

continued heavy bleeding

a fever

cramps that get worse or pain that won't go away

Birth control should be used if the woman does not want to get pregnant again. If a future pregnancy is desired, the couple may try to conceive again after 2 to 3 months. They have an 85% chance of having a successful, full-term pregnancy after 1 year.

How is the condition monitored?

A woman's doctor may do weekly blood tests to follow the HCG level until it is nearly zero. This ensures that the pregnancy has ended. Sometimes tests are done on the fetal tissue to learn about its genetic makeup. If a woman has had several miscarriages, her doctor may recommend a complete evaluation for infertility.

Attribution

Author:Eva Martin, MD
Date Written:
Editor:Crist, Gayle P., MS, BA
Edit Date:04/23/02
Reviewer:Eileen McLaughlin, RN, BSN
Date Reviewed:09/14/01

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