Miscarriage

What is Miscarriage?

Miscarriage or spontaneous abortion is the term used to denote the loss of a fetus within the womb before the 20th week of pregnancy is completed.

Many pregnancies are lost spontaneously before a woman recognizes that she is pregnant, and the clinical signs of miscarriage are mistaken for a heavy or late menses.

The term miscarriage is often subdivided for clinical purposes into:

Threatened abortion: A pregnancy complicated by bleeding before 20 weeks’ gestation.
Inevitable abortion: The products of conception have not been expelled but a miscarriage will happen.
Incomplete abortion: Some, but not all, of the products of conception have been passed; retained products may be part of the fetus, placenta or membranes.

Missed abortion: A pregnancy in which there is a fetal demise (usually for a number of weeks) but the products of conception are not expelled.
Complete abortion: All products of conception have been passed without the need for surgical or medical intervention.
What are the Causes and risk factors of Miscarriage?
Following are the most important known causes of spontaneous abortion.
Genetic and uterine abnormalities
Endocrine and immune system dysfunctions
Infectious agents
Environmental pollutants
Psychogenetic factors and
Endometriosis
Some of the risk factors that have been associated with increased incidences of spontaneous pregnancy loss include
Advanced maternal age
Maternal alcohol abuse
Maternal cigarette smoking
Medications
Multiple previous elective abortions
Previous spontaneous abortion and
Chronic exposure to toxins.
Certain maternal disorders such as poorly controlled diabetes, celiac disease and autoimmune diseases also play a role. 1,2
What are the Signs and Symptoms of Miscarriage?
The hallmark of spontaneous abortion in a pregnant woman is vaginal bleeding, which may vary from scanty spotting to frank bleeding. It may be associated with mild to severe pain in the abdomen.
The pattern of bleeding is slight in case of a threatened miscarriage while greater amounts may signify an inevitable miscarriage.
Partial or complete expulsion of the products of conception may occur within a few hours of the onset of symptoms, or expulsion may be delayed for several days.
How is Miscarriage Diagnosed?
The doctor diagnoses the condition based on the following:
Signs and symptoms observed,
Vaginal examination,
Certain laboratory investigations and
Imaging stud Vaginal examination helps the doctor to assess the severity of the condition and determine the status of the other organs of reproduction.
Blood tests are advised to know the levels of different hormones and also as a routine investigation to rule out other abnormalities.
Ultrasound examination is used to confirm the diagnosis.
What is the Treatment for Miscarriage?
The management depends on the type of abortion and ranges from expectant management to prompt surgical evacuation. Severe cases may require hospitalization and surgical evacuation of the contents of the uterus. In case of threatened abortion, if symptoms are mild, one may be advised bed rest and the avoidance of sexual intercourse along with increased fluid intake. This may be successful in preventing pregnancy loss when the gestation is greater than 12 weeks. Painkillers and sedatives may be advised to reduce the anxiety. However, it is considered as a high-risk pregnancy, which can progress to abortion at any stage.
If the bleeding does not stop with the above steps, evacuation of the products of conception may be carried out by the administration of certain drugs or by surgical measures.
These procedures are also carried out in case of inevitable and incomplete abortions. Other types are managed appropriately based on the signs of miscarriage. 1,2

What are the Complications of Miscarriage?

Complications to the mother are quite rare. However, in certain cases one may suffer from infection due to retained products of conception, which may need surgical intervention.
How can Miscarriage be Prevented
Proper care of the underlying disorders can prevent complications of these disorders resulting in miscarriage. Always speak to the doctor before planning for a pregnancy and discuss the precautions that need to be taken along with periodic visits to the antenatal clinics.