Overview, Causes, & Risk Factors
A miscarriage occurs when a pregnant woman's
womb expels the fetal tissue before the infant is fully-grown. This may result from
natural causes within the first 20 weeks of pregnancy. In an incomplete miscarriage,
part of the fetal tissue stays inside the womb.
What is going on in the body?
Eighty-five percent of miscarriages take place in the first 12 weeks of
pregnancy. This time is called the
first trimester. These
early miscarriages are most often the result of
problems with the fetus. For example, the fetus may have abnormal chromosomes,
or a genetic defect, that affects health and development. Miscarriages in the early
part of the second trimester
of pregnancy, which is from 12 to 20 weeks, are most often caused by factors related to the
mother.
A miscarriage takes place after the fetus and placenta stop growing, which causes
pregnancy hormone levels to fall. The following symptoms of pregnancy may disappear:
breast tenderness
nausea
fatigue
A miscarriage occurs when the uterus, or womb, starts to contract. This causes
cramping, discomfort, and vaginal spotting or bleeding. A miscarriage is complete
once the womb expels its contents. An incomplete miscarriage occurs
when some of the tissue remains in the uterus and the cervix stays open. This may
increase a woman's risk of infection and continued bleeding.
What are the causes and risks of the condition?
A fetus that fails to develop or that is malformed most often causes
miscarriages in the first 12 weeks of pregnancy.
Miscarriages in the second trimester are most often caused by factors
related to the mother, such as:
an abnormal-shaped womb, including one with a wall down the middle of it
an age of 35 years or older
autoimmune disorders,
in which the woman's body creates antibodies to its own tissue, including fetal tissue.
Systemic lupus erythematosus, an autoimmune disorder that involves many organ
systems and is linked with a high risk of miscarriage, is one example.
bacterial infections, such as the sexually transmitted disease
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certain conditions and diseases, such as diabetes
or hypothyroidism, a
condition caused by low levels of thyroid hormones
cervical incompetence,
which means that the opening from the womb does not stay closed through the whole
pregnancy
cocaine use
eating foods, such as chocolate and drinking liquids, such as coffee, that have
caffeine in them
noncancerous tumors in the womb, called
fibroids
exposure to chemical solvents and other toxins, such as paint thinners
herbal remedies,
which can cause birth defects as well as miscarriage. The March of Dimes
advises that pregnant women avoid all dietary supplements, over-the-counter
medicines, and prescription medicines unless recommended by their doctors.
hormonal disorders, such as a low level of the female hormone progesterone
infertility lasting
longer than 1 year
polycystic ovary syndrome,
a condition in which abnormal hormone levels cause growths within the ovary
posttraumatic stress disorder,
called PTSD, which occurs in some people who have gone through a major traumatic
event
viral infections, such as herpes,
rubella,
and cytomegalovirus, known as CMV,
in the first trimester
A woman who has had three or more miscarriages in a row has a
condition called habitual abortion.
Symptoms & Signs
What are the signs and symptoms of the condition?
A pregnant woman who is having an incomplete miscarriage may
experience:
low back pain
pelvic or abdominal cramping
some tissue or clots passing from the vagina
vaginal bleeding or spotting
Diagnosis & Tests
How is the condition diagnosed?
A blood or urine pregnancy test will be done to confirm a pregnancy.
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 little or no growth
of a malformed or dying fetus.
Other tests can include the following:
complete blood count, called CBC,
if the woman is bleeding heavily
white blood cell count
to rule out infection
a progesterone level to find out if enough of the hormone is being made to
maintain the pregnancy
pregnancy ultrasound
to check for any fetal movement and heartbeat. The ultrasound can also rule out an
ectopic pregnancy.
This problem occurs when the egg implants outside of the uterus.
pelvic exam to see
if the cervix is open and whether there is any fetal tissue in the vagina or the cervix
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:
Eat a diet rich in folic acid
and take multivitamins. This helps prevent birth defects called
neural tube defects.
It also helps a woman lay down a foundation of good nutrition.
Stop smoking.
Avoid all medicines unless recommended by the doctor. This includes over-the-counter medicines, prescriptions, and
herbal remedies.
Avoid alcohol and
caffeine.
Stay away from pesticides and
chemical solvents, such as paint thinners.
Maintain good control of diseases such as diabetes
and hypothyroidism.
Report any symptoms of sexually transmitted disease
to the doctor.
Notify the doctor of any other risk factors. This includes
PTSD,
polycystic ovary syndrome,
or cervical incompetence.
He or she can then help minimize the risk factor.
If a woman has had infertility tests for imbalanced hormones, the doctor
may screen her for first trimester
hormone problems that could cause miscarriage. If a problem is found,
hormones can be prescribed.
What are the long-term effects of the condition?
The long-term effects of an incomplete miscarriage vary. There are many
myths about what causes miscarriage. A woman may feel anxiety, fear, and guilt if
she believes she has "hurt her baby" by lifting heavy furniture, exercising too much,
having sex, or doing something else to cause the miscarriage. A healthy
pregnancy cannot
be harmed by any of these activities. A woman should discuss feelings or worries
such as these with her doctor.
Delaying diagnosis and treatment of an incomplete miscarriage may
increase a woman's risk of the following:
bleeding
developing Rh sensitization,
which is a blood incompatibility that can harm a later pregnancy
infection
infertility from
damage to the fallopian tubes
What are the risks to others?
An incomplete miscarriage is not catching and poses no risk to
others.
Treatment & Monitoring
What are the treatments for the condition?
The treatments that may be used for an incomplete miscarriage include the following:
dilatation and curettage,
also called D & C, which is a procedure to remove any fetal tissue that remains in the womb following the miscarriage
antibiotics to prevent infection
medicines to help the womb contract so that bleeding subsides
Rh immune globulin, if the mother's blood is Rh-negative. Otherwise,
Rh sensitivity could
affect later pregnancies and cause blood incompatibilities between the mother and
fetus.
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 womb contract may cause
rash, upset stomach,
abdominal cramps, and allergic reaction.
What happens after treatment for the condition?
Within hours of having a D & C,
a woman is usually sent home to get better. She should rest in bed for 1 to 2 days.
A woman should contact her doctor if she has any of these symptoms:
a fever
cramps that get worse or pain that lasts
continued heavy bleeding
any other new or worsening symptoms
Birth control
should be used if the woman does not wish to get pregnant again. If a future
pregnancy is desired, a couple can try to conceive again after 2 to 3 months. They
have an 85% chance of 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.
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