Miscarriage, also known as spontaneous abortion, is the natural death of an embryo or fetus before it is able to survive independently, typically before the 20th week of gestation. Some of the symptoms may include bleeding, abdominal pain, and cramping. The risk of miscarriage may be increased by a number of factors, including older parental age, previous miscarriage, exposure to tobacco smoke, obesity, diabetes, and drug or alcohol use. In many cases, the cause of the miscarriage is unknown. Usually, treatments involve either allowing the process to happen naturally or procedures to remove the dead or dying tissue if it doesn’t pass from the womb on its own. Emotional support is usually offered as miscarriage can be a very difficult situation to cope with emotionally.

Miscarriage

Causes of Miscarriage

Miscarriages, or loss of a pregnancy before 20 weeks, can result from several factors. However, in many cases, the specific cause of a miscarriage is unknown. Here are some common reasons:

1. Chromosomal Abnormalities: This is the most common cause of miscarriages, accounting for about 50% of all cases. Chromosomal abnormalities can occur when an egg or sperm has too few or too many chromosomes, leading to problems with the development of the fetus.

2. Hormonal Imbalances: Conditions such as polycystic ovary syndrome (PCOS) can lead to hormonal imbalances that affect the body’s ability to maintain a pregnancy. Inadequate levels of progesterone, a hormone crucial for maintaining the early stages of pregnancy, can also result in a miscarriage.

3. Structural Abnormalities: Physical problems with the uterus, such as an abnormally shaped uterus or the presence of fibroids or when the cervix (the lower part of the uterus) cannot stay closed as the fetus grows can cause a miscarriage.

4. Age: As women age, particularly after the age of 35, the risk of miscarriage increases because eggs may have more chromosomal abnormalities.

5. Listeria: Miscarriages can be caused by certain bacterial infections like Listeria which can be contracted from contaminated food.

6. Chronic Diseases: Health conditions such as uncontrolled diabetes, severe high blood pressure, kidney disease, autoimmune disorders (for example, systemic lupus erythematosus, or SLE), and thyroid disease can increase the odds of having a miscarriage.

7. Lifestyle Factors: Excessive consumption of caffeine and alcohol, smoking, use of illegal drugs, and exposure to environmental toxins can increase the risk of miscarriage.

8. Physical Complications: Trauma or injury can sometimes contribute to miscarriage as well.

9. Issues with Immune Response: If the mother’s immune system does not respond appropriately to the pregnancy, it may increase the risk of miscarriage.

Please note that having one or even two miscarriages doesn’t increase your risk of having future miscarriages. In cases of repeated miscarriage, medical investigation may be suggested to identify any detectable issues. Always consult with health care professionals for guidance.

Risk Factors of Miscarriage

Miscarriage is a relatively common complication of early pregnancy, causing the loss of pregnancy within the first 20 weeks. Numerous risk factors associated with miscarriage have been identified:

1. Age: This is a significant factor, especially in women over the age of 35. The quality of a woman’s eggs declines with age, increasing the risk of chromosomal abnormalities that can lead to miscarriage.

2. Chronic Diseases: Women with certain long-term health conditions, such as diabetes, lupus, high blood pressure, or kidney disease have a higher risk of miscarriage.

3. Certain Infections: Some bacterial and viral infections can increase the risk of miscarriage, including rubella (German measles), cytomegalovirus, bacterial vaginosis, and some sexually transmitted infections.

4. Uterine or Cervical Problems: Abnormalities in the shape of the uterus can increase the risk of miscarriage. A weakened cervix (also known as cervical insufficiency) can also cause a miscarriage.

5. Smoking, Alcohol, and Drug Use: These habits can increase the risk of miscarriage. This includes exposure to secondhand smoke.

6. High Caffeine Intake: Some studies suggest that high levels of caffeine consumption can increase the risk of miscarriage.

7. Obesity: Women who are overweight or obese (with a BMI over 30) have a higher risk of miscarriage compared with those of a normal weight.

8. Physical Trauma or Injury: Severe trauma may cause miscarriage, particularly in late-first or second-trimester.

9. Hormonal Problems: Problems with the hormonal balance, such as Polycystic Ovary Syndrome (PCOS), can also increase the risk.

10. Certain Medications: Some drugs can increase the risk of miscarriage, such as nonsteroidal anti-inflammatory drugs (NSAIDs), certain antidepressants, and some antibiotics.

11. Previous Miscarriages: Having two or more consecutive miscarriages (also called recurrent miscarriage) could increase the risk in future pregnancies.

It is important to note that having one or more risk factors does not guarantee a miscarriage will occur, it just increases the likelihood. Similarly, many miscarriages occur without any identifiable risk factors. It’s also worth noting that many miscarriages happen because the fetus isn’t developing normally and not due to the mother’s actions.

Signs and Symptoms of Miscarriage

Miscarriage, or the loss of a pregnancy before the 20th week, can present several signs and symptoms. However, it’s essential to note that these symptoms can occur in normal pregnancies as well, so experiencing them doesn’t necessarily mean a miscarriage is happening. If you have concerns about your pregnancy, it’s always best to consult a healthcare professional. Here are some symptoms associated with miscarriage:

1. Vaginal Bleeding: This could range from light spotting to bleeding that is heavier than a normal period. The blood may look brown or red and could be accompanied by clumps of tissue or clots.

2. Abdominal Pain: This might be located in the lower abdomen or pelvic area and could range from a dull ache to severe cramps. Pain can also be felt in the lower back.

3. Loss of Pregnancy Symptoms: One may notice a sudden decrease in pregnancy symptoms. These include breast tenderness or morning sickness that were present but abruptly disappeared.

4. Fluid or tissue passing from the vagina: Miscarriage can cause expulsion of tissue or fluid from the vagina.

5. Feeling faint or light-headed, or severe emotional distress.

Seek immediate medical care if you’re pregnant and experience any of these symptoms. Even if these symptoms stop, it’s still important to consult with your care provider to ensure the health of your pregnancy.

Diagnosis Miscarriage

A miscarriage is the loss of a pregnancy before 20 weeks gestation. Most miscarriages often happen within the first 7-12 weeks of pregnancy.

A miscarriage can happen for many different reasons. Often, it is due to chromosomal abnormalities in the developing fetus, which are out of the parents’ control. Other causes can include health conditions in the mother, age, lifestyle or environmental factors, or problems with the placenta or uterus.

The common symptoms may include vaginal spotting or bleeding, pain or cramping in the lower abdomen or back, fluid or tissue passing from the vagina, or a sudden decrease in pregnancy signs.

Depending upon how far along the pregnancy was, a woman may undergo several types of medical treatment post-miscarriage, including watchful waiting, medication, a D&C (Dilation and Curettage) procedure, or a minor surgical procedure.

It should be noted that having one miscarriage doesn’t necessarily mean a woman will have another if she gets pregnant again. Many women who experience a miscarriage go on to have healthy, full-term pregnancies in the future.

Treatment of Miscarriage

A miscarriage can be a heartbreaking event, and treatment is often determined by the type and timing of the miscarriage. Before treatment, it’s crucial to get a confirmed diagnosis. The general treatments consist of:

1. Watchful Waiting: If the miscarriage is complete (there are no remaining fetal tissues in the uterus), a watchful waiting approach may be enough. Regular doctor appointments will ensure that blood levels of hCG, a pregnancy hormone, are returning to non-pregnant levels.

2. Medical treatment: In some cases, doctors can provide a medication to help facilitate the completion of the miscarriage. These may be taken orally or inserted vaginally. The medication causes the uterus to contract and expel the remaining fetal tissue.

3. Surgical Treatment (Dilation and Curettage): If there are complications or if other treatments don’t work, a surgical procedure named dilation and curettage (D&C) may be performed. This operation involves dilating the cervix and using an instrument to remove tissue from the uterus.

Alongside physical treatment, emotional support is very important. Counseling or support groups might be recommended as coping mechanisms. Also, it’s crucial to follow up with your healthcare provider to make sure the treatment has worked and you are healing well.

A full recovery is normally possible, and a miscarriage typically doesn’t influence the chances of a successful future pregnancy. However, multiple miscarriages might signify an underlying issue which needs medical attention.

After a miscarriage, it’s important to allow the body and mind time to heal before trying for another pregnancy, usually a few months is considered adequate, but it varies from person to person.

Remember this is a general explanation, and every individual’s situation is unique. Always seek advice from your healthcare provider if you have any health concerns.

Medications commonly used for Miscarriage

There are several types of medications that may be used following a miscarriage, primarily aimed at managing symptoms, preventing infections, and ensuring the complete removal of pregnancy tissues. However, medication may not be needed in every case, this will depend on individual medical circumstances. Here are the most commonly used types of medication:

1. Misoprostol: This is a prostaglandin medication that encourages the uterus to contract and expel any remaining pregnancy tissue. It is often used in cases of incomplete miscarriage or missed miscarriage.

2. Mifepristone: Usually used in combination with misoprostol, this medication helps in preparing the uterus to expel the pregnancy tissue.

3. Antibiotics: These can be prescribed to prevent or treat infections that may develop following a miscarriage.

4. Pain relievers: Over-the-counter pain relief medications are often recommended to manage pain following a miscarriage.

5. Antidepressants or anti-anxiety medications: If a woman is having difficulty coping with the emotional impact of miscarriage, these medications can be recommended by a healthcare professional.

6. Hormonal contraceptives: These can help regulate a woman’s menstrual cycle after a miscarriage and prevent pregnancy until she is physically and emotionally ready.

Always consult a healthcare provider for personalized advice regarding medication. It’s important to follow their instructions closely to ensure a safe and effective treatment process.

Prevention of Miscarriage

Miscarriages are often caused by issues that are out of a woman’s control such as chromosomal abnormalities, and sometimes the cause is unknown. However, there are some strategies and lifestyle choices that may help in the prevention of miscarriage:

1. Regular Prenatal Care: Regular prenatal visits can help your doctor monitor your health and the health of your baby. These appointments can help identify any potential issues early.

2. Healthy Lifestyle: A healthy lifestyle can improve your chances of a healthy pregnancy. This includes eating a well-balanced diet, regular exercise, maintaining a healthy body weight, staying hydrated, and getting plenty of sleep.

3. Avoid Risky Substances: Limit exposure to potential harmful substances, such as lead, radiation, and heavy metals. Also, avoid recreational drugs, smoking and limit caffeine consumption.

4. Take Folic Acid: Start taking 400 mcg of folic acid each day at least one month before getting pregnant to help prevent birth defects.

5. Managing Chronic Conditions: If you have a chronic condition, such as diabetes or hypertension, keeping it under control can increase your chances of a healthy pregnancy. It’s important to talk to your healthcare provider about any necessary medication adjustments before you try to conceive.

 

6. Avoid Alcohol: No amount of alcohol has been found to be safe during pregnancy. It can increase risks of complications and problems in the baby.

7. Avoid Certain Foods: Some foods are linked to miscarriage, including unpasteurized dairy, deli meats, raw or undercooked seafood, excessive caffeine and certain types of fish high in mercury.

8. Limit Exposure to Infectious Diseases: Certain infections can increase the risk of miscarriage, so wash hands frequently, avoid sharing food and drink, and stay up to date on immunizations.

9. Regular Exercise: Moderate-intensity exercise for at least 30 minutes a day can promote overall health and increase the chances of carrying a pregnancy to term.

10. Reduce Stress: High levels of stress may increase the risk of miscarriage. Implementing stress management techniques, such as relaxation exercises, mindfulness, yoga or therapy can be beneficial.

Remember, while these steps can help reduce the risk of miscarriages, they cannot eliminate them completely. It’s important to follow your healthcare provider’s advice and report any troubling symptoms promptly.

FAQ’s about Miscarriage

1. What is a miscarriage?
A miscarriage, also known as spontaneous abortion, is the loss of a pregnancy before 20 weeks of gestation. The majority of miscarriages occur in the first trimester of pregnancy.

2. What causes a miscarriage?
Most miscarriages are caused by chromosomal abnormalities that happen by chance when the sperm combines with the egg. Other factors can include maternal health conditions, age, lifestyle factors such as smoking and drug use, hormonal problems, and infections.

3. What are the main signs of a miscarriage?
Signs of a miscarriage include heavy spotting, abdominal pain, cramping, loss of pregnancy symptoms, white-pink mucus, passing tissue or clot-like material. However, all these symptoms don’t necessarily lead to miscarriage and require professional medical attention.

4. Can a miscarriage be prevented?
In many cases, a miscarriage cannot be prevented as it often happens due to chromosomal abnormalities. However, maintaining a healthy lifestyle, managing pre-existing medical conditions, regular prenatal care, avoiding smoking, alcohol, and certain foods can help reduce risk.

5. How long does it take to recover from a miscarriage?
The physical recovery can vary depending on how far along the pregnancy was. Generally, the bleeding will stop within 2 weeks and the hormonal cycle should return to normal within 4-6 weeks. Emotional recovery is different for everyone and can take much longer.

6. Can I get pregnant after a miscarriage?
Yes, most women go on to have successful pregnancies after a miscarriage. It’s recommended to wait until any bleeding has stopped, and you’ve had at least one menstrual cycle before trying again, to allow your body time to recover. It’s also important to speak to your healthcare provider for advice tailored to your circumstances.

7. How common are miscarriages?
Miscarriages are relatively common. About 10-20 percent of known pregnancies end in a miscarriage. But the actual number is likely higher because many miscarriages occur before a woman realizes she’s pregnant.

8. Do I need medical treatment if I’ve had a miscarriage?
In many cases, the miscarriage will complete on its own without the need for medical intervention. However, in some cases, a procedure called a D&C (dilation and curettage) is needed to remove the remaining foetal tissue. It is important to speak to a healthcare professional who can provide advice tailored to your situation.

9. Is it normal to feel grief after a miscarriage?
Yes, it is absolutely normal to feel a sense of loss and grief following a miscarriage. Many people experience a range of emotions from shock and disbelief to guilt, anger, sadness, and even depression. Everyone’s experience is unique and it’s important to take the time to grieve and seek support if needed.

10. How can I support someone who has had a miscarriage?
Being there to listen and provide emotional support is crucial. It can also be helpful to acknowledge their loss, provide comfort, and encourage them to take the time they need to recover. Encouraging them to seek professional help if their emotional wellbeing is significantly impacted can also be beneficial.

Useful links

Miscarriage is the loss of a pregnancy before the 20th week. Most miscarriages occur before the 12th week of pregnancy. There are many factors that can contribute to a miscarriage, such as age, chronic diseases, uterine or cervical problems, smoking, alcohol, unresolved chronic conditions, and others.

Here are some links to scientific journals about miscarriages:

  1. https://pubmed.ncbi.nlm.nih.gov/33915094/
  2. https://pubmed.ncbi.nlm.nih.gov/32978069/

Always remember to consult with a healthcare professional in case of a medical concern. These journals can provide more in-depth insights but are not a substitute for professional medical advice.

Complications of Miscarriage

A miscarriage refers to the spontaneous loss of a pregnancy before the 20th week. Complications can arise both physically and emotionally. Some of these complications include:

1. Hemorrhaging or Severe Bleeding: This can occur during or after a miscarriage and require medical intervention.

2. Infection: If any tissue from the pregnancy remains in the body after a miscarriage, it can lead to infection.

3. Incomplete Miscarriage: If some pregnancy tissues remain in the uterus, it can cause bleeding or infection. This may require surgical intervention to remove the remaining tissue.

4. Complications in Future Pregnancies: Having one miscarriage doesn’t necessarily mean you’ll have another, but women who have had two or more consecutive miscarriages are at higher risk of future pregnancy complications.

5. Emotional Trauma: A miscarriage can cause significant emotional distress. Many women experience feelings of grief, depression, anxiety, and post-traumatic stress disorder (PTSD) following a miscarriage.

6. Physical Pain: Miscarriage could be associated with abdominal pain and cramping.

7. Hormonal Issues: After a miscarriage, hCG pregnancy hormone levels may take a few weeks to return to non-pregnant levels. If the levels remain high, it may indicate that some pregnancy tissue is still present in the uterus.

8. Rh Sensitization: If an Rh negative woman miscarries an Rh positive fetus, this could lead to future pregnancy complications if not treated with Rh immune globulin.

It’s always important to consult a health care provider for concerns or complications related to pregnancy and miscarriage.

Home remedies of Miscarriage

It’s important to clarify that miscarriage is not something that can be treated or prevented by home remedies. It often happens due to chromosomal abnormalities, infection, health issues in the mother, and certain medical disorders. If the act of miscarriage is understood as an occurrence that you want to avoid during a pregnancy, there are certain best practices that can generally contribute to a healthy pregnancy:

1. Regular prenatal care: Routine check-ups and screenings will allow your doctor to detect and treat any health problems as early as possible.

2. Follow a healthy lifestyle: This includes eating a balanced diet rich in vitamins and nutrients, avoiding stress, getting regular exercise, keeping a proper sleep routine.

3. Avoid risky substance: This includes substances like alcohol, tobacco, drugs. Some prescription and over-the-counter medications could also increase the risk of miscarriage, hence always discuss with your doctor before taking any medication.

Remember that these steps will generally improve the health of a pregnancy but do not guarantee that a miscarriage will not occur. If you think you’re having a miscarriage, seek immediate medical help. Seek support from loved ones, a counselor, or therapist to help cope with the emotional implications.

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Women's Health,

Last Update: January 5, 2024