Miscarriage – Understanding Symptoms, Causes, and Treatment

What is a miscarriage? 

A miscarriage is the unexpected loss of pregnancy loss that occurs before the 20th week of pregnancy. This pregnancy complication is also referred to as early mid-trimester pregnancy loss, spontaneous abortion, or fetal demise. The term used to describe the loss of a fetus after 20 weeks of pregnancy is stillbirth. 

Since some women experience miscarriages without confirmation from a health care provider, making it very difficult for researchers to know the number of women who experience early pregnancy loss. Gynecologists estimate that miscarriages are common and occur in roughly 10% of confirmed pregnancies. 

Symptoms of a miscarriage

Miscarriages happen most often during the first trimester of pregnancy, which is within the first 13 weeks. Symptoms can include: 

• Vaginal bleeding which can include light bleeding, often called spotting 
• Pain or cramping in the abdomen, pelvic area or lower back 
• Fluid, tissue, or clot-like material passing from the vagina 
• Fast heartbeat 

It is important to understand that bleeding from the vagina during pregnancy does not always mean a miscarriage. Pregnant women often have spotting and cramping early in pregnancy but do not miscarry. It is always recommended that a woman consult with her healthcare provider immediately when experiencing such symptoms. 

If a woman has passed tissue from her vagina, it is recommended to place it in a clean container to give to a healthcare professional. A lab can exampine the tissue to check for signs of a miscarriage. 

Some women who have a miscarriage may also be prone to an infection in the uterus, which can be life threatening. While it is rare in the United States, it is important that women who experience the following symptoms for over 24 hours, should call 911 immediately: 

• High fever over 100.4 degrees Fahrenheit on more than two occasions 
• Severe pain in the lower abdomen
• Bloody vaginal discharge which could include pus and contain a foul smell 

Causes of a miscarriage

Early pregnancy loss may occur for many reasons, and sometimes the cause can remain unknown, despite completing additional tests. Causes of miscarriage may include:

Irregular genes or chromosomes 

Miscarriages often happen because the unborn baby does not develop properly. Anywhere from 50% to 66% of miscarriages in the first trimester are linked to irregular genes, often extra or missing chromosomes. Two sets of chromosomes, one from each parent, unite when an egg and sperm come together. However, if either set of chromosomes has and irregular number of chromosomes than usual, that can lead to a miscarriage. Chromosome conditions may lead to: 

• Anembryonic pregnancy, which happens when no embryo forms. The embryo may form but is absorbed back into the body. 
• Intrauterine fetal demise, which is when an embryo forms but stops developing. The embryo dies before any symptoms of pregnancy loss occurr. 
• Molar pregnancy, which is when a fetus does not develop. This happens most often if both sets of chromosomes come from the sperm and is linked with irregular growth of the placenta. With a partial molar pregnancy, the fetus may develop, however it cannot survive. This happens when there is an extra set of chromosomes, known as triploidy. Both molar and partial molar pregnancies cannot go to full term because they can lead to serious health problems. It has also been found that it can sometimes be linked with changes of the placenta that can lead to cancer in the woman who is pregnant. 

There are certain routine activities that are well known to NOT cause miscarriage which include: 

• Exercise
• Sex
• Use of birth control before getting pregnant
• Working (as long as you’re not exposed to harmful chemicals or radiation) 

If you are curious to know how these routine activities may impact your pregnancy, it is recommended to discuss that with a healthcare physician. 

Understanding risk factors of a miscarriage

There are various factors that could raise the risk of a miscarriage or early pregnancy loss, including: 

• Age: Women over the age of 35 have a higher risk of miscarriage than a younger person. The risk changes increase as the woman gets older jumping from a 20% risk at age 35 to 57% to 80% at age 45. 
• Previous miscarriage: If a woman has experienced a miscarriage before, this puts her at a higher risk of early pregnancy loss. 
• Long term conditions: if a woman experiences ongoing health conditions, such as uncontrolled diabetes, she may have a higher risk of miscarriage. 
• Uterine and/or cervical problems: Certain uterine conditions or having a weak cervix or cervical tissues might raise the chances of a miscarriage. 
• Gestational diabetes mellitus (GDM): a temporary and it is characterized by the pancreas inability to produce enough insulin, or the body’s inability to use that insulin effectively.
• Smoking, consuming alcohol or caffeine, and illegal drugs: It is widely known that people who smoke have a higher risk of early pregnancy loss than those who do not. Heavy consumption of caffeine or drinking alcohol also increases the risk. As does the use of illegal drugs such as cocaine or methamphetamine.
• Weight: Being underweight or overweight has been connected with a higher risk of miscarriage and lower the risk of successful pregnancies. 
• Genetic conditions:  One partner may be healthy but can carry a genetic problem that raises the risk of a miscarriage. As an example, one partner could have a unique chromosome that formed when the pieces of two different chromosomes attached to one another, which is called translocation. If either partner carries a chromosome translocation, passing it to an unborn child increases the chances of birth defects or miscarriage.
• Ectopic Pregnancy: This is when the embryo attaches itself outside of the womb, typically on a fallopian tube. This can be life threatening for the mother, and always results in a miscarriage.

Preventing a miscarriage

While there is often nothing that one can do to prevent a miscarriage, it is recommended to focus on taking care of the health of the mother and her unborn baby. This includes: 

• Regular prenatal care while pregnant and right after giving birth 
• Stay away from things that may increase risk factors of a miscarriage. This could include smoking or consuming caffeine or alcohol. 
• Consulting with a healthcare physician about supplemental multivitamins
• If you have experienced a previous miscarriage, it is recommended to consult with a healthcare professional about the use of a low-dose aspirin. 

Miscarriage diagnosis and treatment 

In order to diagnose a miscarriage, your healthcare professional will likely perform one or more tests which could include: 

• Blood tests which will check the level of the pregnancy hormone, hCG or human chorionic gonadtropin, in your blood. This test is often repeated after 48 hours to evaluate if there are a pattern of changes in your hCG. 
• A pelvic exam will allow your healthcare professional to check and see if your uterus has begun to open. A miscarriage is more likely if it has started to open. 
• An ultrasound will allow your healthcare professional to check for a fetal heartbeat. If the result of the test isn’t clear, you may need to schedule a follow up ultrasound. 
• Tissue tests if you have passed what looks like a tissue, which will then be sent to a lab for results. 
• Chromosomal tests are recommended if you have had two or more previous miscarriages. Often, blood tests are also recommended for both partners as well to help find out which partner’s chromosome make-up may be linked to an increased risk for miscarriage. 

If tests results confirm that a miscarriage did occur or you are at risk of having one, there are several different terms that may be used to describe what happened, including: 

• Threatened miscarriage, which means that there is bleeding from the vagina but the cervix hasn’t started to open. 
• Inevitable miscarriage, which is used to describe a miscarriage that cannot be avoided because of bleeding, cramping and the cervix being open. 
• Incomplete miscarriage, which is when pregnancy tissue has been passed but some remains in the uterus. 
• Missed miscarries is when the placental and embryonic tissues remain in the uterus but the embryo has died or never fully formed. 
• Complete msicarriage, which means that you have passed all pregnancy tissues and is common for early pregnancy loss before 12 weeks. 
• Septic miscarriage is a condition that happens when an inflection occurs in the uterus after a miscarriage. This can be life threatening and medical care is needed immediately. 

Treatments 

If tests confirm that a miscarriage occurred or will occur, your healthcare professional might recommend one of the following treatment options: 

• Expectant management which is when the miscarriage progresses naturally. This often happens within a few weeks of finding out that the embryo has died and can take up to 8 weeks. If the pregnancy tissue does not pass from the body on it’s won, a treatment with medicines or surgery may be needed. 
• Medical treatment can be needed to help the uterus pass the pregnancy tissue from the body if it does not occur naturally. A combination of medicines including mifepristone and misoprostol is found the be more effective than misoprostol alone and has a higher rate of helping the body release all remaining pregnancy tissue. 
• Surgical treatment may be necessary if you have a miscarriage along with heavy bleeding or show signs of an infection. During this procedure, the healthcare team will open the cervix and remove tissue from inside the uterus, called uterine aspiration. While complications are rate, they can include damanage to the connective tissue of the cervix or the wall of the uterus.
• Support from your family, friends, thery, and support groups may be necessary after a miscarriage. A miscarriage can be a traumatic experience, and professional counseling may be necessary.

A miscarriage can be a terrifying prospect for an expecting mother, but taking the right precautions and working closely with your doctor in many cases can help reduce the risk.