MISCARRIAGE

(Spontaneous Abortion)

 Basic information

description

Loss of a pregnancy prior to the 20th week is generally considered a miscarriage. It happens in about 20% to 30% of first pregnancies. It may occur so early that a woman is unaware of being pregnant. A miscarriage may be "threatened," but pregnancy continues to term.

FREQUENT SIGNS & SYMPTOMS

• Uterine cramps.
• Vaginal bleeding (from slight to heavy).
• Sudden decrease in signs of pregnancy.

causes

There are many reasons a pregnancy ends in miscarriage. Most miscarriages occur because a pregnancy is not developing normally. Sometimes, no cause is found. Work, exercise, and having sex do not increase the risk.

risk increases with

• Genetic factors (problems with fetal chromosomes).
• Problems with a woman's uterus or cervix.
• Age over 30 years or under 15 years.
• Certain infections during pregnancy.
• Chronic maternal diseases.
• Alcohol use, drug or substance abuse.
• Cigarette smoking.
• Being very overweight or underweight.
• Caffeine use (heavy).
• Certain drugs.
• Conceiving after infertility.
• Conception within three to six months after delivery.
• Exposure to environmental and workplace hazards.
• Intrauterine device use.
• Having two previous miscarriages.
• Radiation or severe malnutrition.

PREVENTIVE MEASURES

• Cannot always be prevented. To reduce risk factors:
  • Obtain regular medical check-ups.
  • Eat a normal, well-balanced diet.
  • Avoid risk factors where possible.
  • Don't use nonprescription drugs or herbal products without medical advice.

expected outcomes

With treatment, a miscarriage is not life-threatening. It usually does not affect a woman's ability to carry a healthy baby to term in the future. Feelings of loss and grief are common. Feelings of guilt may also be present.

possible complications

• Uterine infection (fever, chills, and aching).
• Hemorrhaging (bleeding) from other body parts.
• "Incomplete" abortion, in which some placenta or fetal tissue remains in the uterus, or missed abortion, in which the fetus dies but remains in the uterus.

 diagnosis & treatment

general measures

• Your obstetric provider may do a pelvic exam. Questions will be asked about your symptoms. Other tests can include blood studies, ultrasound, and tissue study (if you have passed tissue). Types of miscarriage are: threatened, inevitable, incomplete, complete, missed, or septic. Treatment depends on type. Your obstetric provider will discuss options with you.
• For a threatened miscarriage, bed rest at home may help stabilize the pregnancy. Bleeding may be severe, requiring hospital care and blood transfusion.
• Following a complete miscarriage:
  • Expect a small amount of vaginal bleeding or spotting for 8 to 10 days. Avoid tampons for 2 to 4 weeks.
  • Wait through 2 or 3 normal menstrual cycles (or as advised) before attempting to become pregnant again.
• Surgery may be done to remove any remaining tissue or a dead fetus. D & C (dilatation and curettage) or D & E (dilatation and evacuation) may be needed.
• Counseling for patient and partner may be helpful.

medications

• Oxytocin to control bleeding may be given.
• Pain relievers may be prescribed.
• Antibiotics may be prescribed for an infection.
• RhoD (immune globulin) for Rh-negative female.

activity

• For a threatened miscarriage, rest in bed until symptoms disappear. Avoid sexual intercourse.
• After a miscarriage, reduce activity and rest often during the next 48 hours.

diet

• For a threatened miscarriage, drink fluids only, if bleeding and cramping are severe.
• After a miscarriage, no special diet.

 notify our office if

• You or a family member has vaginal bleeding during pregnancy.
• Bleeding and cramps worsen, you pass tissue, or fever and chills occur.

Special Notes: