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Miscarriage (Spontaneous Abortion)

Definition


Disease: Miscarriage (Spontaneous Abortion) Miscarriage (Spontaneous Abortion)
Category: Gynecological diseases

Disease Definition:

The spontaneous loss of a pregnancy before the 20th week is called miscarriage. Most miscarriages occur because the fetus isn't developing normally. About 10 to 20% of known pregnancies end in miscarriage. However, because many miscarriages occur so early in pregnancy that the woman doesn’t even know that she’s pregnant, the actual number may be much higher.

That miscarriage is a relatively common experience doesn't make it any easier. By understanding what medical care might be needed, what increases the risk and what can cause a miscarriage, a woman should take a step toward emotional healing because ending a pregnancy without a baby to hold in the arms is heartbreaking.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Before the 12th week of pregnancy is when most miscarriages occur. The following are included in the signs and symptoms:

 

  • Fluid or tissue passing from the vagina
  • Vaginal bleeding or spotting, although spotting or bleeding in early pregnancy is fairly common
  • Pain or cramping in the abdomen or lower back


Women should keep in mind that bleeding or spotting early in the pregnancy is quite normal. Women who experience light bleeding in the first trimester go on to have successful pregnancies in some cases. Even heavier bleeding doesn't result in miscarriage sometimes.
An infection in the uterus develops in some women who miscarry. The following may be experienced when experiencing this infection, which is also called a septic miscarriage:

 

  • Body aches
  • Fever
  • Vaginal discharge that's thick and has a foul odor
  • Chills


If the woman experiences the following, the doctor should be called:

 

  • Passing of tissue from the vagina
  • Bleeding, even light spotting
  • A gush of fluid from the vagina without bleeding or pain


Though it’s unlikely that any testing would define a cause, however, confirming the passage of placental tissue helps the doctor determine that the symptoms aren't related to a tubal (ectopic) pregnancy. So in a clean container, the patient may bring any tissue that is passed into her doctor's office. 

Causes:

USUALLY ABNORMAL GENES OR CHROMOSOMES:
As mentioned before, most miscarriages result because the fetus isn’t developing normally. The result of errors that occur by chance as the embryo divides and grows is typically problems with the baby's genes or chromosomes, not problems inherited from the parents. The following are some examples of abnormalities:

Blighted ovum:
The cause of about half of all miscarriages that occur in the first 12 weeks is blighted ovum, which is common. When a fertilized egg develops a placenta and membrane but no embryo, this condition occurs.

Intrauterine fetal demise:
The embryo is present but has died before any symptoms of pregnancy loss have occurred in this situation. Genetic abnormalities within the embryo may be the cause of this situation.

Molar pregnancy:
Occurring in about 1 in 1,000 pregnancies, a molar pregnancy, which is called gestational trophoblastic disease as well, is less common.

A mother's health condition may lead to miscarriage in a few cases, such as:

 

  • Thyroid disease
  • Uterus or cervix problems
  • Hormonal problems
  • Uncontrolled diabetes
  • Infections


Miscarriage is not provoked by routine activities like the following:

 

  • Lifting or straining
  • Exercise
  • Working, provided one is not exposed to harmful chemicals
  • Having sex


The risk of miscarriage may increase due to certain factors:

Age:
The risk of miscarriage is higher in women older than age 35. At age 35, a woman has about a 20% risk. At age 40, the risk is about 40%. And at age 45, it's about 80%. The paternal age may play a role as well. Some studies indicate that the chance of miscarriage is higher if the woman's partner is age 35 or older, with the chance increasing as men age.

More than two previous miscarriages:
After one miscarriage, a woman's risk of miscarriage is the same as that of a woman who's never had a miscarriage. But in women with a history of two or more previous miscarriages, the risk of miscarriage is higher.

Uterine or cervical problems:
The risk of miscarriage may be increased due to certain uterine abnormalities or a weak or unusually short cervix.

Invasive prenatal tests:
There is a slight risk of miscarriage in some prenatal genetic tests, such as chorionic villus sampling and amniocentesis.  

Smoking, alcohol and illicit drugs:
The risk of miscarriage is greater in women who smoke or drink alcohol during pregnancy than it is in nonsmokers and women who avoid alcohol during pregnancy. The risk of miscarriage also increases due to illicit drug use.

Chronic conditions:
The risk of miscarriage is higher in women with certain chronic conditions, such as thyroid disease or diabetes.

Complications

Complications:

None

Treatments:

Resting until the bleeding or pain subsides may be recommended if one is having a threatened miscarriage. Avoiding traveling, especially to areas where it would be difficult to receive prompt medical care, is a good idea. The patient may also be asked to avoid exercise and sex.

It's now much easier to determine whether the embryo has died or was never formed, and that a miscarriage will definitely occur, with the expansion of the use of ultrasound. There are several choices to consider in this condition:

Surgical treatment:
A minor surgical procedure called suction dilation and curettage (D and C) in which the doctor dilates the cervix and gently suctions the tissue out of the uterus is an option. After the suction, to scrape the uterine walls, a long metal instrument with a loop on the end (curet) is sometimes used. Damage to the connective tissue of the cervix or the uterine wall may be included in the rare complications of this procedure.

Expectant management:
Before the use of ultrasound in early pregnancy, most women did not know they were destined to have a miscarriage until it was already in process. From this experience, a woman may choose to let the miscarriage progress naturally. This usually happens within a couple of weeks of determining that the embryo has died. However, it may take up to 3 to 4 weeks and could be an emotionally difficult time for the woman.

Medical treatment:
Medication can cause the body to expel the pregnancy tissue and placenta, if after a diagnosis of certain pregnancy loss the patient prefers to speed the process. To increase the effectiveness of the medication and minimize side effects such as stomach pain, diarrhea and nausea, applying the medication vaginally may be recommended, although the patient can also take the medication by mouth. The specific timing of the miscarriage may vary and it will likely happen at home. The patient may need more than one dose of the medication. The treatment works within 24 hours for about 70% of women, the patient may experience the miscarriage within several days to weeks in case it doesn’t work within 24 hours.

To stop the bleeding, surgical treatment may be necessary in the case of an inevitable miscarriage.

Prognosis:

Not Available

Expert's opinion

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