Miscarriage
A miscarriage is the spontaneous loss of a pregnancy in the first twenty weeks. The most common obstetrical complication, a miscarriage results in up to 25% of all recognized pregnancies. The statistic is actually higher because many woman experience a miscarriage very early on without even being aware of the pregnancy; the miscarriage is experienced as a heavier than normal menstrual period occurring slightly later than expected. As a normal pregnancy progresses the risk of miscarriage decreases. After 8 weeks gestation the miscarriage risk is only 2%.
The most common reason for a miscarriage is a chromosomal problem affecting the embryo. Factors which can increase the risk of miscarriage include hormonal problems, infections, cigarette smoking, intake of large amounts of caffeine, and age. Women who are over 35 have a 35% chance of miscarrying and women over 45 a 50% chance. Recent research also show miscarriage rates increase with the age of the father independent of the mother's age. Medical conditions increasing the risk of miscarriage include uncontrolled diabetes, untreated hypothyroidism, and autoimmune diseases like lupus or rheumatoid arthritis.
Vaginal bleeding is the most common sign of a miscarriage. Since it is common in normal pregnancies as well, bleeding alone is not diagnostic of a miscarriage. Abdominal cramping and back pain associated with vaginal bleeding are more worrisome. If a sonogram (ultrasound) has not confirmed the pregnancy to be in the uterus this should be performed to exclude the possibility of an ectopic pregnancy.
Miscarriages are divided into three types. A complete miscarriage means all the tissue has passed out of the uterus. An incomplete or inevitable miscarriage means some tissue has passed but some remains in the uterus. In this case a dilation of the cervix (opening to the uterus) and suction curettage to remove the tissue will stop bleeding and prevent infection. A missed miscarriage is where the gestational sac remains in the uterus but the pregnancy has stopped growing. There may be a fetus with no heart beat. Frequently there are no symptoms warning the patient of this miscarriage.
Recurrent or habitual miscarriage is defined as three or more miscarriages in a woman. It is very important to make sure no structural or hormonal abnormalities exist in the mother and no chromosomal abnormalities are present in either parent when repeated miscarriages occur. In 30% of recurrent miscarriages no cause is found.
Psychologically a miscarriage is devastating to parents. The sense of loss is often great and emotional support from friends and family is very important. Most health care providers recommend a short wait of one or two months before trying to conceive again allowing for physical and emotional healing.
Most miscarriages cannot be prevented as they happen due to chromosomal abnormalities specific to that conception. It is, however, important to be under a physician's care even before pregnancy. Leading a healthy lifestyle in keeping with medical advice will help prevent complications in case a miscarriage should occur.
