Pregnancy Loss (Miscarriage)

Overview

Miscarriage is the unexpected loss of a pregnancy before the 20th week, with about 10% to 20% of known pregnancies ending in miscarriage. It occurs when the unborn baby doesn't develop properly. Symptoms include vaginal bleeding, cramping, and passing tissue. Causes include genetic problems, maternal health conditions, and hormonal issues. Routine activities, exercise, sex, arguments, and the use of birth control pills before getting pregnant do not cause miscarriage. Seek medical attention if experiencing severe symptoms like fever, chills, pain, foul-smelling discharge, or heavy bleeding.

Understanding the disease

Symptoms

The symptoms of pregnancy loss (miscarriage) may include bleeding from the vagina with or without pain, including light bleeding called spotting, pain or cramping in the pelvic area or lower back, and fluid or tissue passing from the vagina. Other symptoms can include a fast heartbeat. Keep in mind that most pregnant people who have vaginal spotting or bleeding in the first trimester go on to have successful pregnancies. It's essential to consult a healthcare professional if experiencing any of these symptoms.

Risk Factors

Risk factors for developing pregnancy loss through miscarriage include:

1. Age: If you're older than 35, your risk increases. At age 35, your risk is about 20%, and at age 40, it ranges from 33% to 40%.
2. Past miscarriages: Having one or more prior miscarriages increases your risk.
3. Long-term health conditions: Uncontrolled diabetes, hormonal problems, thyroid disease, and obesity are examples of conditions that can raise your risk.
4. Uterine or cervical problems: Certain uterine conditions or weak cervical tissues might raise the chances of miscarriage.
5. Smoking, alcohol, caffeine, and drug use: Using tobacco, consuming alcohol, caffeine, or using illegal drugs such as cocaine increases your risk.
6. Genetic conditions: In some cases, having a genetic condition or carrying a chromosome translocation can lead to a higher risk of miscarriage.
7. Weight: Being underweight or overweight increases the risk of miscarriage. Please note that routine activities like exercise, sex, arguments, using birth control pills before getting pregnant, working, and genetic conditions do not cause miscarriage. Most miscarriages occur due to a random event and are not anyone's fault.

Development

Miscarriage typically occurs when the unborn baby does not develop properly, and about half to two-thirds of miscarriages in the first trimester are linked with extra or missing chromosomes. Chromosomes are structures in each cell that contain genes, and when an egg and sperm unite, two sets of chromosomes join together. If either set has fewer or more chromosomes than usual, it can lead to a miscarriage. Miscarriage can also happen due to irregular genes or chromosomes.

Assessment and Diagnosis

Triage

If you suspect a pregnancy loss or miscarriage, you should see a doctor as soon as possible. The symptoms include vaginal bleeding with or without pain, pelvic or lower back pain, fluid or tissue passing from the vagina, and a fast heartbeat. If you have passed tissue from your vagina, it is essential to place it in a clean container and contact your healthcare professional or go to the hospital for further examination. Heavy bleeding or bleeding with cramping pain during the first trimester should be reported to your pregnancy care team immediately.

Diagnosis

To diagnose a pregnancy loss or miscarriage, your health care team might perform several tests, including:

1. Blood tests: These tests can check the level of the pregnancy hormone, human chorionic gonadotropin (hCG), in your blood. Irregular changes in hCG levels might indicate pregnancy loss. Blood tests can also determine your blood type, which may be important if you have an Rh-negative blood type.
2. Pelvic exam: Your health care professional may examine your cervix to check if it has begun to open, which increases the risk of miscarriage.
3. Ultrasound: This imaging test can detect a fetal heartbeat and determine if the pregnancy is growing properly. If the test results are unclear, you might need another ultrasound after a week.
4. Tissue tests: If you have passed tissue that appears to be from the pregnancy, it can be sent for laboratory analysis to confirm a miscarriage.
5. Chromosomal tests: If you have had two or more previous miscarriages, your health care professional may recommend blood tests for you and your partner to determine if chromosomal abnormalities may be contributing to the miscarriages. Based on the test results, your health care team will use terms like "threatened miscarriage," "inevitable miscarriage," "incomplete miscarriage," "missed miscarriage," or "complete miscarriage" to describe the situation.

Management and Treatment

Complications

Complications of pregnancy loss (miscarriage) can include septic miscarriage, which occurs when pregnancy tissue remains in the uterus after a miscarriage and leads to a uterine infection. Symptoms of septic miscarriage may include fever higher than 100.4 degrees Fahrenheit, chills, pain in the lower stomach area, foul-smelling vaginal discharge, and vaginal bleeding. Heavy bleeding from the vagina, called a hemorrhage, can also be a complication of miscarriage, which may require medical care such as blood transfusions or surgery.

Home Remedies

Home remedies for pregnancy loss (miscarriage) are limited, as most miscarriages happen due to factors outside of a person's control, such as genetic abnormalities or issues with the developing fetus. However, here are some general suggestions for maintaining overall health and well-being during pregnancy:

1. Regular Prenatal Care: Ensure you are receiving regular prenatal care from a healthcare professional while you are pregnant and after giving birth.
2. Avoid Miscarriage Risk Factors: Stay away from known risk factors for miscarriage, such as smoking, drinking alcohol, and using illegal drugs.
3. Take a Daily Multivitamin: Take a daily multivitamin, including folic acid, to support your baby's development.
4. Limit Caffeine: Keep your caffeine intake to no more than 200 milligrams per day, which is equivalent to a 12-ounce cup of brewed coffee. Check food labels for caffeine content and consult your pregnancy care team for personalized advice.
5. Manage Chronic Conditions: Work with your healthcare team to keep any pre-existing health conditions under control, such as diabetes or thyroid disorders.
6. Pelvic Floor Exercises: Perform Kegel exercises regularly to strengthen your pelvic floor muscles, which can help support your growing uterus and pelvic organs.
7. Diet and Hydration: Maintain a healthy diet, rich in fruits, vegetables, whole grains, and lean proteins. Drink plenty of fluids to prevent constipation, which can put strain on your pelvic muscles.
8. Proper Lifting Techniques: Avoid heavy lifting and use proper lifting techniques, engaging your legs instead of your waist or back.
9. Manage Stress: Practice stress-reduction techniques like deep breathing, meditation, or yoga to promote emotional well-being.
10. Seek Medical Attention: If you experience any symptoms of miscarriage, such as vaginal bleeding or severe abdominal pain, seek medical attention immediately.

Treatment

Treatment for pregnancy loss (miscarriage) depends on the specific circumstances and the stage of the pregnancy. In most cases, there is no medical treatment to reverse a miscarriage once it has started. However, prompt medical care can help manage the symptoms and complications that may arise. Some treatments include:

1. Expectant management: In cases where the miscarriage is inevitable, healthcare providers may recommend waiting for the miscarriage to complete naturally. This approach is typically used when the pregnancy is not viable or when there is a risk of severe bleeding or infection.
2. Medications: Your healthcare provider may recommend medications to manage pain, reduce bleeding, or prevent infection. For example, they may prescribe pain relievers like acetaminophen or ibuprofen, or they may administer medications like misoprostol or prostaglandin to help manage the process.
3. Surgical intervention: In some cases, a surgical procedure called a dilation and curettage (D&C) may be performed to remove any remaining pregnancy tissue from the uterus. This procedure can help to prevent infection and promote healing.
4. Emotional support: It is important to seek emotional support during this difficult time. Talking to a counselor, joining a support group, or seeking comfort from friends and family can help with the grieving process. It is essential to consult with a healthcare professional for personalized advice and treatment options.

Preparing for medical consultation

To prepare for an appointment for pregnancy loss (miscarriage), you should:

1. Ask for any instructions: Contact your health care team to inquire about any specific instructions you should follow, like limiting your activities before the appointment.
2. Find a support person: Invite a loved one or friend to accompany you to the appointment, as they can provide emotional support and help remember important information discussed during the appointment.
3. Prepare a list of questions: Compile a list of questions to ask your health care professional about miscarriage, such as treatment options, necessary tests, symptoms to watch for, potential causes, and future pregnancy prospects.
4. Review your medical history: Gather information about your menstrual cycle, use of birth control, any previous miscarriages or complications during pregnancy, health conditions, and blood type to share with your health care professional.
5. Expect your health care professional to ask questions: Be prepared for your doctor to ask about your last menstrual period, use of birth control, symptom onset, bleeding patterns, and any previous pregnancy history. By being well-prepared and asking relevant questions, you can ensure that you receive the information and support you need during your appointment.