Alternative Names spontaneous abortion, complete abortion
Definition Miscarriage is the loss of a foetus during pregnancy due to natural causes.
What is going on in the body? Miscarriages are very common, especially in the first three months of pregnancy or the first trimester. As many as half of all fertilised eggs die before a woman even notices any pregnancy symptoms. About one in 10 pregnancies diagnosed by urine or blood tests miscarry, usually between the seventh and twelfth week of pregnancy.
A healthy pregnancy cannot be harmed by normal activities. Most miscarriages occur because the foetus has a serious health problem that keeps it from surviving. Pregnancy hormone levels fall in response and symptoms such as nausea, tender breasts, and fatigue may go away. The body triggers uterine cramps and vaginal bleeding to expel the foetus. If no foetal tissue remains in the uterus, the cervix, or entry to the uterus, will close. The uterus will shrink in size and bleeding will slow then stop.
It is important to know that spotting or bleeding in the first trimester occurs in one in five women. It is not a sure sign of miscarriage. Less than half of the women who experience it will go on to miscarry.
What are the signs and symptoms of the condition? Symptoms of a miscarriage include:
vaginal bleeding
low back pain
abdominal pain
dull or sharp cramping
tissue or clots passing from the vagina
What are the causes and risks of the condition? Most miscarriages are linked to:
A pregnant woman has a higher risk for miscarriage if she:
is older than age 35
has an ongoing disease or immune system disorder
has a serious viral infection, such as herpes or rubella, in the first trimester
has had 3 or more miscarriages
smokes or uses illicit drugs
What can be done to prevent the condition? Not all miscarriages can be prevented. However, taking certain actions can lower the risk. For example, it helps to detect and treat health problems like diabetes or other disorders before the mother conceives.
Several months before pregnancy and during the entire pregnancy a woman should:
eat a diet rich in folic acid and take multivitamins. This helps prevent birth defects called, neural tube defects, and lays down a foundation of good nutrition.
stop smoking
avoid illegal drugs and over-the-counter drugs
avoid alcohol
keep her blood sugar under good control if she has insulin-dependent (Type I) diabetes
be sure to always wear a seat belt
avoid hazards like toxic chemicals, infectious diseases and x-rays
If a woman has had infertility evaluations for hormone imbalances, a doctor may screen her for problems that could cause early miscarriage. If a problem is found, hormone therapy can be prescribed.
How is the condition diagnosed? A pelvic examination may reveal:
an open or closed cervix, depending on whether all the contents of the uterus have been expelled
amniotic fluid in the vagina
foetal tissue in the vagina or cervix
a firm, non-enlarged uterus
A woman may have other tests, too.
A blood or urine test may be done to confirm pregnancy.
The level of pregnancy hormone (HCG) may be checked over a period of time to be sure the pregnancy has ended and no foetal tissue stayed in the uterus.
A full blood count (FBC) may be done to learn how much blood has been lost.
Other blood tests may be done to rule out infection and find out the mother's blood type.
A pregnancy ultrasound may be done to look for any tissue in the uterus or rule out a pregnancy outside the uterus.
What are the long-term effects of the condition? A miscarriage may or may not have long-term physical effects. The vast majority of women who have a miscarriage can go on to have a full-term pregnancy at a later time. If severe blood loss occurs during a miscarriage, anaemia (low iron in the blood) can set in.
Long-term psychological effects vary. A grieving woman's support system can make a big difference. A woman may feel anxiety, fear and guilt if she believes she has hurt her baby by lifting heavy furniture, exercising too much, having sex or doing anything else to cause the miscarriage. A healthy pregnancy cannot be harmed by normal activities. If a woman has any feelings or worries like this, she should discuss them with her doctor. Some women grow depressed after miscarriage. If this occurs, a woman should ask her doctor to refer her to a trained counsellor.
What are the risks to others? Miscarriage only affects the health of the mother and her baby. There certainly can be a psychological impact on the father and other family members as well. Referral for counselling can help in those instances.
What are the treatments for the condition? Some doctors suggest that a woman try to collect any tissue that passes from her vagina so it can be checked.
Antibiotics may be used for 24 to 48 hours.
Medication may be given to help the uterus contract and stop the bleeding.
If the mother's blood type is Rh negative and the foetus was Rh positive, the mother needs to have a Injection of Rh immune globulin (Anti-D). Otherwise, later pregnancies can be harmed by Rh sensitisation.
Sometimes, a miscarriage is incomplete. This means some foetal tissue stayed in the uterus. To avoid infection, a procedure called a D & C must be done to empty the uterus completely.
What are the side effects of the treatments? These side effects are usually short-term.
Drugs for pain relief may cause:
drowsiness
fatigue
nausea and vomiting
Antibiotics may cause:
a rash
diarrhoea
an allergic reaction
an upset stomach
Anaesthetics used for a D & C may cause a few hours of:
drowsiness
fatigue
nausea
What happens after treatment for the condition? A woman who has had a miscarriage or D & C may be advised to rest in bed for 24 hours. She should not have intercourse or use tampons for 2 weeks unless her doctor tells her otherwise.
A woman should call her doctor if she has:
a fever
lasting, heavy bleeding
worsening cramps or pain
If a woman does not want to get pregnant again, she should use birth control. If a pregnancy is desired, some doctors suggest using the natural family planning method of birth control for 2 to 3 months before trying to conceive.
How is the condition monitored? A woman's doctor may do weekly blood tests to follow the HCG level until it is nearly zero. This ensures that the pregnancy has ended.
Occasionally, tests are done on the foetal tissue to learn about its genetic makeup.
Author: Eva Martin, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
