Miscarriage And Types of Miscarriages. Miscarriage occurs when a pregnancy ends before the embryo or fetus can survive on its own outside the uterus. Nearly every pregnant woman thinks about miscarriage during pregnancy, but it occurs in only about 15% of all pregnancies.
What Causes a Miscarriage?
We don't usually know and are often unable to find out what causes a miscarriage. The most common finding in early miscarriages is an abnormality in the development of the early embryo. Studies indicate more than half of all early miscarriages have chromosomal abnormalities.
Many factors can affect the embryo and its environment, including radiation, chemicals (drugs or medications) and infections. Called temtogens, these adverse factors are discussed in depth in Week 4.
We believe various maternal factors are important in some miscarriages. Unusual infections, such as listeriosis, toxoplasmosis and syphilis, have been implicated in miscarriages.
We have no concrete evidence that deficiency of any particular nutrient or even a moderate deficiency of all nutrients causes a miscarriage. Women who smoke have a higher rate of miscarriage. Alcohol is also blamed for an increase in miscarriages.
The trauma of an accident or major surgery has been related to an increase in miscarriages, although this is difficult to verify. An incompetent cervix (see Week 24) is a cause of pregnancy loss after the first trimester. Many women have blamed emotional upset or trauma for a miscarriage, but this is hard to prove.
Below is a discussion of different types and causes of miscarriage. It is included to alert you about what to watch for if you have any symptoms of a miscarriage. If you have questions, discuss them with your healthcare provider.
Threatened Miscarriage
A threatened miscarriage may be presumed when there is a bloody discharge from the vagina during the first half of pregnancy. Bleeding may last for days or even weeks. There may or may not be any cramping or pain. Pain may feel like a menstrual cramp or a mild backache. Resting in bed is about all you can do, although being active does not cause miscarriage. No procedures or medication can keep a woman from miscarrying.
Threatened miscarriage is a common diagnosis because 20% of all women experience bleeding during early pregnancy but not all miscarry.
Inevitable Miscarriage
An inevitable miscarriage occurs with the rupture of membranes, dilatation of the cervix and passage of blood clots and even tissue. Miscarriage is almost certain under these circumstances. The uterus usually contracts, expelling the fetus or products of conception (so-called when no embryo or fetus is present).
Incomplete Miscarriage
With an incomplete miscarriage, the entire pregnancy may not be passed at once. Part of the pregnancy is passed while part of it remains in the uterus. Bleeding may be heavy and continues until the uterus is empty.
Missed Miscarriage
A missed miscarriage can occur with prolonged retention of an embryo that died earlier. There may be no symptoms or bleeding. The time period from when the pregnancy failed to the time the miscarriage is discovered is usually weeks.
Habitual Miscarriage
This term usually refers to three or more consecutive miscarriages.
If You Have Problems
If you have problems, notify your doctor immediately! Bleeding usually appears first, followed by cramping. Ectopic pregnancy must be considered a possibility. A quantitative HCG may be useful in identifying a normal pregnancy, but a single test report usually won't help. Your caregiver needs to repeat the test over a period of days.
Ultrasound may help if you are more than 5 gestational weeks into your pregnancy. You may continue to bleed, but seeing your baby's heartbeat and a normal-appearing pregnancy may be reassuring. If the first ultrasound is not reassuring, you may be asked to wait a week or 10 days, then repeat the ultrasound.
The longer you bleed and cramp, the more likely you are having a miscarriage. If you pass all of the pregnancy and bleeding stops and cramping goes away, you may be done with it. However, if everything is not expelled, it may be necessary to perform a dilatation and curettage (D&C) to empty the uterus. It is preferable to do this so you won't bleed for a long time, risking anemia and infection.
Some women are given the hormone progesterone to help them keep a pregnancy. The use of progesterone to prevent miscarriage is controversial. Doctors do not agree on its use or its effectiveness.
Rh-Sensitivity and Miscarriage
If you're Rh-negative and you have a miscarriage, you will need to receive RhoGAM. This applies only if you are Rh-negative. RhoGAM is given to protect you from making antibodies to Rh-positive blood. (This is discussed in Week 16.)
If You Have a Miscarriage
One miscarriage can be traumatic; two in a row can be very difficult to deal with. Repeated miscarriages occur due to chance or "bad luck" in most cases.
Most doctors don't recommend testing to find a reason for miscarriage unless you have three or more. Chromosome analysis can be done, and other tests investigate the possibility of infections, diabetes and lupus.
Don't blame yourself or your partner for a miscarriage. It is usually impossible to look back at everything you've done, eaten or been exposed to and find the cause of a miscarriage.
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