Miscarriage: Types, Symptoms, Causes, Diagnosis and Treatment

Overview  

Miscarriage is the loss of a pregnancy 20 weeks before the duration of gestation. Most miscarriages happen in the first trimester of pregnancy. Chromosomal problems are the most common reason for miscarriages.  

This blog will further dive into a deeper understanding of miscarriage, its symptoms, causes, diagnoses and treatments.   

What is a miscarriage? 

Miscarriage is the loss of the fetus b efore the 20th week of pregnancy. The medical term for a miscarriage is called spontaneous abortion. But it cannot be termed an abortion in the common or the most understood meaning of the term. 

Nearly 50% of all pregnancies may end in miscarriages. Often women do not know they are pregnant, or it occurs before missing a menstrual period. However, close to 15 to 25% of known pregnancies may lead to a miscarriage, and more than 80% of pregnancies end within the first three months of pregnancy. It is crucial to note that women may miscarry after 20 weeks, and if they do, they are termed as a late miscarriage. 

What are the types of miscarriages? 

There are varied kinds of miscarriages, including:  

• Inevitable miscarriage: Bleeding and cramping are observed, and the cervix dilates. A miscarriage is likely.  
• Threatened miscarriage: When there is bleeding and the threat of a miscarriage, the cervix hasn’t dilated. The pregnancy will likely continue without any issues.  
• Missed miscarriage: When the embryo dies or is not developed, the tissues remain in the uterus.
• Complete miscarriage occurs before the 12^th week of pregnancy when the entire pregnancy tissues leave the body. 
• Recurrent miscarriage (RM): When a women experience consecutive loss of three or more pregnancies during the first trimester is known as recurrent miscarriage. It affects only 1% of couples trying to conceive a baby.
• Incomplete miscarriage:  when a woman miscarries, the entire tissue from the embryo may not leave the body. Such miscarriages are known as incomplete miscarriages.

What are the symptoms of miscarriage? 

Most miscarriages occur before 12th week of pregnancy. 

The signs and symptoms of a miscarriage may include: 

• Pain or cramping in the stomach or lower back 
• Vaginal spotting or bleeding 
• Fluid or tissue passing from the vagina 

If a woman has miscarried through the vagina, placing the embryo in a clean container for further analysis in the hospital may help determine the cause of the miscarriage.

Most women with vaginal spotting or bleeding in the first trimester continue to have successful pregnancies. 

 When to seek medical advice for miscarriage?

 If a pregnant woman notices signs of miscarriage, seek immediate medical attention.

Request an appointment at Apollo Hospitals

What causes miscarriage? 

In the first trimester of pregnancy, nearly 50% of all miscarriages occur due to chromosomal abnormalities. These chromosomes are microscopic structure in the body’s cell that carry the genes – it determines various attributes, including sex, hair and eye colour, and blood type.

During fertilization, when the egg and sperm get together, two sets of chromosomes also combine. However, when an egg or sperm has more or fewer chromosomes than normal, the fetus may have an odd number of chromosomes. As a fertilized egg develops into a fetus, its cells divide and multiply several times, and there may be abnormalities. Abnormalities during this process also lead to miscarriage.  

Most chromosomal problems happen by chance. It’s not entirely known why this happens.  

Several factors may cause miscarriage that may, including:  

• Infection  
• Improper implantation of fertilized egg in the uterine lining  
• Age  
• Uterine abnormalities  
• Hormonal imbalances  
• Exposure to TORCH diseases  
• Disorders of the immune system, such as lupus  
• Severe kidney disease  
• Congenital heart disease  
• Lifestyle factors like drinking alcohol, smoking or using recreational drugs  
• Thyroid disease  
• Radiation  
• Uncontrolled diabetes  
• Incompetent cervix (cervix begins to open too early in pregnancy)  
• Some medicines like the acne drug isotretinoin  
• Severe malnutrition  

There is no scientific proof yet that sexual activity, exercise, stress or prolonged use of birth control pills are the reasons causes of miscarriage. Whatever the situation, it’s essential not to blame oneself for having a miscarriage. Most of the miscarriages that occur have nothing to do with something an individual did or didn’t do.  

What is cervical insufficiency? 

A miscarriage sometimes occurs when the mother has a weakened cervix, known as cervical insufficiency. Such cases typically occur in the second trimester.

A few symptoms can usually be observed before a miscarriage caused by cervical insufficiency. The following are the signs:

• A sudden pressure 
• Water breaks
• Tissues from the baby and placenta may start to leave the body without pain

However, if a woman has experienced miscarriage due to cervical insufficiency in the past, the doctor may treat the subsequent pregnancy with a circling stitch. The stitch securely closes the cervix until it is time for delivery, and the doctor removes the stitches.

If one has experienced miscarriage for other reasons, known or unknown, but the doctors diagnose cervical insufficiency in the present pregnancy, it is also treated with a cervical stitch.

How is a miscarriage diagnosed? 

The pregnancy care provider may perform an ultrasound test to confirm a miscarriage. These tests check for a fetal heartbeat or the presence of a yolk sac. A blood test is recommended to check for miscarriage as the test measures human chorionic gonadotropin (hCG), a hormone created by the placenta. A low level of hormones indicates miscarriage. The healthcare provider may perform a pelvic exam to check if the cervix has opened. 

What are the treatments for a miscarriage? 

When a woman experiences a miscarriage, the entire tissue of the fetus must be removed from the uterus. Failure to do so or if some parts of the tissue remain inside the uterus may result in infection, bleeding, and other complications.

However, no further treatment is usually needed if the body has expelled all the fetus tissue from the body. The individual’s pregnancy care provider may conduct an ultrasound to ensure nothing remains in the uterus. 

In certain circumstances, if the tissue doesn’t expel on its own or the woman hasn’t started bleeding, the doctor may remove the tissue either with the help of medication or surgery.

Nonsurgical Treatment

The healthcare provider may recommend waiting to see if the individual passes the pregnancy independently. It may be the case if they have a missed miscarriage. Sometimes, a woman may want to wait for a miscarriage which could take several days. However, it may not be safe. If a person wishes to terminate the pregnancy at the earliest, the doctors may prescribe medications that assist the uterus in passing the pregnancy. These options are typically only available if one has miscarried ten weeks before pregnancy. If a miscarriage wasn’t confirmed, but they had symptoms of a miscarriage, their provider may prescribe bed rest for several days.  

They may be admitted to the hospital overnight for observation. When the bleeding stops, one may continue with their everyday activities. If the cervix is dilated, they may diagnose the individual with an incompetent cervix and perform a procedure to close the cervix (cervical cerclage).  

Surgical Treatment

Dilation and curettage (D&E) or dilation and evacuation (D&E) are the procedures the healthcare provider performs when the uterus has passed out the fetus’s tissues or if a woman is experiencing heavy bleeding. 

However, in cases where gestation is beyond ten weeks, surgery may be the only option. During any of the procedures performed by the doctor, the cervix is dilated, and any remaining tissues are gently suctioned or scraped out from the uterus. The healthcare provider performs these surgeries in a hospital, and the individual is under anaesthesia. 

Conclusion 

Most miscarriages occur because there’s a problem with the pregnancy. One can’t prevent them. If the doctor does a test and finds a problem, treatment options may be available. 

If one has an illness, treating it can improve the chances of a successful pregnancy. One step that an individual can take is to get as healthy as they can before they try to have a baby: 

• Get regular exercise 
• Cut back on caffeine 
• Maintain a healthy weight 
• Eat a healthy, well-balanced diet 
• Don’t smoke, drink alcohol, or take illegal drug 
• Avoid infections