asked Questions about Miscarriage
Approximately 15 to 20% of all pregancies end in miscarriage. Although
miscarriage can happen any time before 20 weeks, most take place in
the first twelve weeks of pregnancy. We do know that miscarriage is
NOT something which the mother has caused to happen. There is no treatment
which can prevent a miscarriage once it has started. Most women who
miscarry can conceive in the future and carry that pregnancy to term.
About 60-80% of the miscarriages occurring during the first twelve
weeks of pregnancy are caused by problems in the chromosomes of the
embryo. Often the miscarriage
occurs before the woman is aware she is pregnant. Most chromosomal problems
happen by chance and are not likely to happen again.
Rarely, though, the
chromosomal problem is inherited from the parents. This is
more likely with repeated miscarriages or in families
where there is a history of midcarriages or birth defects. Genetic testing
can be ordered on the fetal tissue from the miscarriage, or on blood
- There are maternal diseases that may lead to a higher incidence
of miscarriage, including: poorly controlled diabetes, systemic
lupus erythematosis (SLE or lupus), high blood pressure. Sometimes
a hormonal imbalance can cause an early miscarriage.
- Some people have a genetic condition which makes them more likely
to form blood clots which may increase the risk of miscarriage. Most
commonly this involves second and third trimester fetal loss.
- Some women form antibodies that might make them more likely to
- Infection with some viruses (eg, rubella, herpes simplex, and measles
viruses; cytomegalovirus; and coxsackieviruses), bacteria (Listeria)
or parasites (Toxoplasmosis) can cause a miscarriage.
- Congenital uterine abnormalities have been associated most often
with second-trimester pregnancy loss. However, 10-15% of women with
recurrent early pregnancy loss have congenital uterine abnormalities.
- Sometimes the cervix is incapable
of holding a pregnancy beyond the second trimester (incompetent cervix). This might be due to previous
cervical surgery or injury.
- Although a common concern of patients, environmental factors rarely
have been linked to sporadic pregnancy loss.
- Study results are conflicting on the association of smoking, use
of alcohol, and use of caffeine with sporadic pregnancy loss. They
may act in a dose-dependent fashion or synergistically to increase
the rate of sporadic pregnancy loss. It is best to minimize these risks by avoiding smoking, alcohol, caffeine and other drug use.
- Normal exercise does
not appear to increase the rate of sporadic pregnancy loss, particularly
in women in good physical condition.
- Ideally all women should take folic acid for one to three months
before conception. Deficiencies in folic acid have been associated
with neural tube defects.
- The most common symptoms of impending miscarriage are vaginal bleeding
and cramping. Not all pregnancies with bleeding end in miscarriage,
though. About 30% of
normal pregnancies have early vaginal bleeding and go on to term and with
a healthy baby. Because
the threat of miscarriage exists with bleeding, your doctor will
want to watch you more carefully over the next few days. You may be followed
with ultrasounds or blood tests.
- Sometimes an ultrasound will show that the fetus is no longer alive,
or didn't develop even though the pregnancy has not yet miscarried.
ultrasound shows the pregnancy is over what are my options? |top
- 1. To allow the pregnancy to pass on its own
- 2. Take a medication to induce passage of the pregnancy
- 3. A surgical procedure called a Dilation and Currettage (D&C)
can remove the pregnancy.
See below for more information on each option:
Managment: What if I want the miscarriage to pass naturally? |top
Once the diagnosis of impending miscarriage is made, it is difficult to determine when a miscarriage will occur. Sometimes
this can occur within a day or two of the diagnosis of a failed pregnancy,
most commonly within two weeks of the diagnosis of miscarriage. Rarely some miscarriages can take months to complete.
at the beginning of a miscarriage may be light, continuing over several
days. Mild lower abdominal or lower back aches may
accompany the bleeding. As the miscarriage progresses,
the bleeding will get heavier and the cramping may get more painful.
cervix dilates (opens), you may see blood and small clots. Rarely, you may notice
a gush of clear fluid from the vagina, without pain or bleeding. You
may take tylenol or motrin for the cramping.
- You can expect bleeding for 7-10 days
with spotting for a few days after that.
to call your doctor if you have any of the following
| Heavy or persistent bleeding saturating a heavy maxipad each hour for more than 2-3 hours.
| Feeling dizzy or light headed.
| Your heart is racing.
- It is important to be certain all the tissue relating
to the pregnancy has passed.
A blood test will be scheduled to ensure the pregnancy hormone has declined to zero. Sometimes the body does not completely expel
all the products of conception. A medication or a surgical procedure might need to be performed
to finish the process. Sometimes the bleeding from a miscarriage
is so heavy a D&C might be needed to prevent further blood loss.
- The advantage of expectant management is that you may avoid surgery
and the side effects of some medications. Disadvantages are that
the uncertainty of the waiting period can be difficult, especially
an emotionally trying time.
medications can I take to complete the miscarriage? |top
- If a miscarriage is diagnosed and you meet certain criteria, you
may be elligible to take a medication to induce your body to pass the
- The medication is called Misoprostol and works about 80-90% of the
time. Most people have some heavy bleeding and cramping a few hours
taking this medication and will pass the pregnancy in 12-24 hours.
A small percentage of women may take up to a week to pass the pregnancy.
- You can expect bleeding for 7-10 days after passing the pregnancy
with spotting for a few days after that.
- Advantages of medical induction of miscarriage are that you may avoid
a surgical procedure and you may miscarry in the privacy of your own
home with support from your partner, family, or friend. Disadvantages
it can be painful and that a small percent will not completely miscarry
on their own or may have heavy bleeding and may require a D&C to
remove the remaining products of conception.
- Side effects from Misoprostol include uterine cramping, nausea,
vomiting, and diarrhea.
- If your pregnancy has
miscarried but you have not passed it your doctor may offer
you a D&C (Dilation and Currettage). This is a surgical procedure
in which the cervix or the opening to the uterus is gently widened
(dilated) and the pregnancy is removed
- This is highly effective and a very safe procedure. This can usually
be scheduled within a few days to a week.
- Benefits of a D&C are that a light intravenous sedative or anesthetic
can be used so that any discomfort
involved can be minimized. There are some rare risks to the procedure
including bleeding, infection, scarring, retained products and perforation
of the uterus or the surrounding organs, potentially requiring additional
surgery, including another D&C.
You may notice some spotting or bleeding and
discomfort for a few days up to two weeks. Taking it easy for a
few days will keep the bleeding to a minimum. Please call your
notice any of the following:
Heavy bleeding (saturating a pad an hour for more than 2-3 hours)
Fever or chills
- We recommend that you refrain from using tampons or intercourse
for two weeks after a miscarriage is complete.
tests will be done to determine the cause? |top
Because miscarriage is unfortunately so common, we do not generally
do any tests after the first miscarriage. Most women (60-70%) will
go on to have a healthy pregnancy the next time.
If you have had a
second miscarriage we will do some tests to investigate some
of the causes of recurrent miscarriage.
- However in 50% or more of couples
with recurrent pregnancy loss, an evaluation, including genetic testing
and evaluation of the reproductive organs will be inconclusive.
Therefore, a majority (approximately 50-75%) of couples with recurrent
pregnancy loss will have no certain diagnosis.
- Some tests are:
A karyotype might
be done on you and your partner to identify a possible parental
chromosome abnormality, which
occurs in approximately in 2-3% of couples who have recurrent
A hysterosalpingogram to determine if there is
a structural abnormality of the uterus
A karyotype on the products
Hormonal studies of thryroid
Anticardiolipin and antiphopholipid
- Some experts believe that tender loving care by your health care
provider and family and stress/anxiety reduction may play an
- A miscarriage, no matter how early, can leave women
with a sense of loss. Although there may not be physical changes
others could see, bonding may have taken place between the mother and
fetus. Many women go through a period of sadness, guilt and anger
about the miscarriage.
- You need to be
aware that most of the time there was nothing you could have
done to prevent the loss. Most women go on to have a normal
pregnancy in the future.
- If you need help or support in recovering from the loss of a pregnancy,
talk to your physician. There are resources and support groups available.
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