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About Miscarriage
Miscarriage is the spontaneous loss of a pregnancy before the 20th week. Around 10% to 20% of known pregnancies end in miscarriage. However, the actual number may be higher, as many miscarriages occur very early in pregnancy before a person is even aware of being pregnant.
The prevalence of miscarriage in Indian women is estimated to be as high as 32%. In many cases, the fetus is expelled naturally during a miscarriage; however, an ultrasound examination and proper follow-up care are essential to ensure complete expulsion of pregnancy tissue.
If the miscarriage is incomplete, it may lead to complications such as infection, recurrent miscarriage, infertility, and, in rare cases, serious health risks to the mother.
What is a Miscarriage?
The term “miscarriage” may suggest that something went wrong during the pregnancy, but this is rarely the case. Most miscarriages occur because the fetus is not developing as expected.
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Miscarriage is a relatively common experience; however, it can still be emotionally difficult. Understanding its causes, risk factors, and required medical care can help in managing the condition better.
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A miscarriage is the spontaneous loss of a pregnancy that occurs before 20 weeks of gestation. It is often marked by sudden or repeated vaginal bleeding and cramping during pregnancy.
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In such cases, it is important to consult a gynecologist immediately. In some cases of threatened miscarriage, if the cervix remains closed, there may still be a chance to continue the pregnancy with proper medical care.
Why Does It Happen?
Unlike what its name may suggest, a miscarriage does not always occur due to a problem in carrying the pregnancy. In most cases, it happens because of the following reasons:
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Abnormal formation of the embryo due to an extra or missing chromosome
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Abnormal growth of the fetus and placenta due to improper cell division
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Improper implantation of the embryo in the fallopian tubes, ovaries, cervix, or abdomen instead of the uterus
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Health conditions in the mother such as uncontrolled diabetes, high blood pressure, thyroid disorders, or hormonal imbalances
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Infections in the cervix or uterus
Types of Miscarriage:
Inevitable Miscarriage
Complete Miscarriage
Incomplete Miscarriage
Missed Miscarriage
Risk Factors
Symptoms
Risk Factors for Miscarriage:
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Uncontrolled diabetes
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Infections
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Hormonal problems
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Uterine or cervical abnormalities
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Thyroid disease
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Teenage or advanced maternal age
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Underweight or overweight conditions
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Fluctuations in blood pressure
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Accidents or physical trauma
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Most miscarriages occur because the fetus is not developing as expected. Around 50% of miscarriages are associated with extra or missing chromosomes.
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Most miscarriages occur before the 12th week of pregnancy.
Signs and symptoms of a miscarriage might include:
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Vaginal spotting or bleeding
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Pain or cramping in your abdomen or lower back
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Fluid or tissue passing from your vagina
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If you have passed fetal tissue from your vagina, place it in a clean container and bring it to your health care provider's office or the hospital for analysis.
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Most women who have vaginal spotting or bleeding in the first trimester go on to have successful pregnancies.
Diagnosis of Miscarriage
Transvaginal Ultrasound / Abdominal Ultrasound
Procedure:
Both transvaginal and abdominal ultrasounds are simple imaging tests that usually take 7–10 minutes. They use high-frequency sound waves to create internal images of the reproductive organs.
As the name suggests, a transvaginal ultrasound is performed by inserting a probe into the vaginal canal, while an abdominal ultrasound is performed over the abdominal surface. Since the transvaginal probe is closer to the uterus, it can detect early pregnancy changes more accurately than an abdominal ultrasound.
Confirmation:
The development and condition of the fetus help determine the status of the pregnancy. If the fetus is found to have stopped developing or shows no signs of viability, it may indicate a miscarriage or an impending miscarriage.
Prevention of Miscarriage
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Often, there is nothing you can do to prevent a miscarriage. However, you can reduce the risk by taking good care of yourself during pregnancy:
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Seek regular prenatal care
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Avoid known risk factors such as smoking, alcohol consumption, and illicit drug use
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Take a daily prenatal multivitamin as advised by your doctor
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Limit caffeine intake, as high consumption (more than two caffeinated drinks per day) may increase the risk of miscarriage
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If you have a chronic condition, work with your healthcare provider to keep it well controlled
Risks & Complications if left untreated:
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Delaying treatment or leaving a miscarriage untreated may lead to serious complications, especially if the miscarriage is incomplete. In such cases, retained pregnancy tissue can increase the risk of infection in the uterus or cervix.
This may lead to:
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Fever
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Nausea
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Foul-smelling vaginal discharge and itching
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Abdominal and pelvic pain
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Increased risk of miscarriage in future pregnancies
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In rare cases, infertility or long-term reproductive complications
MISCARRIAGE SPECIALISTS DOCTORS
Dr. ABCD
MBBS,
10 yrs of experience
Dr. ABCD
MBBS,
10 yrs of experience
Dr. ABCD
MBBS,
10 yrs of experience
Treatment By Medicine
If the miscarriage happens early in the pregnancy and the diagnostic tests negate any chances of infection, the cleaning treatment can be done through medications.
Procedure: Typically, the prescribed medications include a combination of 2 different pills (commonly known as RU486. These can be taken both- orally and directly through the vaginal passage. When used together, they dilate the cervix and help quicken the process of expulsion.
Side effects: Some of the side effects include-
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Abdominal pain
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Vaginal bleeding
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Nausea
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Vomiting
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Diarrhea
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Dizziness
Surgical Treatment
A miscarraige in the later weeks or where the doctor may detect sepsis is best removed through D&C method (dilation and curettage).
Procedure: First, the doctor gives you the medicine for the complete dilation of the cervix. This is particularly important for the pregnancy tissue to expel out of the birth canal. It may take 30-40 minutes or more. Then, once the cervix is fully dilated, the surgeon uses a curettage instrument to remove all the pregnancy tissues out of the uterus. Soon after a few hours, the cervix contracts naturally and the pregnancy is ended without any cuts or sutures.
**The cleaning treatment differs in case of ectopic and molar pregnancy. You can read more about both, here.