Miscarriage: Types, Causes, Diagnosis, Treatment And Preventions

Miscarriage: Types, Causes, Diagnosis, Treatment And Preventions.

What is a miscarriage?

Miscarriage can be called a spontaneous abortion, is a medical condition that results in the loss of a fetus before 20 weeks of pregnancy. It typically happens during the first trimester, or first three months, of the pregnancy.

Miscarriages can happen for a variety of medical reasons, many of which are not within a person’s control. But knowing the risk factors, signs, and causes can help you to better understand the event and get any support or treatment you may need.

Miscarriage rate by week

Most miscarriages happen within the first trimester (first 12 weeks) of pregnancy. The earliest weeks of pregnancy are when a woman is at the highest risk of a miscarriage. However, once pregnancy reaches 6 weeks, this risk drops.

From weeks 13 to 20 of pregnancy, the risk of miscarriage drops further. However, it’s important to keep in mind that miscarriage risk doesn’t change much after this, as complications can arise at any point in a pregnancy. Discover further details about miscarriage rate by week.

Miscarriage statistics

The early loss of a pregnancy is common. According to the American College of Obstetricians and Gynecologists (ACOG), it occurs in 10% of known pregnancies.

Sometimes the cause of a miscarriage will remain unknown. However, the Mayo Clinic estimates that about 50% of miscarriages are due to chromosome issues.

The risk of miscarriage definitely increases with age. According to the Mayo Clinic, the risk of miscarriage is 20% at age 35. It increased to 40% at age 40 and rises further to 80% at age 45.

A miscarriage doesn’t mean that you won’t go on to have a baby. According to the Cleveland Clinic, 87% of women who have had a miscarriage will go on to carry a baby to full term. Approximately only 1% of women have three or more miscarriages.

What are the types of miscarriage?

The types of miscarriage are listed below:

Threatened miscarriage

If you are bleeding but your cervix has not begun to dilate, there is a threat of miscarriage. Such pregnancies often proceed without any further problems.

Inevitable miscarriage

 Inevitable miscarriage comes with bleeding, cramping and dilated cervix. This miscarriage is considered inevitable.

Complete miscarriage

If you have passed all the pregnancy tissues, it's considered a complete miscarriage. This is common for miscarriages occurring before 12 weeks.

Incomplete miscarriage

If you pass fetal or placental material but some remains in your uterus, it's considered an incomplete miscarriage.

Missed miscarriage

In a missed miscarriage, the placental and embryonic tissues remain in the uterus, but the embryo has died or was never formed.

Septic miscarriage

If you develop an infection in your uterus, it's known as a septic miscarriage. This can be a severe infection and demands immediate care.

Recurrent miscarriage (RM)

You lose three or more pregnancies in a row during the first trimester. This type of miscarriage only affects about 1% of couples trying to have a baby.

Miscarriage or period?

Many times, a miscarriage can happen before you even know that you’re pregnant. Additionally, as with your menstrual period, some of the symptoms of a miscarriage involve bleeding and cramping.

What causes Miscarriage?

The causes of miscarriage are sometimes remain unknown.

Most miscarriages happen when the unborn baby has fetal genetic problems. Usually, these problems are not related to the mother.

Risk factors of miscarriage

Problems that can increase the risk of miscarriage include:

Infection

Smoking

Drinking alcohol

Mother who has medical condition such as diabetes or thyroid disease

 Hormone problems

 Immune system responses

Physical problems in the mother

Uterine abnormalities

Drugs abuse or self medication

Exposure to radiation or toxic substances.

A woman has a higher risk of miscarriage if they:

1. Are over age 35

2. Have certain diseases, such as diabetes or thyroid problems

3. Have had three or more miscarriages

4. Cervical insufficiency: A miscarriage sometimes happens when the mother has a weakness of the cervix. Doctors call this a cervical insufficiency. It means the cervix can not hold the pregnancy. This type of miscarriage usually happens in the second trimester.

There are usually few symptoms before a miscarriage caused by cervical insufficiency. You may feel sudden pressure, your water might break, and tissue from the baby and placenta could leave your body without much pain. Doctors usually treat an insufficient cervix with a "circling" stitch in the next pregnancy, usually around 12 weeks. The stitch holds your cervix closed until the doctor removes it around the time of delivery. If you never had a miscarriage but your doctor finds that you have cervical insufficiency they might add the stitch to prevent a miscarriage.

Sings and symptoms of Miscarriage

The symptoms of a miscarriage vary, depending on your stage of pregnancy. In some cases, it happens so quickly that you may not even know you are pregnant before you miscarry.

Here are some of the symptoms of a miscarriage:

Heavy spotting

Vaginal bleeding

Discharge of tissue or fluid from vagina

Severe abdominal pain or cramping

Mild to severe back pain.

Call your doctor right away if you experience any of these symptoms during your pregnancy. It’s also possible to have these symptoms without experiencing a miscarriage. But your doctor will want to conduct tests to make sure that everything is fine.

Miscarriage or period?

Many times, a miscarriage can happen before you even know that you’re pregnant. Additionally, as with your menstrual period, some of the symptoms of a miscarriage involve bleeding and cramping.

So how can you tell if you are having a period or a miscarriage?

When trying to distinguish between a period and a miscarriage, there are several factors to consider:

Symptoms: Severe or worsening abdominal or back pain as well as passing fluids and large clots could indicate a miscarriage.

Time: A miscarriage very early in pregnancy can be mistaken for a period. However, this is less likely after eight weeks into a pregnancy.

Duration of symptoms: The symptoms of a miscarriage typically get worse and last longer than a period.

If you are experiencing heavy bleeding or believe that you are having a miscarriage, you should contact your doctor.

  Diagnosis of miscarriage

Variety of tests would be carried out by a health care provider to diagnose it. 

These are:

I. Pelvic exam

Your health care provider might check to see if your cervix has begun to dilate.

II. Ultrasound

During an ultrasound, your health care provider will check for a fetal heartbeat and determine if the embryo is developing normally. If a diagnosis can not be made, you might need to have another ultrasound in about a week.

III. Blood tests

Your health care provider might check the level of the pregnancy hormone, human chorionic gonadotropin (HCG), in your blood and compare it to previous measurements. If the pattern of changes in your HCG level is abnormal, it could indicate a problem. Your health care provider might check to see if you're anemic which could happen if you have experienced significant bleeding and may also check your blood type.

IV. Tissue tests

If you have passed tissue, it can be sent to a lab to confirm that a miscarriage has occurred and that your symptoms are not related to another cause.

V. Chromosomal tests

If you have had two or more previous miscarriages, your health care provider may order blood tests for both you and your partner to determine if your chromosomes are a factor.

How miscarriage is treated?

Threatened miscarriage

For a threatened miscarriage, your health care provider might recommend resting until the bleeding or pain subsides. Bed rest hasn't been proved to prevent miscarriage, but it's sometimes prescribed as a safeguard. You might be asked to avoid exercise and sex, too. Although these steps haven't been proved to reduce the risk of miscarriage, they might improve your comfort.

In some cases, it's also a good idea to postpone traveling especially to areas where it would be difficult to receive prompt medical care. Ask your doctor if it would be wise to delay any upcoming trips you have planned.

Miscarriage

With ultrasound, it's now much easier to determine whether an embryo has died or was never formed. Either finding means that a miscarriage will definitely occur. In this situation, you might have several choices as follows:

Expectant management

If you have no signs of infection, you might choose to let the miscarriage progress naturally. Usually this happens within a couple of weeks of determining that the embryo has died. Unfortunately, it might take up to three or four weeks. This can be an emotionally difficult time. If expulsion doesn't happen on its own, medical or surgical treatment will be needed.

Medical treatment

If after a diagnosis of certain pregnancy loss, you'd prefer to speed the process, medication can cause your body to expel the pregnancy tissue and placenta. The medication can be taken by mouth or by insertion in the vagina. Your health care provider might recommend inserting the medication vaginally to increase its effectiveness and minimize side effects such as nausea and diarrhea. For about 70 to 90 percent of women, this treatment works within 24 hours.

Surgical treatment

Another option is a minor surgical procedure called suction dilation and curettage (D&C). During this procedure, your health care provider dilates your cervix and removes tissue from the inside of your uterus. Complications are rare, but they might include damage to the connective tissue of your cervix or the uterine wall. Surgical treatment is needed if you have a miscarriage accompanied by heavy bleeding or signs of an infection.

   Physical recovery from miscarriage

In most cases, physical recovery from miscarriage takes only a few hours to a couple of days. In the meantime, call your health care provider if you experience heavy bleeding, fever or abdominal pain.

You may ovulate as soon as two weeks after a miscarriage. Expect your period to return within four to six weeks. You can start using any type of contraception immediately after a miscarriage. However, avoid having sex or putting anything in your vagina such as a tampon for two weeks after a miscarriage

   Future pregnancies after miscarriage

It's possible to become pregnant during the menstrual cycle immediately after a miscarriage. But if you and your partner decide to attempt another pregnancy, make sure you're physically and emotionally ready. Ask your health care provider for guidance about when you might try to conceive.

Keep in mind that miscarriage is usually a one-time occurrence. Most women who miscarry go on to have a healthy pregnancy after miscarriage. Less than 5 percent of women have two consecutive miscarriages, and only 1% have three or more consecutive miscarriages.

If you experience multiple miscarriages, generally two or three in a row, consider testing to identify any underlying causes — such as uterine abnormalities, coagulation problems or chromosomal abnormalities. If the cause of your miscarriages can't be identified, don't lose hope. About 60 to 80 percent of women with unexplained repeated miscarriages go on to have healthy pregnancies.

Can I get pregnant after I have had a miscarriage?

Yes. Most women (87%) who have miscarriages have subsequent normal pregnancies and births. Having a miscarriage does not necessarily mean you have a fertility problem. About 1% of women might have repeated miscarriages (three or more). Remember that usually a miscarriage cannot be prevented and often occurs because the pregnancy is not normal. Some researchers believe this is related to an autoimmune response.

Although there is no recommended waiting period to attempt pregnancy, it may be appropriate to discuss the timing of your next pregnancy with your healthcare provider. To prevent another miscarriage, your healthcare provider might recommend treatment with progesterone, a hormone needed for implantation in the uterus. If the mother has an illness, treating the condition can improve the chances for a successful pregnancy.

Taking time to heal both physically and emotionally after a miscarriage is important. Above all, don’t blame yourself for the miscarriage. Counseling is available to help you cope with your loss. A pregnancy loss support group might also be a valuable resource to you and your partner. Ask your healthcare provider for more information about counseling and support groups.

If you’ve had three miscarriages in a row, you should stop trying to conceive, use a form of birth control, and ask your healthcare provider about performing diagnostic tests to determine the cause of the miscarriages.

When to Try to Conceive After a Miscarriage?

Discuss the timing of your next pregnancy with your doctor. Some experts say you should wait a certain amount of time (from one menstrual cycle to 3 months) before you try again. To prevent another miscarriage, the doctor may suggest treatment with progesterone, a hormone that helps the embryo implant and supports early pregnancy in your uterus.

Taking time to heal both physically and emotionally after a miscarriage is important. Above all, don't blame yourself. Counseling is available to help you handle your loss.

How to prevent  Miscarriage? 

Miscarriages can not be prevented. Most miscarriages happen because there is a problem with the pregnancy. If your doctor does testing and finds a problem, treatment options may be available.

If you have an illness, treating it can improve your chances for a successful pregnancy. 

One step you can take is to get as healthy as you can before you try to have a baby:

Get regular exercise.

Eat a healthy, well-balanced diet.

Maintain a healthy weight.

Avoid infections.

Do not smoke

Do not drink alcohol

 Do not take illegal drugs.

Cut back on caffeine.

Sources:

Mayo clinic

Health line

Cleveland clinic

Web MD