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Miscarriage

What is a miscarriage?

Miscarriage is usually defined as an early pregnancy loss. Miscarriage is also called spontaneous abortion. Types of miscarriage include the following:

  • Threatened. Spotting or bleeding in the first trimester may or may not mean a miscarriage will occur. About 10% to 20% of women will miscarry in the first trimester. The woman is monitored for further bleeding. Ultrasound exams  are usually done to monitor growth of the fetus and to monitor fetal heartbeat.

  • Complete. The fetus, placenta, and other tissues are passed with bleeding

  • Incomplete. Only a part of the tissues are passed; some remain in the uterus. There may be heavy vaginal bleeding.

  • Missed abortion. The embryo or fetus dies, but is not passed out of the uterus. Sometimes, dark brown spotting occurs, but there is no fetal heartbeat or growth.

  • Septic. Miscarriage that becomes infected, the mother develops fever and may have bleeding and discharge with a foul odor; Abdominal pain is common. This is a serious condition and can result in shock and organ failure if not treated. Antibiotics and dilation and curettage (D & C) may be necessary. This procedure uses special instruments to remove the abnormal pregnancy.

  • Recurrent. 2 or more miscarriages.

What is an incompetent cervix?

Fetal loss in the second trimester may occur when the cervix is weak and opens too early. This is called incompetent cervix. In some cases of incompetent cervix, a health care provider can help prevent pregnancy loss by suturing the cervix closed until delivery, called a cerclage.

How is miscarriage diagnosed?

The most common signs of miscarriage are vaginal spotting or bleeding, passing of tissue, and cramping. Ultrasound is usually used to diagnose miscarriage. If the fetus is no longer in the uterus, or there is no longer a fetal heartbeat, miscarriage is diagnosed. Other tests that may be used include pregnancy blood tests for the hormone human chorionic gonadotrophin (hCG). No increase in this hormone level or a decrease can indicate that the pregnancy is not growing.

Treatment for miscarriage

Treatment for miscarriage in early pregnancy includes a procedure to remove the fetus and other tissues if they have not all been naturally passed. The procedure is called a surgical evacuation of the uterus, or a dilation and curettage (D&C). Anesthesia is used as the procedure can be painful to the mother. The cervical opening is dilated (opened) and either suction or an instrument called a curette is used to remove all the pregnancy tissues inside the uterus. These tissues may be sent to the lab for culture or testing for genetic or chromosomal abnormalities. However, not all miscarriages require a D&C. An early miscarriage may also be treated with expectant management or the drug misoprostol.

Later pregnancy loss may need a different procedure using hormones such as prostaglandin or Pitocin to cause the uterus to contract and push out the fetus and tissues.

Pregnancy loss does not usually cause other serious medical problems, unless an infection is present, or unless a missed abortion occurred in which the fetus and other tissues are not passed. A serious complication with a late miscarriage is disseminated intravascular coagulation (DIC), a severe blood clotting problem. This is more likely if there is a long time (usually a month or more) until the fetus and other tissues are passed.