Miscarriage
Other namesSpontaneous abortion, early pregnancy loss
An ultrasound showing a gestational sac containing a yolk sac but no embryo.
SpecialtyObstetrics and gynecology
SymptomsVaginal bleeding with or without pain[1]
ComplicationsInfection, bleeding,[2] sadness, anxiety, guilt[3]
Usual onsetBefore 20 weeks of pregnancy[4]
CausesChromosomal abnormalities,[1][5] uterine abnormalities [6]
Risk factorsBeing an older parent, previous miscarriage, exposure to tobacco smoke, obesity, diabetes, autoimmune diseases, drug or alcohol use[7][8][9]
Diagnostic methodExamination, human chorionic gonadotropin, ultrasound[10]
Differential diagnosisEctopic pregnancy, implantation bleeding.[1]
PreventionPrenatal care[11]
TreatmentExpectant management, misoprostol, vacuum aspiration, emotional support[8][12]
Frequency10–50% of pregnancies[1][7]

Miscarriage, also known as spontaneous abortion and pregnancy loss, is the natural death of an embryo or fetus before it is able to survive independently.[1][4] Some use the cutoff of 20 weeks of gestation, after which fetal death is known as a stillbirth.[13] The most common symptom of a miscarriage is vaginal bleeding with or without pain.[1] Sadness, anxiety and guilt may occur afterwards.[3][14] Tissue and clot-like material may leave the uterus and pass through and out of the vagina.[15] When a woman keeps having miscarriages, infertility is present.[16]

Risk factors for miscarriage include being an older parent, previous miscarriage, exposure to tobacco smoke, obesity, diabetes, thyroid problems, and drug or alcohol use.[7][8] About 80% of miscarriages occur in the first 12 weeks of pregnancy (the first trimester).[1] The underlying cause in about half of cases involves chromosomal abnormalities.[5][1] Diagnosis of a miscarriage may involve checking to see if the cervix is open or closed, testing blood levels of human chorionic gonadotropin (hCG), and an ultrasound.[10] Other conditions that can produce similar symptoms include an ectopic pregnancy and implantation bleeding.[1]

Prevention is occasionally possible with good prenatal care.[11] Avoiding drugs, alcohol, infectious diseases, and radiation may decrease the risk of miscarriage.[11] No specific treatment is usually needed during the first 7 to 14 days.[8][12] Most miscarriages will complete without additional interventions.[8] Occasionally the medication misoprostol or a procedure such as vacuum aspiration is used to remove the remaining tissue.[12][17] Women who have a blood type of rhesus negative (Rh negative) may require Rho(D) immune globulin.[8] Pain medication may be beneficial.[12] Emotional support may help with processing the loss.[12]

Miscarriage is the most common complication of early pregnancy.[18] Among women who know they are pregnant, the miscarriage rate is roughly 10% to 20%, while rates among all fertilisation is around 30% to 50%.[1][7] In those under the age of 35 the risk is about 10% while it is about 45% in those over the age of 40.[1] Risk begins to increase around the age of 30.[7] About 5% of women have two miscarriages in a row.[19] Some recommend not using the term "abortion" in discussions with those experiencing a miscarriage in an effort to decrease distress.[20]

References edit

  1. ^ a b c d e f g h i j k The Johns Hopkins Manual of Gynecology and Obstetrics (4 ed.). Lippincott Williams & Wilkins. 2012. pp. 438–439. ISBN 9781451148015. Archived from the original on September 10, 2017.
  2. ^ "Spontaneous Abortion - Gynecology and Obstetrics". Merck Manuals Professional Edition. Archived from the original on December 4, 2020. Retrieved May 5, 2018.
  3. ^ a b Robinson GE (January 2014). "Pregnancy loss". Best Practice & Research. Clinical Obstetrics & Gynaecology. 28 (1): 169–78. doi:10.1016/j.bpobgyn.2013.08.012. PMID 24047642.
  4. ^ a b "What is pregnancy loss/miscarriage?". www.nichd.nih.gov/. July 15, 2013. Archived from the original on April 2, 2015. Retrieved March 14, 2015.
  5. ^ a b Vaiman D (2015). "Genetic regulation of recurrent spontaneous abortion in humans". Biomedical Journal. 38 (1): 11–24. doi:10.4103/2319-4170.133777. PMID 25179715.
  6. ^ Chan YY, Jayaprakasan K, Tan A, Thornton JG, Coomarasamy A, Raine-Fenning NJ (October 2011). "Reproductive outcomes in women with congenital uterine anomalies: a systematic review". Ultrasound in Obstetrics & Gynecology. 38 (4): 371–82. doi:10.1002/uog.10056. PMID 21830244.
  7. ^ a b c d e "How many people are affected by or at risk for pregnancy loss or miscarriage?". www.nichd.nih.gov. July 15, 2013. Archived from the original on April 2, 2015. Retrieved March 14, 2015.
  8. ^ a b c d e f Oliver A, Overton C (May 2014). "Diagnosis and management of miscarriage". The Practitioner. 258 (1771): 25–8, 3. PMID 25055407.
  9. ^ Carp HJ, Selmi C, Shoenfeld Y (May 2012). "The autoimmune bases of infertility and pregnancy loss". Journal of Autoimmunity (Review). 38 (2–3): J266-74. doi:10.1016/j.jaut.2011.11.016. PMID 22284905.
  10. ^ a b "How do health care providers diagnose pregnancy loss or miscarriage?". www.nichd.nih.gov/. July 15, 2013. Archived from the original on December 22, 2017. Retrieved March 14, 2015.
  11. ^ a b c "Is there a cure for pregnancy loss/miscarriage?". www.nichd.nih.gov/. October 21, 2013. Archived from the original on April 2, 2015. Retrieved March 14, 2015.
  12. ^ a b c d e "What are the treatments for pregnancy loss/miscarriage?". www.nichd.nih.gov. July 15, 2013. Archived from the original on April 2, 2015. Retrieved March 14, 2015.
  13. ^ "Stillbirth: Overview". NICHD. September 23, 2014. Archived from the original on October 5, 2016. Retrieved October 4, 2016.
  14. ^ Radford EJ, Hughes M (June 2015). "Women's experiences of early miscarriage: implications for nursing care". Journal of Clinical Nursing. 24 (11–12): 1457–65. doi:10.1111/jocn.12781. PMID 25662397.
  15. ^ "What are the symptoms of pregnancy loss/miscarriage?". www.nichd.nih.gov/. July 15, 2013. Archived from the original on April 2, 2015. Retrieved March 14, 2015.
  16. ^ "Glossary | womenshealth.gov". womenshealth.gov. January 10, 2017. Archived from the original on February 3, 2021. Retrieved September 11, 2017.  This article incorporates text from this source, which is in the public domain.
  17. ^ Tunçalp O, Gülmezoglu AM, Souza JP (September 2010). "Surgical procedures for evacuating incomplete miscarriage". The Cochrane Database of Systematic Reviews (9): CD001993. doi:10.1002/14651858.CD001993.pub2. PMC 7064046. PMID 20824830.
  18. ^ National Coordinating Centre for Women's and Children's Health (UK) (December 2012). "Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage". NICE Clinical Guidelines, No. 154. Royal College of Obstetricians and Gynaecologists. Archived from the original on October 20, 2013. Retrieved July 4, 2013.
  19. ^ Garrido-Gimenez C, Alijotas-Reig J (March 2015). "Recurrent miscarriage: causes, evaluation and management". Postgraduate Medical Journal. 91 (1073): 151–62. doi:10.1136/postgradmedj-2014-132672. PMID 25681385.
  20. ^ Greaves, Ian; Porter, Keith; Hodgetts, Tim J.; Woollard, Malcolm (2005). Emergency Care: A Textbook for Paramedics. London: Elsevier Health Sciences. p. 506. ISBN 978-0-7020-2586-0. Archived from the original on April 26, 2016.