Miscarriage

Miscarriages are a very common occurrence, although many people prefer to avoid the topic. They actually occur in 15-20% of all pregnancies, meaning that 1 in 5 verified pregnancies are lost. If we include pregnancies that occur before a patient has missed her first period, the incidence is probably much higher, about 30-40%.

CAUSE

The cause of most miscarriages is unknown, although most people feel it is mother nature's way of taking care of pregnancies where the fetus is not developing properly. Very rarely can any action of the mother be established as the cause of the miscarriage. We do know that miscarriages are more common with advanced maternal age. They are seen more frequently in women who have uterine abnormalities such as fibroids, uterine septum, and certain infections. They are also experienced more often by women with illnesses such as diabetes, lupus, and hypertension. Most of the time, the actual cause of the miscarriage is totally unknown.

RECURRENCE

With each pregnancy, there is a 15-20% chance of miscarriage. After one miscarriage, the chance of another one goes up only slightly. In fact, after two or three miscarriages in a row, there is still an excellent chance that the next pregnancy will be carried normally.

SYMPTOMS

The most common symptoms of an impending miscarriage are cramping and bleeding. It is common for women to have spotting or bleeding for a few days prior to actually miscarrying. Occasionally, women may not have any symptoms at all and then experience cramping, bleeding and pass tissue all at once. Unfortunately, usually by the time any symptoms occur, the baby has already stopped developing and there is no treatment to save the pregnancy. It is important to note that 30-40% of all pregnant women will have spotting or bleeding during the first few months of their pregnancy. While these symptoms increase our concern that a miscarriage may occur, they do not at all indicate that it is inevitable.

CLASSIFICATION

We classify women who are bleeding and cramping into four major categories:

A threatened miscarriage is one in which the patient has some bleeding, but no other evidence of miscarriage.

An inevitable miscarriage is one in which there is usually cramping and bleeding and the cervix has started opening, but there is not yet any passage of tissue.

An incomplete miscarriage is one where some tissue has passed, but there is still tissue left inside the uterus that needs to be removed.

A missed miscarriage is one where there was cramping and bleeding which eventually stops, but yet the fetus has stopped developing or failed to develop.

EVALUATION

If the mother has cramping and bleeding early in her pregnancy it is not uncommon to obtain an ultrasound in order to check whether the baby has developed appropriately. However, if it is very early in her pregnancy, an ultrasound may not be able to identify the baby. In this situation a hormone called beta human chorionic gonadotropin (HCG) can be measured. The level of HCG usually doubles every two days in a normal pregnancy if the mother is carrying a healthy baby. If the baby is not developing appropriately, or in an ectopic pregnancy, the levels of this hormone do not increase appropriately.

If you experience any of the above mentioned symptoms of a miscarriage, it is important to contact our office immediately so that a proper evaluation can be performed