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Miscarriage: Signs, causes, and treatment

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Miscarriage is the loss of a pregnancy in the first 20 weeks. In medical articles, you may see the term 'spontaneous abortion' used in place of miscarriage. About 10 to 20 percent of known pregnancies end in miscarriage, and more than 80 percent of these losses happen before 12 weeks. This doesn't include situations in which you lose a fertilized egg before a pregnancy becomes established. Studies have found that 30 to 50 percent of fertilized eggs are lost before or during the process of implantation — often so early that a woman goes on to get her period at about the expected time. If you have these signs of miscarriage, call your doctor or midwife right away so she can determine whether you have a problem that needs to be dealt with immediately:. If you have both bleeding and pain, the chances of your pregnancy continuing are much lower. It's very important to be aware that vaginal bleeding, spotting, or pain in early pregnancy can also signal an ectopic or a molar pregnancy. Also, if your blood is Rh-negative , you may need a shot of Rh immune globulin within two or three days after you first notice bleeding, unless the baby's father is Rh-negative as well. Some miscarriages are first suspected during a routine prenatal visit, when the doctor or midwife can't hear the baby's heartbeat or notices that your uterus isn't growing as it should be. Often the embryo or fetus stops developing a few weeks before you have symptoms like bleeding or cramping. If your practitioner suspects that you've had a miscarriage, she'll order an ultrasound to see what's going on in your uterus. She may also do a blood test. Between 50 and 70 percent of first-trimester miscarriages are thought to be random events caused by chromosomal abnormalities in the fertilized embryo. Most often, this means that the egg or sperm had the wrong number of chromosomes , and as a result, the fertilized embryo can't develop normally. Sometimes a miscarriage is caused by problems that occur during the delicate process of early development. This would include an egg that doesn't implant properly in the uterus or an embryo with structural defects that prevent it from developing. Since most healthcare practitioners won't do a full-scale workup of a healthy woman after a single miscarriage, it's usually impossible to tell why the pregnancy was lost. And even when a detailed evaluation is performed — after you've had two or three consecutive miscarriages, for instance — the cause still remains unknown half the time. When the fertilized egg has chromosomal problems, you may end up with what's sometimes called a blighted ovum now usually referred to in medical circles as an early pregnancy loss or missed abortion. In this case, the fertilized embryo implants in the uterus and the placenta and gestational sac begin to develop, but the resulting embryo either stops developing very early or doesn't form at all. Because the placenta begins to secrete hormones, you'll get a positive pregnancy test and may have early pregnancy symptoms, but an ultrasound will show an empty gestational sac. In other cases, the embryo does develop for a little while but has abnormalities that make survival impossible, and development stops before the heart starts beating. If your baby has a normal heartbeat — usually first visible on ultrasound at around 6 weeks — and you have no symptoms like bleeding or cramping, your odds of having a miscarriage continue to decrease with each passing week and drop significantly at the end of the first trimester. Though any woman can miscarry, some are more likely to miscarry than others. Here are some risk factors:. Call your doctor or midwife immediately if you ever notice unusual symptoms such as bleeding or cramping during pregnancy. Your practitioner will examine you to see if the bleeding is coming from your cervix and check your uterus. She may also do a blood test to check for the pregnancy hormone hCG and repeat it in two to three days to see if your levels are rising as they should be. If you're having bleeding or cramping and your practitioner has even the slightest suspicion that you have an ectopic pregnancy , you'll have an ultrasound right away. If there's no sign of a problem but you continue to spot, you'll have another ultrasound in a couple of weeks. At this point, if the sonographer sees an embryo with a normal heartbeat, you have a viable pregnancy and your risk of miscarrying is now much lower, but you'll need to have another ultrasound later if you continue to bleed. If the sonographer determines that the embryo is the appropriate size but there's no heartbeat, it may mean that the embryo didn'tform or didn't survive. If you're in your second trimester and an ultrasound shows your cervix is shortening or opening , your doctor may decide to perform a procedure called cerclage, in which she stitches your cervix closed in an attempt to prevent miscarriage or premature delivery. This is assuming your baby appears normal on the ultrasound and you have no signs of an intrauterine infection. Cerclage isn't without risk, and you may not meet the criteria for it. Note that bedrest is no longer prescribed because it's atually quite harmful and not at all helpful. But your caregiver may suggest that you not have sex while you're having bleeding or cramping. Sex doesn't cause miscarriage, but it's a good idea to abstain while you're having these symptoms. You may have light bleeding and cramping for a few weeks. You can wear sanitary pads but no tampons during this time and take acetaminophen for the pain. If you are miscarrying, the bleeding and cramping will likely get worse shortly before you pass the 'products of conception' — that is, the placenta and the embryonic or fetal tissue, which will look grayish and may include blood clots. If you can, save this tissue in a clean container. Your caregiver may want to examine it or send it to a lab for testing to try to find out why you miscarried. In any case, she'll want to see you again at this point, so call her to let her know what's happened. There are different ways of handling this, and it's a good idea to discuss the pros and cons of each with your caregiver. If there's no threat to your health, you may choose to wait and let the tissue pass on its own. More than half of women spontaneously miscarry within a week of finding out that the pregnancy is no longer viable. Or you may decide to wait a certain amount of time to see what happens before having a procedure to remove the tissue. In some cases, you can use medication to speed up the process. If you choose to wait or take medication to try to speed it up, there's a small chance you won't pass all the tissue on your own. If you find that it's too emotionally trying or physically painful to wait for the tissue to pass, you may have it removed surgically. You'll definitely need to have the tissue removed right away if you have any problems that make it unsafe to wait, such as significant bleeding or signs of infection. And your practitioner may recommend the procedure if this is your second or third miscarriage in a row, so the tissue can be tested for a genetic cause. The procedure doesn't usually require an overnight stay unless you have complications. As with any surgery, you'll need to arrive with an empty stomach — no food or drink since the night before. The doctor will insert a speculum into your vagina, clean your cervix and vagina with an antiseptic solution, and dilate your cervix with narrow metal rods unless your cervix is already dilated from having passed some tissue. In most cases, you'll be given sedation through an IV and a local anesthetic to numb your cervix. Then she'll pass a hollow plastic tube through your cervix and suction out the tissue from your uterus. Finally, she'll use a spoon-shaped instrument called a curette to gently scrape any remaining tissue from the walls of your uterus. The whole thing may take about 15 to 20 minutes, though the tissue removal itself takes less than ten minutes. Finally, if your blood is Rh-negative , you'll receive a shot of Rh immune globulin unless the baby's father is Rh-negative, too. Whether you pass the tissue on your own or have it removed, you'll have mild menstrual-like cramps afterward for up to a day or so and light bleeding for a week or two. Use pads instead of tampons and take ibuprofen or acetaminophen for the cramps. Avoid sex, swimming, and using vaginal medications for at least a couple of weeks and until your bleeding has stopped. If you begin to bleed heavily soaking a sanitary pad in an hour , have any signs of infection such as fever, achiness, or foul-smelling vaginal discharge , or feel excessive pain, call your practitioner immediately or go to the emergency room. If your bleeding is heavy and you begin to feel weak, dizzy, or lightheaded, you may be going into shock. In this case, call right away — don't wait to hear from your caregiver, and don't drive yourself to the ER. It's understandable to be worried about the possibility of another miscarriage, but fertility experts don't consider a single early pregnancy loss to be a sign that there's anything wrong with you or your partner. Some practitioners will order special blood and genetic tests to try to find out what's going on after two miscarriages in a row, particularly if you're 35 or older or you have certain medical conditions. Others will wait until you've had three consecutive losses. In certain situations, such as if you had a second-trimester miscarriage or an early-third-trimester premature birth from a weakened cervix, you might be referred to a high-risk specialist after a single loss so your pregnancy can be carefully managed. You may have to wait a bit. Whether you miscarry spontaneously, with the help of medication, or have the tissue removed, you'll generally get your period again in four to six weeks. You can start trying to conceive again after this period, but you may want to wait longer so that you have more time to recover physically and emotionally. You'll need to use birth control to prevent conception during this time, because you may ovulate as early as two weeks after you miscarry. Though you may be physically ready to get pregnant again, you may not feel ready emotionally. Some women cope best by turning their attention toward trying for a new pregnancy as soon as possible. Others find that months or more go by before they're ready to try to conceive again. Take the time to examine your feelings, and do what feels right for you and your partner. For more information see our article on coping with pregnancy loss. You may find help in a support group your caregiver can refer you to one or in our Community's miscarriage support discussions. If you're feeling overwhelmed by your sadness, call your caregiver. She can put you in touch with a therapist who can help. If you're wondering how to explain a pregnancy loss to your child, read about how to talk to your preschooler about pregnancy loss. Practice bulletin Early pregnancy loss. American College of Obstetricians and Gynecologists. Spontaneous abortion: Management. Patient information: Miscarriage beyond the basics. Karen Miles is a pregnancy and parenting writer and mom of four. Join now to personalize. By Karen Miles. Medically reviewed by Layan Alrahmani, M. Photo credit: Thinkstock. What is a miscarriage? Spotting the signs of a miscarriage If you have these signs of miscarriage, call your doctor or midwife right away so she can determine whether you have a problem that needs to be dealt with immediately: Bleeding or spotting. Vaginal spotting or bleeding is usually the first sign of miscarriage. Keep in mind, though, that up to 1 in 4 pregnant women have some bleeding or spotting finding spots of blood on your underpants or toilet tissue in early pregnancy, and most of these pregnancies don't end in miscarriage. Abdominal pain. Abdominal pain usually begins after you first have some bleeding. It may feel crampy or persistent, mild or sharp, or may feel more like low back pain or pelvic pressure. Show sources ACOG. Is it true that stress, fright, and other emotional distress can cause a miscarriage? Molar pregnancy. Ectopic pregnancy. Pregnancy announcement ideas. Prenatal tests: An overview. How to stay hydrated during pregnancy. Constipation during pregnancy. New to BabyCenter? Join now. Password Forgot your password? Keep me logged in. Log in. Get the BabyCenter app. Download now. See all in Getting Pregnant. Napping Ages 2 to 3 See all in Child.

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