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Know all about miscarriages in 2021

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Know all about the miscarriages in 2021

 

What is miscarriage?

Miscarriage is an event of spontaneous loss of women's pregnancy before the 20th week.it is also called as spontaneous abortion because the term spontaneous abortion medically refers the ending of pregnancy intentionally or unintentionally. 

Miscarriages typically happen during the first trimester of pregnancy. There are many medical conditions, risk factors that can cause miscarriage, most of that aren't in your control. In most cases, if the development of the fetus is not done properly, or if there are extreme chromosomal abnormalities in the fetus, the natural miscarriage can be noticed. Practically it is Nature's Law that Nature does not allow a baby to be born with abnormalities.


 

How common is miscarriage?

The early loss of pregnancy is very common worldwide. According to the American College of Obstetricians and Gynecologists, it occurs in  10 percent of all pregnancies. 

Studies show about  1/3 to 1/2 of all pregnancies end in miscarriage before a woman misses a menstrual period or even knows she is pregnant.

What is mean by recurrent miscarriage or consecutive miscarriage?

If a woman experience two or more miscarriages in a row consecutively then it is known as recurrent miscarriage or consecutive miscarriage. Recurrent miscarriages are quite rare. In a study the American College of Obstetricians and Gynecologists (ACOG) suggested that  about 1% of women have repeated miscarriages. Most of the women have an unknown cause for having repeated miscarriages (50 to 75 in 100 or 75 percent). After two or more consecutive miscarriages physical examination and tests are highly recommended for identifying the cause of miscarriages.

Types of miscarriages

There are different types of miscarriages depending on the causes, symptoms and pregnancy stage. 

Complete miscarriage:

In this kind of miscarriages all kinds of pregnancy tissues are expelled from the body. There is no further treatment needed in this case.

Incomplete miscarriage:

In this case some pregnancy tissues or placental materials are expelled and some remains in the woman's body. Here some further treatment is required to excretes all the pregnancy tissues from the body.

Missed miscarriage or silent miscarriage:

If the fetus has died without your knowledge inside the womb but the placenta and embryonic tissues are still present in the woman's uterus then this kind of miscarriage is called missed miscarriage or silent miscarriage. This kind of miscarriage doesn't cause cramps and bleedings that occur in other type of miscarriages. 

Threatened miscarriage:

In this case the expected mother experiences heavy vaginal bleeding with abdominal cramps which indicates that a miscarriage is possible.

Inevitable miscarriage:

In this case the pregnant woman experiences severe vaginal bleeding, cramps and cervical dilation. These symptoms indicates that miscarriage is inevitable.

Septic miscarriage:

An infection occurs in the expected mother's uterus which causes miscarriage.

Miscarriage symptoms

Miscarriage has certain symptoms, the most important of which is heavy vaginal bleeding. In some cases these happen so quickly that you may not even know you were pregnant before you're having the miscarriage. Here we talk about some most common signs or symptoms of miscarriages.

Vaginal bleeding:

Heavy vaginal bleeding is one of the most common symptoms of miscarriage. Although vaginal bleeding is normal during the early pregnancy, if it is severe, a doctor's consultation should be taken immediately.

Severe abdominal cramping and pain:

This is also a very common symptom of miscarriage. Most of the cases women experience severe abdominal cramping and pain if they are facing a miscarriage.

Fluid and tissue passing through the vagina:

When it comes to miscarriage, most women experience tissue passing with fluids or heavy bleeding through vagina. In such cases, you should go to the doctor immediately.

Heavy back pain:

In some cases women experience mild to heavy back pain as a symptom of miscarriage.

Contractions:

Some women reported that the experience labor level contractions with brown or normal bleeding during their miscarriage.

Intuition:

In some cases women don't have any kind of typical syndromes of miscarriages they just reported that they just don't feel like they are pregnant any more. This is also called missed miscarriage.

White pink mucus:

Some women experience white pink mucus passing through their vagina during the miscarriage.

Causes of miscarriage

The causes of miscarriage varies person to person. In most cases no one is responsible for these reasons. Sometimes it has been observed that the baby has chromosomal abnormalities or the baby remains underdeveloped. It is nature's law that it doesn't allow a baby to be born with abnormalities. Sometime there is no such reason of miscarriage. Here we mention some common causes that lead to miscarriages.

Genetic or chromosomal abnormalities

The most common reason of miscarriage is that the fetus develops abnormally and have some chromosomal issues. It has been seen that  About 50 percent of miscarriages are associated with extra or missing chromosomes.

Intrauterine fetal demise:

In this case the embryo is formed but stops developing and dies. It happens before any kind of pregnancy loss symptoms you feel.

Blighted ovum:

In this case the fertilized ovum implants but doesn't become an embryo. As it is implanted the placenta and embryonic sac forms but remains empty. As there is no embryo formed this eventually leads to a miscarriage. The blighted ovum had symptoms of pregnancy like nausea, sore breast, etc.

Molar pregnancy:

Generally when an egg fertilizes and develops into a fetus it has two sets of chromosomes. One set comes from the father and another set from the mother. In the case of molar pregnancy both chromosomal sets come from the father so no further development occurs and the pregnancy leads to miscarriage. This kind of abnormality may lead to tumors in the uterus.

Partial molar pregnancy:

In case of the partial molar pregnancy the fetus contains three sets of chromosomes one from the mother and the other two from the father. This associated with placental and fetal abnormalities which leads to a miscarriage. This kind of abnormality can cause cancerous changes of the placenta in the uterus.

Translocation:

In this case the chromosomes translocates with each other which can cause miscarriage.

Maternal health problems

In many cases maternal health problems can cause miscarriages. Here we mention some maternal health problems, mainly problems in the cervix and uterus that can lead to miscarriages.

Septate uterus:

A Septate uterus is a congenital uterine abnormality that a woman is born with. In this case the uterine tissue or muscle bands divide the uterus into two sections. If a woman has a septate uterus it leads to repeated miscarriages. 

Asherman syndrome:

In this case the uterus has scars or scars tissues in it that can damage the endometrium lining. In this situation repeated miscarriages happen before knowing about the pregnancy. 

Fibroids in uterus:

If a woman has fibroids in the uterus the fibroids limit the space for the baby and interfere in the fetal development. In this case the doctors first recommend removing the fibroids before getting pregnant.

Cervical insufficiency or incomponent cervix:

In case of incomponent cervix the cervix opens (dilated) to early in the pregnancy. It usually happens without pain and contraction. It can lead to repeated miscarriages during the second trimester of pregnancy. In this case the doctor may recommend cerclage, a stitch in the cervix that helps to keep it close during the pregnancy.

Infections:

Infections in the pregnant woman's genital organs can cause miscarriage. STIs or sexually transmitted infections like listeriosis, genital herpes, syphilis can cause miscarriages. 

Thyroid disorders:

Hypothyroidism and hyperthyroidism both can lead to recurrent miscarriages. The thyroid disorders interfere with the function of reproductive hormones. It may cause problems in the ovulation process, implantation process which make the uterus unfavorable for pregnancy.

Uncontrolled diabetes:

Uncontrolled insulin dependent diabetes increase the risk of miscarriage at the first trimester of pregnancy and it also causes birth defects.

Blood clotting disorders:

Blood clotting disorders like systemic lupus erythematosus and antiphospholipid syndrome can cause recurrent miscarriages. It's very rare but occurs. In this kind of case the blood that flows to the placenta may clot, which disturbs the functioning of placenta. 

Immunological disorders:

The American College of Obstetricians and Gynecologists thinks that certain autoimmune disorders like antiphospholipid syndrome (also called APS) and lupus (also called systemic lupus erythematosus or SLE) play a role in miscarriage, especially with recurrent miscarriages.

Hormonal imbalance:

Hormonal imbalance can cause multiple miscarriages in a woman. Hormones are the key factor that controls all the functioning of pregnancy. If some specific pregnancy related hormones like progesterone, estrogen, human chorionic gonadotropin, etc cannot function properly it can lead to repeated miscarriages.

Miscarriage risk factors

There are various risk factors which can increase the risk of miscarriages. Here we mention about some most common risk factors of miscarriage.

Age:

Maternal age is one of the most common risk factors which increases the risk of miscarriages. Studies said that a woman older than 35 have a higher risk of miscarriage than younger woman. National Institutes of Health suggests that a woman in her 30s is half as fertile as a woman in her early 20s.  At age 35, a woman has almost 20 percent risk. After the age 40, the risk is increases about 40 percent. And at age 45, it's near 80 percent.

Smoking, alcohol and illegal drug consumption:

A woman who smoke during pregnancy has a higher risk of miscarriage comparing to the non smokers.  Between 19,000 and 141,000 miscarriages annually in the United States which is linked to smoking during pregnancy. Alcohol and illegal drug consumption during pregnancy also increases the risk of miscarriage.  Consumption of 5 or more units alcohol per week increase the risk of spontaneous abortion.

Weight:

Being underweight or overweight both increase the risk of miscarriages and increases complications during the pregnancy. BMI either below 18.5 or above 25 kg/m2 increase the miscarriage risks.

Chronicle issues:

Chronic conditions like uncontrolled diabetes, thyroid disorders, high blood pressure increase the risk of miscarriage. 

Previous miscarriage:

Studies shown an increased risk for miscarriage in women who have had recurrent miscarriages in the past. That means if a woman has two or more consecutive miscarriages than the risk of next miscarriage increases for her.

Environmental toxins and radiations:

Exposure to environmental toxins can also increase the risk of miscarriages. Chemical agents like mercury, lead, organic solvents, Tetrachloroethylene, Glycol ether, 2-Bromopropane, Petrochemicals, Ethylene oxide, Anesthetic gases, etc increases the risk of miscarriage. Exposure to certain bacteria or parasites like Toxoplasma gondii can also cause miscarriages.

Food poisoning:

During pregnancy food poisoning can lead to severe health problems in the expected mother and the baby too. Listeriosis is a kind of food poisoning which is caused by the Listeria bacteria. It increases the risk of miscarriages, stillbirths and premature births. 

Trauma: 

Studies said that maternal stress or trauma can increase the risk of pregnancy complications like premature birth, birth defects, even miscarriages.

Certain medications:

According to a  2017 study fluoroquinolones like ciprofloxacin (Cipro) and levofloxacin, Sulfonamides, Ibuprofen like Advil and Motrin can increases the risk of birth defects, stillbirths, and even lead to miscarriages.

Certain prenatal tests:

There are some kind of invasive prenatal genetic tests like chorionic villus sampling and amniocentesis Which can carry a slight risk of miscarriage.

Infections: 

There are some infections that can lead to pregnancy complications like preterm birth, stillbirths, birth defects, miscarriages such as Bacterial Vaginosis (BV), Chlamydia, Listeria and Salmonella infections, Toxoplasmosis, Parvovirus B19 (Fifth Disease), herpes simplex, cytomegalovirus, etc.

High fever:

High fever during the early pregnancy can also increases the risk of miscarriage.

Miscarriage rates by weeks

Miscarriage rates vary between women. But it is noticed that the rate of miscarriage starts decreasing as the pregnancy progresses. Miscarriage rates are highest during the first trimester. It is noticed that about  80 percent of miscarriages occur in that time.

Week 0 to 4:

The risk is highest in the first 4 weeks of pregnancy. In this case the woman goes into her miscarriage before she finds out about the pregnancy.They even think it's a late period. As many as  50 to 75 percent of pregnancies end like that.

Week 5:

After week 5 the miscarriage rate decreases. According to  a 2013 study the miscarriage rate after week 5 falls to 21.3 percent.

Week 6 to 7:

At this point of pregnancy an ultrasound can detect the baby's heartbeats and the rate of loss decreases to  5 percent .

Week 8 to 13:

This is the second half of the first trimester and the miscarriage rates are just about  2 to 4 percent overall.

Week 14 to 20:

It is noticed that after week 14 the rate of pregnancy loss is less than  1 percent .

Miscarriage prevention

In most cases, no one is actually responsible for the miscarriage. If there is a chromosomal problem or any other problem in the fetus then  natural miscarriage will happen. In few cases, it has been seen that some certain lifestyle habits also leads miscarriage. Here we give a list of do's and don'ts to maintain a healthy pregnancy.

Do's

  1. Take prenatal vitamins
  2. Maintain a healthy diet plan
  3. Exercise regularly
  4. Stay hydrated
  5. Have enough sleep
  6. Maintain a healthy weight

Don'ts

  1. Avoid smoking.
  2. Avoid alcohol and illegal drug consumption.
  3. Stop using electric blankets, hot tubs etc.
  4. Avoid cat litter.
  5. Avoid chemical exposure.
  6. Avoid sea foods high in mercury.
  7. Avoid undercooked meat, eggs, and unpasteurized milk.

Miscarriage treatments

A Natural complete miscarriage often does not require any external treatment. Again in some cases external treatment becomes necessary later. Today's technological advancement make it very easy to diagnose the miscarriage. Your health care provider then recommends the required treatments.

Expectant management:

In case of natural complete miscarriage if no complications or infections are seen, then no additional external treatment is required. 

Medical treatment:

In some cases the health care provider suggests some medications to take. This helps the body to pass rest of the pregnancy tissues from the uterus.

Surgical treatment:

In some cases after miscarriage some pregnancy tissues are left in the uterus. For those cases the health care provider suggests minor surgical procedures like suction dilation and curettage (D&C). It dilates the cervix and removes the tissues from the uterus.

Getting pregnant again

After a complete miscarriage, you will ovulate again in about 2-3 weeks. That means you can get pregnant again at this time but according to the experts you can try to get pregnant again after crossing at least one normal menstrual cycle.

According to the  National Institutes of Health  one can try to conceive within 1 to 3 months after having an early loss of pregnancy. 

One  2017 study suggest that conceiving again within 3 months of miscarriage have a better outcome.

How do you know if you had an early miscarriage or period?

It is very difficult to differentiate between an early miscarriage and period. Most of the times the woman actually don't know about their pregnancy before they miscarriage. In both of the cases a woman experiences vaginal bleeding, abdominal cramps and passing of blood clots or tissues. 

What is the difference?

If we look closely, we can understand the difference between the two.

Cramping:

Cramping is very common in periods and miscarriage. The difference is in case of miscarriage the woman experience very strong muscle contraction and pain in lower back and pelvis.

Bleeding:

In case of pregnancy loss the bleeding is severe and it can last upto 2 weeks. 

Passing blood clots and tissues:

In case of miscarriage with blood clots pregnancy tissues are also pass out.


 

Conclusion

In this article we try to give you an idea about the whole concept of miscarriages. We discuss the types of miscarriages, symptoms, and causes of miscarriages. We also mention the diagnosis process and treatment procedure. Hope this article will be helpful to you. Thank you very much.



 


Piyali Das

Piyali Das