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. About 20 percent of women will go on to miscarry completely. The woman is monitored for further bleeding. Ultrasound exams (a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs) are usually performed to monitor growth of the fetus.



• 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. D & C (dilatation and curettage) may be necessary.



• 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 a D&C (dilatation and curettage) may be necessary. This procedure uses special instruments to remove the abnormal pregnancy.



• recurrent - more than three miscarriages.

What is an incompetent cervix?

Fetal loss in the second trimester may occur when the cervix is weak and opens too early without significant uterine contractions, called incompetent cervix. In some cases of incompetent cervix, a physician 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 depends on several factors including your gestational age, your preferences, and your doctor's recommendations. Management options include:

1. Expectant management for 1-2 weeks to allow for spontaneous passage of the pregnancy is sometimes recommended initially. Many miscarriages will spontaneously pass without additional therapy; however, these generally occur within the first 1-2 weeks after the miscarriage is diagnosed. This can be associated with heavy bleeding and significant cramping when the miscarriage is completed.



2. Medical management. Sometimes a medication called misoprostol, a potent prostaglandin, is used to facilitate completion of a miscarriage. Heavy bleeding and cramping can occur when the miscarriage is completed. Close followup is needed when medicines are used to treat a miscarriage as additional treatments may be required.



3. Dilatation and curettage, or surgical evacuation of the uterus. This option is recommended when either expectant management or medical management has failed

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 (called products of conception).

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. A longer period of expectant management may also be recommended as spontaneous delivery is the safest.

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.