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more about Miscarriage

Spontaneous abortion

  • Miscarriage refers to a pregnancy in which the fetus (the future baby) cannot survive, or is stillborn before the 20th week of pregnancy.

  • Abdominal pain
  • Cramping and labor like symptoms (i.e., vaginal bleeding)
  • Fever
  • Can be divided to 4 categories:
    1. Threatened abortion -- excessive vaginal bleeding and cramping
    2. Inevitable abortion -- the cervix opening dilates, while the sac around the products of conception (the fetus and placenta) ruptures, causing the fluids to leak into the vagina.
    3. Incomplete abortion -- parts of the fetus are expelled, but the placenta remains intact.
    4. Complete abortion -- all of the products of conception are expelled (including the placenta).  This may look like a blood clot or lump with a disc-shaped placenta resembling a honeycomb at the base, so if you do miscarry, do not look for an actual "fetus."  It may be necessary to collect the expelled material so that your doctor can evaluate it.

  • Unknown in half the cases
  • Chromosomal abnormalities -- chromosomes carrying the parents' genes (i.e., eye color, baldness, etc.) can be damaged (bent or broken) during the early stages of fetal development (after the sperm fertilizes the egg, the male and female chromosomes begin to share genes and divide).
  • Hormonal abnormalities -- in some women, the level of Progesterone (which prepares the uterus for the fetus) is low.
  • Infections of the uterus (womb) or the cervix (part of the uterus that opens in to the vagina) by bacteria such as Syphilis or viruses.
  • Abnormalities of the uterus or cervix -- fibroids (benign tumors of the uterus) and a damaged cervix due to repeated D&C (dilation and curettage)
  • Abnormal immune reactions -- the immune system protects the body against foreign invaders using specific cells and Proteins (antibodies).  In some cases, the fetus and the placenta (where the fetus is attached to the uterus), mistaken for foreign invaders, are attacked by the mother's immune system.

  • The first miscarriage is usually not worked up extensively, since the chance of subsequent pregnancy is very good.
  • A general physical exam, coupled with a review of the full medical history of the patient
  • A pelvic or bi-manual exam, in which the physician looks and feels for abnormalities in the vagina, cervix, and the uterus.  This is uncomfortable, but generally painless.
  • Examination of expelled products of conception may be done.
  • Beta HCG is a chemical hormone detected in the blood during a normal pregnancy.  After a miscarriage, the blood levels of this chemical fall.
  • A blood test is done to ascertain the degree of blood loss, liver or kidney function, hormones, and to look for infection.
  • Blood tests for immune problems (check for antibodies such as lupus anticoagulant)
  • The products of conception may be sent for genetic studies (chromosomal abnormalities).  Ultrasound uses sound waves (painless) to see if the fetus has a heartbeat, to determine what is left in the uterus after miscarriage, and to show fibroids and other structural problems.
  • Hysteroscopy can directly look in the uterus using a thin, penlike camera.
  • Endometrial biopsy (scraping a bit of the lining of the uterus) sometimes needs to be done.
  • Conditions that may be similar:
    1. Ectopic Pregnancy (pregnancy outside the uterus)
    2. Menorrhagia (heavy menstrual bleeding)
    3. Cancer of the cervix

  • Alcohol
  • Smoking
  • Medications such as those used in treatment of cancer or acne
  • Presence of other diseases (i.e., heart, diabetes, and thyroid disease)
  • After one miscarriage, the risk of second one is 10%-13%
  • After two miscarriages, the risk of another rises to 35-40%

  • The following treatments can prevent or reduce the risk of a miscarriage:
    1. Normalizing low Progesterone levels
    2. Normalizing the abnormal levels of thyroid hormones
    3. Controlling sugar (glucose) levels in diabetes
  • Treating infections:
    1. Surgical correction of abnormal uterine structures or removing Uterine Fibroids
    2. Management of pain and bleeding
    3. Antibiotics for infections
    4. Tylenol for pain and fever.  Avoid painkillers from a class known as non-steroidal anti-inflammatory drugs (i.e., aspirin, Ibuprofen, Naproxen) because they may worsen the bleeding.
    5. Surgical procedures such as D&C (dilation and curettage) or D&E (dilation and evacuate) are used to dilate the cervix and remove the products of conception.
    6. If Depression ensues, then psychological counseling may be helpful.

  • If cramping, bleeding, or passing of any of the products of conception occur, contact your doctor or call 911 immediately.  The doctor may refer you to an obstetrics & gynecology (ob-gyn) specialist.
  • Do not become depressed.  Your chances are very good for second pregnancies.  More information is available at the pregnancy and infant loss center at 1-612-473-9372, or by visiting

more about Miscarriage

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