Miscarriage

Also known as: Spontaneous abortion

Anatomy or system affected: Psychic-emotional system, reproductive system, uterus

Definition: A pregnancy that self-terminates within the first twenty weeks of gestation; the same condition occurring after twenty weeks is termed a stillbirth.

Causes and Symptoms

Approximately 10 to 20 percent of all known pregnancies will end in miscarriage. Furthermore, it is estimated that as many as 75 percent of all fertilized eggs fail to implant in the uterus—a situation generally unknown to the woman. The likelihood of a miscarriage drops during the pregnancy’s duration. Approximately 6 to 21 percent of miscarriages occur in the first six weeks after implantation. For pregnancy before eleven weeks, the risk of miscarriage drops to 10 percent, and from this point up to twenty weeks, the risk of miscarriage drops to 5 percent.

The symptoms of a threatened spontaneous abortion may include spotting of blood, which may turn into heavier bleeding; cramping, possibly accompanied by lower back pain; and vaginal discharge of tissue, clots, or pinkish fluid. A completed miscarriage may also demonstrate changes in pregnancy signs, such as nausea and breast sensitivity. A hormonal sign of a threatened miscarriage is the failure of human chorionic gonadotropin (hCG) levels to double every two days.

There are three conditions where a woman experiences a miscarriage, and the developing child is missing in the sac. Miscarriages before the eighth gestational week are often caused by blighted ova, as an embryo has failed to develop. Complete molar pregnancies arise when a sperm (or two) fertilizes an egg that has lost its genes. The resulting development of pregnancy tissues—absent the developing child—usually leads to the symptoms of a miscarriage in the first several gestational weeks, but expulsion of the placenta may not occur. Because of the higher likelihood of residual disease (including cancer) in the abnormal tissue, if any is left behind, surgical removal of the molar tissue is often warranted. Women who have aborted a molar pregnancy are advised not to get pregnant again for a year, and then they must be closely monitored for subsequent pregnancies, as they are at increased risk for further abnormalities that can become malignant. Finally, a woman may have a recognized pregnancy yet not realize that she was actually pregnant with twins and that one died. This is called “vanishing twin syndrome.”

Analyses reveal the probability of the most common causes of miscarriages are, in the order of prevalence, genetic abnormalities; defects in the uterus (such as double or septal uterus) or the cervix (such as incomplete closure); and hormonal (such as low progesterone or thyroxin) and/or autoimmune disorders (such as lupus or antiphosphid antibody syndrome). A woman’s poor health, history of disease (such as endometriosis), history of miscarriages, and advanced age (there is an estimated 50 percent miscarriage rate for women forty-five and older) also increase the probability of a miscarriage. Studies have indicated that the presence of bacterial vaginosis is associated with late-onset miscarriages and preterm deliveries. The presence of the bacteria known as beta strep in the mother’s birth canal is tied to preterm labor when it goes untreated. Lifestyle choices that can compromise a successful pregnancy may involve the abuse of substances, such as caffeine, cocaine, or nicotine; the contraction of sexually transmitted diseases (STDs), such as chlamydia, human immunodeficiency virus (HIV), or human papillomavirus (HPV); or exposure to harmful agents, such as radiation. Polycystic ovary syndrome, food poisoning, certain medications, and chronic health conditions, such as diabetes, have also been associated with second-trimester miscarriages. Miscarriages are not caused by emotional distress, working, air travel, or engaging in intercourse, exercise, or lifting, despite common beliefs.

Treatment and Therapy

Little can be done to stop a miscarriage in the first two months of pregnancy, though some effective interventions are possible in later gestational periods. Magnesium sulfate is effective in combating preeclampsia (high blood pressure during pregnancy) and premature labor contractions. A cervical stitch (cerclage) can rectify an incompetent cervix (premature dilation). Most medical efforts, however, are directed toward the prevention of future miscarriages—the treatment of disease, lifestyle changes, RhO shots for Rh problems—and recovery from the present miscarriage. For example, medications to reduce the risk of miscarriage include antibiotics, which treat or prevent infections, and aspirin and similar medications that treat blood-clotting issues. Surgical procedures are also used to prevent miscarriages by treating certain uterine problems, such as uterine fibroids and a weakened cervix.

There are two aspects of recovery from a miscarriage. The physical part involves the natural or artificial removal of pregnancy tissue—either chemically, as with Pitocin, or surgically, as with dilation and curettage (D & C)—and the establishment of a new menstrual cycle. A typical physical recovery ranges from a few days to a few weeks for the miscarriage itself and one to two months after the miscarriage for the next period. Women are usually advised to wait one to two normal periods before trying to conceive again. Most women trying to conceive will be successful within six months of the miscarriage.

The psychological recovery may take longer than the physical recovery. Social support, good mental health prior to the miscarriage, and successful grieving (mourning, not denying, the loss, and then moving forward in life) are some of the factors correlated with a better psychological recovery. Support groups exist for individuals who have suffered miscarriage, stillbirth, or infant death. Similar groups exist to provide social support to individuals who are pregnant after the loss of an earlier pregnancy. Such support is essential in decreasing anxiety.

Perspective and Prospects

Until the latter half of the twentieth century, miscarrying women received little focus from the medical community. In fact, many of the drugs introduced in the mid-twentieth century, such as diethylstilbestrol (DES) and its numerous estrogenic cousins, caused more harm than good. However, by the latter part of the twentieth century, significant progress was made in diagnosing and preventing miscarriages.

In the early twenty-first century, three avenues of research appeared promising. Studies revealed certain genetic predispositions for miscarriages, such as the low production of nitric oxide, resulting in less blood to the uterus. Miscarriages were also linked to autoimmune disorders and hormonal deficiencies. The use of hormone injections for women who were found to have a hormonal imbalance helped to prevent miscarriage. Specifically, the use of progesterone proved to be effective in preventing miscarriage. Finally, assisted reproductive technologies offered intriguing possibilities, such as the ethically controversial opportunity to screen preimplantation embryos for chromosomal abnormalities. In these and other areas of research, new hopes were raised for old griefs.

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