Miscarriage

Miscarriage, also known as spontaneous abortion, is the natural loss of a pregnancy before the fetus has developed enough to survive independently, usually before 20 weeks of gestation. It is a common event, yet often emotionally distressing for the individuals involved.

Classification

Miscarriages can be classified into various types depending on the stage and nature of pregnancy loss:

• Threatened Miscarriage: Indicated by vaginal bleeding, with or without pain, while the cervix is closed and the fetus is viable.
• Inevitable Miscarriage: Characterized by bleeding and dilatation of the cervix, indicating that pregnancy loss is impending.
• Incomplete Miscarriage: Some, but not all, of the products of conception have been expelled from the uterus.
• Complete Miscarriage: All the pregnancy tissues have been expelled without the need for surgical or medical intervention.
• Missed Miscarriage: The fetus has died but remains in the uterus, often with no symptoms.
• Recurrent Miscarriage: Defined as three or more consecutive pregnancy losses.

Causes and Risk Factors

While the exact cause of a miscarriage often remains unknown, chromosomal abnormalities are the most common reason, especially in the first trimester. Other potential causes include hormonal imbalances, uterine abnormalities, incompetent cervix, chronic illnesses, infections, and immunological disorders.

Risk factors include advanced maternal age, previous miscarriages, certain medical conditions (like diabetes and thyroid disease), lifestyle factors (such as smoking, alcohol, and high caffeine intake), and certain medications or environmental toxins.

Symptoms and Diagnosis

The most common symptom of a miscarriage is vaginal bleeding, which may be accompanied by cramping and pain in the lower back or abdomen. However, bleeding doesn't always mean a miscarriage is occurring, and some miscarriages occur without any bleeding at all.

Diagnosis is usually based on symptoms, a physical examination, ultrasound, and sometimes blood tests to measure levels of human chorionic gonadotropin (hCG) and progesterone.

Management and Treatment

Treatment depends on the type of miscarriage and can range from expectant management (waiting for the miscarriage to complete naturally), medical management (using medications to expedite the process), to surgical management (like dilation and curettage) to remove any remaining pregnancy tissues.

Psychological support is a crucial part of management due to the emotional distress that miscarriage can cause.

Prognosis

Most women who experience a miscarriage can have a successful pregnancy in the future. Recurrent miscarriages may require further medical evaluation and treatment.

References

• Practice Committee of American Society for Reproductive Medicine (2008). "Definitions of infertility and recurrent pregnancy loss". Fertility and Sterility. 90 (5): S60.
• Ammon Avalos, L; Galindo, C; Li, DK (June 2012). "A systematic review to calculate background miscarriage rates using life table analysis". Birth Defects Research. Part A, Clinical and Molecular Teratology. 94 (6): 417–23.

Miscarriage Resources
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