PREGNANCY-RELATED CONDITIONS
MISCARRIAGE
A miscarriage is the spontaneous termination of a pregnancy before or up to the 20th week of gestation (~ end of 5th month). If termination of the pregnancy occurs after the 20th week of gestation, it is considered a stillbirth.
Contrary to common belief, miscarriages - especially during the first trimester - are quite common. It is estimated that miscarriages occur in approximately 15% of all clinically recognizable pregnancies (i.e. pregnancies that you and your doctor are able to identify as such). The actual number of early miscarriages might be even higher - taken into account the considerable amount of miscarriages that remain unnoticed due to their early occurrence and menstruation-like symptoms (vaginal bleed and abdominal cramping).
Many women suffer a miscarriage, and go on to carry out healthy pregnancies afterwards. So having a miscarriage in and of itself is not a reason to be alarmed. Most miscarriages occur because of random chromosomal (genetic) malformations that develop during the first weeks and months of pregnancy, and prevent a fetus from ever forming or cause it to die prematurely. These genetic abnormalities are usually not caused by any type of hereditary disease passed down from the parents or by maternal health conditions.
If you are affected by a recognizable miscarriage, there are certain points to consider. Most importantly, you want to make sure that all fetal tissue was completely miscarried, and that there are no fetal or placental fragments remaining behind in the uterus, which can cause later inflammation or formation of tumors. Moreover, there is a variety of tests which can be done to analyze the miscarried fetal tissue for abnormalities. This can be helpful in determining whether you are at risk of future miscarriage and whether you need additional treatments.
Risk Factors
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History of miscarriages
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Advanced maternal age (> 35)
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Smoking, alcohol and other drugs
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High or low BMI (lower than 18 or higher than 30)
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Invasive prenatal tests such as amniocentesis or chorionic villus sampling
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Exposure to certain chemicals (e.g. paints, cleaning products, pesticides, etc.)
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Chronic and autoimmune disorders, such as diabetes, thyroid disease, lupus, or coagulative disorders
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Cervical abnormalities, in particular cervical insufficiency (cervix opens and triggers contractions prematurely)
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Uterine abnormalities such as uterine fibroids, endometriosis or uterine scarring from some type of previous trauma
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Some medications, such as isotretinoin (i.e.an acne medication, which can cause serious birth defects and miscarriage)
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Infections, such as STD (sexually transmitted diseases) or listeria infection (from improperly processed meat and dairy products)
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Hormonal imbalance, such as polycystic ovary syndrome or luteal phase defect (causing decreased secretion of pregnancy hormones in the ovaries)
Symptoms
- Vaginal spotting or bleeding (similar to menstruation)
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Abdominal cramping and pain
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Sudden discontinuance of pregnancy symptoms
Treatments
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Observant approach: If the fetal tissue has died, but has not yet been miscarried, treatment can consist of mere careful observation until the body's own mechanisms expel the dead tissue. This is usually the case within a few days of diagnosis. However, this approach is a viable option only if you don't suffer from bleeding or infection, in which case the abnormal tissue needs to be removed immediately, either by medical treatment or surgical approach.
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Medical approach (misoprostol): If you can't or don't want to use the observant approach, miscarriage of fetal tissue can also be induced with certain drugs. The most common medication used for this purpose is misoprostol (brand name: Cytotec), a drug which is also used for medical abortion. It works by causing uterine contractions, which in term expel the fetal tissue. (Recent studies have also investigated mifepristone, brand name Mifeprex, another abortion medication, for miscarriage management. It works by blocking the hormone progesterone, which causes the uterine lining to degrade and be expelled by the body together with any fetal tissue.) These medications can be given orally or through a vaginal pessary (suppository) for a more targeted and concentrated administration. Either procedure often allows you to miscarry at home, usually within a day of taking the medication. After the procedure, you should follow up with your doctor to get appropriate diagnostic testing and make sure that all tissue was miscarried in its entirety.
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Surgical approach (dilatation and curettage): If your miscarriage is accompanied by complications such as infection or bleeding, your best option might be to have a small surgical procedure to remove fetal and placental tissue as well as potentially inflamed and bleeding tissue. This procedure is a fairly easy and quick vaginal procedure, during which your doctor dilates your cervix (in order to be able to access the uterus) and then trims away and removes the unhealthy tissues (or sometimes even the entire endometrium). This can be done under general or local anesthesia. While this is a fairly safe procedure, risks include bleeding and scarring of the uterus (and, as in any surgery, infection).