Miscarriage

From WikiParenting

A miscarriage is defined as a pregnancy that ends spontaneously before the 20th week of gestation. Pregnancies that end spontaneously after the 20th week of gestation are termed preterm deliveries, or stillbirth. Miscarriages are also referred to as spontaneous abortions. They are called spontaneous because they occur without medical intervention, in contrast to an elective or therapeutic abortion. About 20 percent of women who know they are pregnant will suffer a miscarriage, with the majority of them happening in the first 12 weeks. About 50 percent of early pregnancies end in spontaneous abortion before the mother knows she is pregnant.

[edit] Causes

The majority of miscarriages in the first 12 weeks of gestation are caused by the fertilized egg having the wrong number of chromosomes. An egg with the wrong number of chromosomes will not develop normally. A pregnancy can miscarry because of implantation, developmental, or structural problems as well. Other factors that can cause a miscarriage are related to the health of the mother, such as:

• Hormonal problems
• Chronic health problems
• Maternal infections
• Smoking
• Drug use
• Malnutrition
• Exposure to radiation or toxins
• Excessive caffeine
• Maternal trauma

If you have a single miscarriage your doctor will most likely not order a battery of tests to discover the cause of the miscarriage, so the cause will not be determined. If you suffer repeated miscarriages, he may order a full scale work up to try to discover the reason for the repeated miscarriages. But even then, the cause is only discovered about half of the time. Things that have not been proven to cause miscarriage are sex during normal pregnancy and moderate exercise.

[edit] Risk factors

A miscarriage can happen to anyone, but there are factors that raise the chances that you will miscarry. They are:

• Pregnancy after age 35. Older mothers have a greater chance of having a fertilized egg with chromosomal problems, the leading cause of miscarriage.
• Repeated miscarriages. If you have had 2 or more miscarriages, it raises the risk of miscarrying again.
• Chronic health problems
• Insufficient cervix
• Uterine abnormalities
• A family history of birth defects
• Infections. Some infections appear to raise the risk of miscarriage, infections such as listeria, mumps, rubella, measles, cytomegalovirus, parvovirus, gonorrhea, HIV, and others.
• Substance abuse. Drinking alcohol while pregnant, smoking, and using drugs – especially ecstasy and cocaine – raise the risk of having a miscarriage. Women who smoke, drink, or use drugs should quit. Too much caffeine has also been liked to miscarriage, so if you drink more than the equivalent of 4 or more cups of coffee a day, you should cut down.
• Certain medications. Many drugs, including over the counter medications, can raise your risk of suffering a miscarriage. Tell your doctor about any and all medications that you take.
• Exposure to radiation or toxins. You may be exposed to hazardous substances at your place of employment, or as part of a hobby. Lead, arsenic, formaldehyde, benzene, radiation and anesthetic gases all can cause miscarriage.

[edit] Signs and symptoms

The first sign that a miscarriage is happening or about to occur may be spotting or bleeding, possibly accompanied by cramps. Back pain can be experienced and range from mild to severe. Other signs that you may be having a miscarriage are:

• A feeling that something is wrong with the pregnancy
• You have an abrupt reduction in the signs of pregnancy
• You experience sudden weight loss
• You detect pink tinged mucous
• You have contractions that are painful and happen regularly every 5 to 20 minutes
• You pass tissue and clots

[edit] What you should do

Call your healthcare provider immediately if you think that you are having a miscarriage or are about to miscarry. Certain conditions that cause a miscarriage, such as an ectopic pregnancy, require immediate emergency medical treatment. Your healthcare provider will want to examine you and run tests to determine the status of the pregnancy. Tests that may be run are:

• A physical exam
• Blood tests to measure the amount of hCG, a pregnancy hormone
• Ultrasound to check for a heartbeat, location of the embryonic sac, and size of the fetus

[edit] Treatment

If no heartbeat is detected in the ultrasound, miscarriage will be confirmed. If a heartbeat can be seen, but it is determined that your cervix is thinning out or opening, your doctor may perform cerclage, to try and avoid a miscarriage or preterm delivery. If your cervix is ok, and the baby has a heartbeat and you are still having signs of miscarriage, you may be put on bed rest. You should avoid sex if you are having symptoms of a miscarriage, and never use tampons while you are pregnant, use sanitary pads instead. If you have a miscarriage you may pass the products of conception on your own, or you may need to be given medicine or have a procedure called dilation and curettage – commonly known as D&C. If you pass it on your own, you will see grayish tissue and blood clots on the sanitary pads and on toilet paper when you wipe. This type of miscarriage is called a complete miscarriage. After you have passed the products of conception you will have cramps for another day or so, and continue to bleed for up to 2 weeks. You should still use pads and not tampons, and avoid swimming, douching, or other feminine products. Call the doctor again if you soak a sanitary pad in an hour or less, if you develop a fever, or if your discharge begins to smell. You should also call if you begin to get dizzy and weak and are bleeding heavily, as you may be going into shock. Do not drive yourself to the doctor, have someone else drive you. If a week has gone by and you have not passed the fetal tissue, you will probably have to have dilation and curettage to remove the tissue, or you may be given medication to speed up the process.