Miscarriage.

 

 Definition

A miscarriage is the loss of pregnancy before 20 weeks of gestation.

Most miscarriages happen in the first trimester (before 12 weeks).

Types of miscarriage

ü Threatened miscarriage:

·        Vaginal bleeding with a closed cervix.

·        Pregnancy may be saved and continue.

 

ü Inevitable miscarriage:

·        Bleeding and open cervix.

·        The miscarriage in unavoidable.

 

ü Incomplete miscarriage:

·        Some pregnancy tissue has passed and some remains in the uterus.

 

ü Complete miscarriage:

·        All pregnancy tissue has passed naturally.

 

ü Missed miscarriage:

·        Fetal has died but there are no symptoms .

·        Detected by ultrasound.

 

ü Recurrent miscarriage :

·        3 or more consecutive pregnancy loses.

·        Requires investigation.

 

  Causes of miscarriage:

 

A.  Genetics: chromosomal abnormalities (most common cause)

B.  Hormonal: Low progesterone level, Thyroid disorders, PCOS.

C.  Infections: Rubella, Cytomegalovirus, Listeria, Malaria.

D.  Anatomical: uterine abnormalities, fibroids, cervical incompetence.

E.  Immune: Autoimmune disorders, (lupus, antiphospholipid syndrome)

F.   Lifestyle: smoking, alcohol, drug use, excessive caffeine.

G.  Other: trauma, uncontrolled diabetes, severe malnutrition.

                                                    Sign & Symptoms

Ø Vaginal bleeding (mild to heavy)

Ø Abdominal cramps or pain.

Ø Passage of tissue or clots.

Ø Loss of pregnancy symptoms (like nausea, breast tenderness).

Ø No fetal heart beat on ultrasound.

                                 Diagnosis:

§  Pelvic exam: check for open cervix.

§  Ultrasound: check fetal heartbeat and development.

§  Blood tests: HCG level (pregnancy hormone), progesterone.

§  Tissue analysis: if tissue is passed it may be tested to know the cuase.

              Management & Treatment

Depends on the type

§  Expectant management: also know us watchfull waiting or natural management.

o   Wait for the miscarriage to happen

o   Used for complete or missed miscarriage.

ü                                                                        

    Medical management:

Medication like:

a)   Misoprostol (cytotec): causes uterine contraction to expel pregnancy tissue.

§  It is usually given (vaginally, orally or sublingually).

§  Misoprostol typically given 800 mcg (microgram) vaginally or sublingually.

b)   Mifepristone (optional): sometimes used 24 hours before misoprostol to improve success.

·        It is 200mg orally sometimes given first (optional, depends on protocol you are using)

·        Uterus begins to contract within 4-6 hours.

·        Bleeding and cramps occur as tissue passes.

·        May repeat the dose after 24-48 hours if needed.

ü Surgical management:

D&C ( Dillation and Curettage): remove retained tissue.

Used in heavy bleeding , infection, or if tissue remains. 

 Emotional & Pyscological impacts :

§  Greif, sadness, anxiety or guilty feeling are common.

§  Emotional support and counseling are important.

§  Miscarriage is not the mother’s fault.    

                    Prevention and next steps:

Ø Some causes can’not be prevented like genetic.

Ø Healthy lifestyle (no smoking,  alcohol, healthy weight).

Ø Control chronic conditions ( like diabetes)

Ø After 2-3 miscarriage detailed testing is advised.

Ø Many woman go on have healthy pregnancies later.