Miscarriage

Approximately 15 to 20% of all pregancies end in miscarriage. Although miscarriage can happen any time before 20 weeks, most take place in the first twelve weeks of pregnancy. Most miscarriages cannot be prevented. This is nature's way of ending a pregnancy that is not developing as it should. Most women who miscarry can conceive in the future and carry that pregnancy to term.

Genetic Factors
Over ½ of the miscarriages occurring during the first thirteen weeks of pregnancy are caused by problems in the chromosomes of the embryo. This is nature's way of eliminating embroyos with genetic problems. Often the miscarriage occurs before the woman is aware she is pregnant. Most chromosomal problems happen by chance and are not likely to happen again.

Sometimes, though, the chromosomal problem is inherited from the parents. This is more likely with repeated miscarriages or in families where there is a history of birth defects. Genetic testing can be ordered on the fetal tissue from the miscarriage, or on blood from the parents.

Health Factors
Physical problems with the uterus or cervix can lead to miscarriage, most frequently during the second trimester (14 to 26 weeks of pregnancy). Some of these defects can be an abnormally shaped uterus or a cervix that is incapable of holding a pregnancy without cervical correction (incompetent cervix).

There are maternal diseases that may lead to a higher incidence of miscarriage, including: poorly controlled diabetes, systemic lupus erythematosis (SLE or lupus), high blood pressure, rubella, and chlamydia. Sometimes a hormonal imbalance can cause an early miscarriage.

Life Style Factors
One thing that women do have control over are the life style factors that can increase the risk of miscarriage. Smoking increases the risk of miscarrying a genetically normal fetus. Heavy alcohol use increases the risk of miscarriage, as does the use of street drugs, especially cocaine.

Symptoms of Miscarriage
The most common symptom of impending miscarriage is vaginal bleeding. Not all pregnancies with bleeding end in miscarriage, though. About ½ of pregnancies with early vaginal bleeding go on to term and end with a healthy baby. Because the threat of miscarriage exists with bleeding, your doctor or midwife will want to watch you more carefully over the next few days. You may be followed with ultrasound or blood tests.

Bleeding at the beginning of a miscarriage may be light, continuing over several days. Mild lower abdominal or lower back aches may accompany the bleeding. As the miscarriage progresses, the bleeding will get heavier and the cramping may get more painful. As the cervix dilates (opens), tissue may be passed. If you think you have passed fetal tissue, put it in a clean container and bring it with you to your doctor or midwife. Rarely, you may notice a gush of clear fluid from the vagina, without pain or bleeding.

Remember to call your doctor or midwife if you hav any of the following symptoms:

• Spotting or bleeding, with or without cramping
• Heavy or persistent bleeding
• A gush of fluid from your vagina, with or without bleeding

If you have heavy bleeding and think you may have passed tissue, place it in a clean container and bring it with you to your doctor or midwife.

It is important to be certain all the tissue relating to the pregnancy is removed, either naturally, or with a D&C. If the cervix is open and tissue has been passed, we will probably follow the progression with blood tests. Sometimes the body does not completely expel all the products of conception. This is when a D&C will be performed to finish the process.

After a Miscarriage
If you have a D&C, your doctor or midwife will want to see you in two weeks. You may notice some spotting or bleeding and discomfort for a few days following the surgery. Taking it easy for a few days will keep the bleeding to a minimum. Please call your doctor or midwife if you notice any of the following:

• Heavy bleeding (changing a pad an hour)
• Fever or chills
• Severe pain

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