MISCARRIAGE (Spontaneous Abortion)

General Information

DEFINITION--Premature termination of a pregnancy before the fetus can survive outside the uterus. It occurs in about 30% of first pregnancies and frequently occurs so early that the woman is unaware that she is pregnant. Most miscarriages occur during the first 14 weeks of pregnancy. Many miscarriages are only "threatened," and the pregnancy continues to term, although symptoms may be the same.

BODY PARTS INVOLVED--Reproductive system.

SEX OR AGE MOST AFFECTED--Women of childbearing age.

> Vaginal bleeding--from slight to heavy.

CAUSES

During the first 3 months (first trimester):

• An abnormal or defective fetus.
• Uterine abnormalities that prevent the fertilized egg from growing normally.

During the second trimester:

• Uterine abnormalities that cause detachment of the fetus and placenta.
• Severe psychological stress (maybe).

Anytime:

• Use of drugs that harm the fetus.
• Infections, especially virus infections, such as rubella or influenza.

RISK INCREASES WITH

• Stress; poor nutrition.
• Illness that has lowered resistance.
• Recent serious infection.
• Medical history of endocrine diseases, such as diabetes mellitus or hypothyroidism.

HOW TO PREVENT--

During pregnancy:

• Obtain regular medical checkups.
• Eat a normal, well-balanced diet.
• Don't drink alcohol, smoke cigarettes or use recreational drugs. Don't use any medications, including non-prescription drugs, without consulting doctor.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Ultrasound (See Glossary).

APPROPRIATE HEALTH CARE

Self-care. Doctor's treatment. > Surgery: D & C (dilatation and curettage) or D & E (dilatation and evacuation) to remove any remaining tissue or a dead fetus (sometimes).

• Hospitalization (sometimes).
• Psychotherapy or grief counseling may help.

POSSIBLE COMPLICATIONS

• Uterine infection, signaled by fever, chills and aching; hemorrhaging from other body parts.
• "Incomplete" abortion, in which some placenta or fetal tissue remains in the uterus, or missed abortion, in which the fetus dies but remains in the uterus.

PROBABLE OUTCOME--

• An inevitable miscarriage cannot be stopped.
• With treatment, a miscarriage is not a life-threatening condition. It usually does not affect a woman's ability to carry a healthy baby to term in the future.
• Feelings of loss and grief are common. If these persist, seek emotional help.

How To Treat

GENERAL MEASURES--

• For a threatened miscarriage, follow your doctor's orders. Bed rest is often enough to stabilize the pregnancy.
• After a miscarriage: Expect a small amount of vaginal bleeding or spotting for 8 to 10 days. Don't use tampons for 2 to 4 weeks. Wait through several normal menstrual cycles (usually 2 to 4) before attempting to become pregnant. Your doctor will advise you.

MEDICATION--

• For a threatened miscarriage, medicine usually is not necessary.
• Your doctor may prescribe: Oxytocin to control bleeding in some patients. Pain medication if needed. After a miscarriage, antibiotics for infection. Blood transfusions for severe blood loss. RhoD (immune globulin) for Rh negative female.

ACTIVITY--

• For a threatened miscarriage: Rest in bed until symptoms disappear. Avoid sexual intercourse until the outcome is known.
• After a miscarriage, rest often and reduce activity during the next 48 hours.

DIET--

• For a threatened miscarriage, drink fluids only, if bleeding and cramping are severe.
• After a miscarriage, no special diet.

Call Your Doctor If

• Any bleeding occurs during pregnancy.
• Bleeding and cramps worsen during a threatened miscarriage or you pass tissue.
• Fever and chills occur during a threatened miscarriage or following miscarriage.
• Unexplained bruising occurs after a miscarriage.
• Infection develops while you are pregnant.