Miscarriage refers to the premature end of a pregnancy before the developing baby is able to survive outside the womb. Miscarriage can occur during the first or second trimester, before 20 weeks. Most occur in the first 12 weeks of pregnancy. They often are unexpected and isolated events. About 15%-20% of recognized pregnancies end this way.
Fetus in First Trimester
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Miscarriages often occur for the following reasons:
In some cases, the cause is unknown.
Factors that may increase the risk of miscarriage include:
Having a miscarriage during your first pregnancy may place you at a higher risk for complications during your next pregnancy. These complications may include:
Symptoms include some or all of the following:
While miscarriage usually is a one-time occurrence, up to 1 in 20 couples experience two miscarriages in a row, and 1 in 100 have three or more. In some cases, these couples have an underlying problem. Couples who have experienced two or more miscarriages should have a complete medical evaluation to learn the cause and how they can prevent another one from occurring.
Testing can reveal the cause of repeat miscarriages in at least 75% of couples.
You will be asked about your symptoms, the length of your pregnancy, and when you first noticed a change in your condition. The doctor will perform physical and pelvic exams.
Prior to miscarriage, tests may include:
After miscarriage, tests may include:
Immediate care usually involves observation only, especially in early or first trimester miscarriages. Medicine may be indicated in the event of heavy bleeding or cramping. A dilation and evacuation (D&E) may be needed if uterine contents are not spontaneously expelled (passed through the vagina). During a D&E, the doctor dilates the cervix, inserts a tool into the uterus, and suctions out remaining material.
Medicines to decrease the chance of miscarriage may include:
Some uterine problems can be corrected to prevent another miscarriage. Examples include:
To help you deal with your loss, the doctor can refer you to a mental health therapist. You may also benefit from participating in a support group .
Before you start to plan your next pregnancy consider the following regarding your health:
The American College of Obstetricians and Gynecologists
The International Council on Infertility Information Dissemination
March of Dimes Foundation
The Society of Obstetricians and Gynaecologists of Canada
Women's Health Matters
Miscarriage. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/pregnancycomplications/miscarriage.html/ . Updated November 2011. Accessed August 10, 2012.
Miscarriage. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated August 3, 2012. Accessed August 10, 2012.
Miscarriage. March of Dimes website. Available at: http://www.marchofdimes.com/baby/loss_miscarriage.html . Updated October 2008. Accessed August 10, 2012.
12/2/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Winther JF, Boice JD Jr, Svendsen AL, Frederiksen K, Stovall M, Olsen JH. Spontaneous abortion in a Danish population-based cohort of childhood cancer survivors. J Clin Oncol. 2008;26:4340-4346.
4/16/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Bhattacharya S, Townend J, Shetty A, Campbell D, Bhattacharya S. Does miscarriage in an initial pregnancy lead to adverse obstetric and perinatal outcomes in the next continuing pregnancy? BJOG. 2008;115:1623-1629.
6/25/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Nakhai-Pour HR, Broy P, Bérard A. Use of antidepressants during pregnancy and the risk of spontaneous abortion. CMAJ. 2010 May 31.
Last reviewed September 2012 by Andrea Chisholm
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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