Miscarriage

A miscarriage is a loss of pregnancy during the first 20 weeks. Miscarriage occurs in about half of all pregnancies, but only 10% of known pregnancies, and most occur in the first 13 weeks of pregnancy.

Often, a miscarriage is nature’s way of ending a pregnancy in which the fetus is not growing as it should or would not have been able to survive. In many cases, there is no known cause for a miscarriage.

Genetic Causes
Most first-trimester miscarriages are caused by chromosomal errors that occur when the fetus is first forming. Chromosomes are tiny structures inside the center of each of the body’s cells. Each chromosome carries many genes, which determine the traits of a person.

Most chromosome problems are not inherited, but happen by chance and are not likely to occur again in another pregnancy. In most cases, there is nothing wrong with the health of the female or male partner.

The Women’s Health
The loss of a pregnancy, no matter how early, can result in feelings of loss and grief. Speak with your doctor if these feelings become overwhelming.

Preexisting health conditions can also cause you to miscarry. In many cases, your doctor can monitor these conditions and manage them so that your pregnancy can be successful. As always, talk with your doctor about any questions or concerns you have about your pregnancy.

Possible conditions that can cause a miscarriage include:

It’s common for a pregnancy to miscarry so early that you don’t even know you’re pregnant.

• Infections that affect the uterus or the fetus

• Problems with your hormones

• Chronic diseases such as diabetes, especially if they are not controlled prior to pregnancy

• An abnormally shaped uterus

• An incompetent cervix

• Bleeding disorders.

There is no proof that working, exercising, having sex, use of birth control pills, most accidental falls, or morning sickness cause miscarriages.

Risk Factors
There are several risk factors that may increase your chances of a miscarriage. These include:

• Increasing age, especially age 35 and older

• A history of two or more miscarriages

• Nonprescription NSAID (such as ibuprofen or naproxen) use when you become pregnant or early in your pregnancy

• Alcohol or drug use during pregnancy

• Cigarette smoking during pregnancy

• Exposure to dangerous chemicals before or during pregnancy

• Heavy caffeine use during pregnancy

• Certain gynecological problems, such as uterine fibroids or other abnormalities of the uterus

• Disease or infection during pregnancy

• Physical trauma.

After the first 12 weeks of pregnancy, when a fetal heartbeat is seen on ultrasound, the risk of miscarriage drops significantly.

Ultrasound is a test that uses reflected sound waves to produce an image of the developing fetus. It does not use X-rays or other types of potentially harmful radiation.

Symptoms of Miscarriage
Common signs of a miscarriage include:

• Vaginal bleeding

• Abdominal or pelvic cramping or pain

• Lower back pain

• Tissue that passes from the vagina.

While most women who have vaginal spotting or bleeding during the early stages of their pregnancy have healthy babies, bleeding is the most common symptom of a miscarriage.

Diagnosing a Miscarriage
If you have any symptoms of a miscarriage, call your doctor right away. Often, your doctor will be able to diagnose a miscarriage from a pelvic exam. If not, your doctor may order blood tests or perform an ultrasound exam.

Treating a Miscarriage
There is no proven medical treatment to stop a miscarriage that has already started. While many miscarriages complete on their own, some require medical treatment. If tissue is left in your uterus after the miscarriage, your doctor may perform a dilation and curettage (D&C). In this procedure, the remaining tissue is gently removed from your uterus. Most D&Cs are performed in the doctor’s office and require no hospital stay.

You should wait until you have had at least one normal menstrual period before attempting to become pregnant again.

Coping With The Loss
It is normal to go through a grieving process after a miscarriage, regardless of the length of your pregnancy. Guilt, anxiety, and sadness are common and normal reactions after a miscarriage. It is also normal to want to know why a miscarriage happened; however, in most cases, a miscarriage is a natural event that could not have been prevented.

Emotional healing is as vital as physical healing after a miscarriage. Grieving is normal and allows you to accept the painful loss of miscarriage and go on with your life. Counseling can help both you and your partner if you have trouble dealing with your feelings after a miscarriage.

Ectopic Pregnancy

In a normal pregnancy, the fertilized egg travels through the fallopian tube into the uterus and implants itself. An ectopic pregnancy occurs when the fertilized egg doesn’t make it to the uterus but becomes implanted somewhere along the route, most often in the fallopian tube.

Ectopic pregnancies occur when the passage to the uterus is blocked, such as when the fallopian tube is twisted or narrowed.

Because the egg is outside the uterus, an ectopic pregnancy cannot grow as it should and must be treated. It can also cause the fallopian tube to burst, which can cause a dangerous loss of blood. A ruptured fallopian tube must be treated by surgery.

Who Is At Risk
Any woman can be at risk for an ectopic pregnancy; however, if you have abnormal fallopian tubes you are at a higher risk. Abnormal fallopian tubes may be present in women who have had:

• Pelvic inflammatory disease

• Previous ectopic pregnancy

Although an ectopic pregnancy can threaten your health and well-being, prompt treatment and follow-up care can help prevent complications.

• Infertility

• Pelvic or abdominal surgery

• Endometriosis

• Sexually transmitted disease (STD)

• Prior tubal surgery, such as tubal ligation.

Other factors that can increase a woman’s risk of an ectopic pregnancy include:

• Cigarette smoking

• Exposure to DES during your mother’s pregnancy

• Increased age.

Today, about 1 in 50 pregnancies is ectopic.

Symptoms
Early symptoms of an ectopic pregnancy sometimes are similar to the symptoms of pregnancy, such as tender breasts or an upset stomach. However, you may have no symptoms in the early stages of this type of pregnancy.

As an ectopic pregnancy progresses, you may have:

• Abnormal vaginal bleeding

• Abdominal or pelvic pain

• Shoulder pain

• Weakness, dizziness, or fainting.

If you have any of these symptoms, call your doctor, even if you do not think you are pregnant.

Diagnosis
An ectopic pregnancy can be difficult to diagnose in its early stages. To determine if you have an ectopic pregnancy, your doctor may:

• Perform a pelvic exam

• Check your blood pressure and pulse

• Perform an ultrasound exam

• Test your blood for increased hormone levels.

Treatment
If your ectopic pregnancy is in its early stages and your fallopian tube has not ruptured, medication can be used to stop the growth of the pregnancy. The medication allows your body to absorb the pregnancy over time and, in most cases, no surgery is needed. It takes your body about four to six weeks to completely absorb the pregnancy.

Your doctor will discuss the best treatment for you based on your medical condition and your future plans for pregnancy.

If your doctor suspects that you have an ectopic pregnancy that has ruptured, emergency surgery will be needed. Depending on the stage of your ectopic pregnancy, surgery may be performed either through a small cut made in the fallopian tube during a laparoscopy or through a larger incision in your abdomen. In either case, some or all of your fallopian tube may need to be removed.

After An Ectopic Pregnancy
Once you have had an ectopic pregnancy, you have an increased risk for future ectopic pregnancies.

If medication was used to treat your ectopic pregnancy and there was little or no damage to your fallopian tube, there is a good chance for a normal pregnancy in the future. If your ectopic pregnancy was treated with surgery in which your fallopian tube was repaired, there is also a good chance for a future normal pregnancy. If your fallopian tube was removed during surgery, you will have to rely on your remaining fallopian tube for any future pregnancies.