MISCARRIAGE

A miscarriage, also known as a spontaneous abortion, is defined as the termination of a pregnancy before the 20th week of gestation. It can be brought on by a variety of factors, including autoimmune diseases, infections, uterine anomalies, maternal age, hormone imbalances, genetic abnormalities, and lifestyle decisions.

Miscarriages occur in around 10–20% of documented pregnancies, according to the American College of Obstetricians and Gynaecologists (ACOG). The Mayo Clinic states that most first-trimester miscarriages occur before a woman even knows she is pregnant.

Symptoms

• Vaginal spotting or bleeding: One common sign of a miscarriage is light bleeding or spotting, which can be pink, red, or brown in color. It can be light or quite intense.
• Abdominal pain or cramps: Women may have mild to severe abdominal pain or cramps that resemble menstruation cramps.
• Fluid or tissue passing from the vagina: Women who experience miscarriages may pass fluid or tissue from the vagina, which can include blood clots or identifiable fetal tissue.
• Reduction in pregnancy symptoms: Abrupt reduction or absence of pregnancy symptoms including breast tenderness, nausea, or exhaustion may also indicate a miscarriage.

It’s crucial to remember that having these symptoms does not always indicate a miscarriage has happened, but if any of them appear while you’re pregnant, you should speak with a healthcare professional.

Causes

• Chromosome abnormalities: When an embryo or fetus has chromosomal abnormalities that hinder normal development, this is the most common cause of miscarriages. Most often, these anomalies develop accidentally during fertilization.
• Hormonal imbalances: Inadequate progesterone levels, for example, can impair the uterine lining’s capacity to sustain a pregnancy, which can result in miscarriage.
• Abnormalities in the uterus: Abnormalities in the uterus that affect implantation or appropriate fetal development, like fibroids or a septum, can raise the chance of miscarriage.
• Maternal age: Due to the greater incidence of chromosomal abnormalities in eggs, advanced maternal age generally defined as 35 years and older is linked to an increased risk of miscarriage.
• Infections: Several infections, including listeria, cytomegalovirus (CMV), and sexually transmitted diseases like gonorrhea or chlamydia, might raise the chance of miscarriage.
• Autoimmune disorders: When the body produces antibodies that target fetal tissue, as in the case of lupus or antiphospholipid syndrome, miscarriage occurs.
• Lifestyle factors: A miscarriage is more likely to occur if a person smokes, drinks too much alcohol, does drugs, is obese, or is exposed to chemicals in the environment.
• Maternal health conditions: If untreated during pregnancy, long-term medical concerns like diabetes, thyroid issues, or uncontrolled hypertension might raise the chance of miscarriage.

After a miscarriage, it’s critical to look after your bodily and psychological needs. The following actions are your options:

• Get in touch with your physician: Make urgent contact with your healthcare practitioner if you fear you are miscarrying or if you notice any symptoms, including vaginal bleeding, abdominal pain, or tissue passing. They can offer support, direction, and medical attention.
• Rest: Give yourself enough time to relax and recover. To help your body heal, stay away from demanding activities and take it easy.
• Drink plenty of water: Stay hydrated throughout this period by consuming lots of liquids, particularly water.
• Track symptoms: Note all of your symptoms, such as the amount of bleeding and any discomfort you may be feeling. When speaking with your healthcare professional, this information may be useful.
• Seek emotional support: Miscarriage can be emotionally challenging. Seek support from loved ones, friends, or support groups who can provide understanding and comfort during this difficult time.
• Follow medical advice: Follow any instructions or recommendations provided by your healthcare provider. This may include follow-up appointments, monitoring your symptoms, or undergoing further testing if necessary.
• Take care of yourself: Engage in self-care activities that promote your well-being, such as getting enough sleep, eating nutritious foods, and engaging in activities that bring you comfort and relaxation.
• Seek emotional support: Losing a pregnancy can be very stressful. Seek out the sympathy and consolation of friends, family, or support groups during this trying time.
• Comply with medical advice: Pay attention to any instructions or advice that your healthcare practitioner gives you. This could entail scheduling follow-up appointments, keeping an eye on your symptoms, or, if needed, getting more tests done.
• Look after your own needs: Take care of yourself by eating healthily, getting enough sleep, and doing things that make you feel comfortable and relaxed. These are examples of self-care practices that support your overall well-being.

Treatment Options

A miscarriage’s treatment options are dependent on circumstances, including the patient’s medical history, preferences, and the stage of pregnancy at which the miscarriage occurred. The following list includes common miscarriage treatments:

• Expectant Management: This refers to allowing the miscarriage proceed naturally without the need for medical assistance in certain situations, particularly in cases of early miscarriages when the body spontaneously expels all pregnancy tissue. To make sure the miscarriage is completed, this strategy could entail regular symptom monitoring and follow-up appointments.
• Medication Management: This entails using drugs to help induce the expulsion of pregnancy tissue, such as mifepristone or misoprostol. When there are missed or incomplete miscarriages, this method is frequently used.
• The surgical removal of pregnancy tissue from the uterus is known as surgical management, sometimes known as dilation and curettage (D&C) or dilation and evacuation (D&E). This method might be suggested in situations where expectant or medical management is impractical, incomplete miscarriages, or missing miscarriages.
• Psychological Support: Providing psychological support, such as counseling, support groups, and resources to help cope with grief, anxiety, and depression associated with pregnancy loss, is essential for individuals and couples experiencing miscarriage, regardless of the management approach that is selected.

References    

1. American College of Obstetricians and Gynaecologists (ACOG). (2020). FAQ: Early pregnancy loss. Retrieved from https://www.acog.org/patient-resources/faqs/pregnancy/early-pregnancy-loss.
2. Mayo Clinic. (2021). Miscarriage. Retrieved from https://www.mayoclinic.org/disease-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298.
3. Black, K., & Louden, D. (2008). Psycho-social aspects of miscarriage: A qualitative study. British Journal of Midwifery, 16(12), 749-754.
4. Dickinson, J. E., & Evans, S. F. (2002). Obstetric outcomes for women with recurrent miscarriage treated with or without invasive testing. Journal of Obstetrics and Gynaecology, 22(5), 498-503.
5. Ewies, A. A., & Alfhaily, F. (2013). Management of miscarriage: expectant, medical, or surgical? Best Practice & Research Clinical Obstetrics & Gynaecology, 27(6), 869-876.
6. Farren, J., Jalmbrant, M., Ameye, L., & Robson, S. (2019). Post-traumatic stress, anxiety, and depression following miscarriage or ectopic pregnancy: a prospective cohort study. BMJ Open, 9(12), e022392.
7. Lemmers, M., Verschoor, M. A., Oude Rengerink, K., & Naaktgeboren, C. A. (2019). Surgical versus expectant management in women with an incomplete evacuation of the uterus after treatment with misoprostol for miscarriage: the TABLET randomized trial. The Lancet, 394(10203), 391-398.
8. Neilson, J. P., Hickey, M., & Vazquez, J. (2006). Medical treatment for early fetal death (less than 24 weeks). The Cochrane Database of Systematic Reviews, (3), CD002253.
9. Trinder, J., Brocklehurst, P., Porter, R., Read, M., & Vyas, S. (2006). Management of miscarriage: expectant, medical, or surgical? Results of a randomised controlled trial (miscarriage treatment (MIST) trial). BMJ, 332(7552), 1235-1240.
10. Wang, X., Chen, C., Wang, L., Chen, D., Guang, W., French, J., Conner, R. D., & Xu, X. (2004). Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study. Fertility and Sterility, 79(3), 577-584.