Miscarriage

Overview

Miscarriage is the spontaneous loss of a pregnancy during the first 22 weeks of gestation. It is a relatively common problem in pregnancy, happening in approximately 15-20% of pregnancies. Most cases occur in the first trimester.

Signs and Symptoms

Abnormal vaginal spotting or bleeding usually bright red or brownish in colour, Abdominal or low back pain, Expulsion of "fleshy” mass from the vagina, Failure of pregnant uterus to grow

Common Causes

Chromosomal problems in the fetus, Endocrine disorders such as diabetes, hypothyroidism and polycystic ovarian syndrome, Immunological disorders, Infections, Anatomical abnormalities such as cervical incompetence, bicornuate uterus, uterine fibroid, Lifestyle factors such as smoking, alcohol consumption

Risk Factors

Advanced maternal age, Previous miscarriages, Smoking, Use of alcohol and illicit drugs, Being overweight or obese, Having chronic conditions such as uncontrolled diabetes, Invasive prenatal tests such as amniocentesis and chorionic villus sampling

Investigation Techniques

Medical history, Pelvic examination, Blood tests including full blood count, blood grouping in case of transfusion needed, serial serum human chorionic gonadotropin (hCG), antiphospholipid antibody levels and lupus anticoagulant, Transvaginal ultrasound, Chromosomal tests if you have had two or more previous miscarriages

Treatment and Prevention

Expectant management to let miscarriage progress naturally, Medical treatment to speed up the process such as misoprostol, mifepristone, oxytocin, ergometrine, Surgical treatment such as suction dilation and curettage (D&C) if there is signs of infection or heavy bleeding, Bed rest and observation by medical staff if threatened miscarriage