Miscarriage

For usage in law, see Miscarriage of justice.

Miscarriage
Other namesspontaneous abortion, early pregnancy loss
An ultrasound showing a gestational sac containing a yolk sac but no embryo
SpecialtyObstetrics and Gynaecology, Neonatology, Pediatrics
SymptomsVaginal bleeding with or without pain[1]
ComplicationsInfection, bleeding,[2] sadness, anxiety, guilt[3]
Usual onsetBefore 20 weeks of pregnancy[4]
CausesChromosomal abnormalities,[1][5] uterine abnormalities[6]
Risk factorsBeing an older parent, previous miscarriage, exposure to tobacco smoke, obesity, diabetes, autoimmune diseases, drug or alcohol use[7][8][9]
Diagnostic methodPhysical examination, human chorionic gonadotropin, ultrasound[10]
Differential diagnosisEctopic pregnancy, implantation bleeding.[1]
PreventionPrenatal care[11]
TreatmentExpectant management, vacuum aspiration, emotional support[8][12]
Medicationmisoprostol
Frequency10–50% of pregnancies[1][7]

Miscarriage, also known in medical terms as a spontaneous abortion, is an end to pregnancy resulting in the loss and expulsion of an embryo or fetus from the womb before it can survive independently.[1][4] Miscarriage before 6 weeks of gestation is defined as biochemical loss by ESHRE.[13][14] Once ultrasound or histological evidence shows that a pregnancy has existed, the term used is clinical miscarriage, which can be "early" (before 12 weeks) or "late" (between 12 and 21 weeks).[13] Spontaneous fetal termination after 20 weeks of gestation is known as a stillbirth.[15] The term miscarriage is sometimes used to refer to all forms of pregnancy loss and pregnancy with abortive outcomes before 20 weeks of gestation.

The most common symptom of a miscarriage is vaginal bleeding, with or without pain.[1] Tissue and clot-like material may leave the uterus and pass through and out of the vagina.[16] Risk factors for miscarriage include being an older parent, previous miscarriage, exposure to tobacco smoke, obesity, diabetes, thyroid problems, and drug or alcohol use.[7][8] About 80% of miscarriages occur in the first 12 weeks of pregnancy (the first trimester).[1] The underlying cause in about half of cases involves chromosomal abnormalities.[5][1] Diagnosis of a miscarriage may involve checking to see if the cervix is open or sealed, testing blood levels of human chorionic gonadotropin (hCG), and an ultrasound.[10] Other conditions that can produce similar symptoms include an ectopic pregnancy and implantation bleeding.[1]

Prevention is occasionally possible with good prenatal care.[11] Avoiding drugs (including alcohol), infectious diseases, and radiation may decrease the risk of miscarriage.[11] No specific treatment is usually needed during the first 7 to 14 days.[8][12] Most miscarriages will be completed without additional interventions.[8] Occasionally the medication misoprostol or a procedure such as vacuum aspiration is used to remove the remaining tissue.[12][17] Women who have a blood type of rhesus negative (Rh negative) may require Rho(D) immune globulin.[8] Pain medication may be beneficial.[12] Emotionally, afterwards, sadness, anxiety or guilt may occur.[3][18] Emotional support may help with processing the loss.[12]

Miscarriage is the most common complication of early pregnancy.[19] Among women who know they are pregnant, the miscarriage rate is roughly 10% to 20%, while rates among all fertilisation is around 30% to 50%.[1][7] In those under the age of 35, the risk is about 10% while in those over the age of 40, the risk is about 45%.[1] Risk begins to increase around the age of 30.[7] About 5% of women have two miscarriages in a row.[20] Recurrent miscarriage (also referred to medically as Recurrent Spontaneous Abortion or RSA)[21] may also be considered a form of infertility.[22]

  1. ^ a b c d e f g h i j k Cite error: The named reference John20122 was invoked but never defined (see the help page).
  2. ^ "Spontaneous Abortion – Gynecology and Obstetrics". Merck Manuals Professional Edition. Archived from the original on December 4, 2020. Retrieved May 5, 2018.
  3. ^ a b Robinson GE (January 2014). "Pregnancy loss". Best Practice & Research. Clinical Obstetrics & Gynaecology. 28 (1): 169–178. doi:10.1016/j.bpobgyn.2013.08.012. PMID 24047642. S2CID 32998899.
  4. ^ a b "What is pregnancy loss/miscarriage?". www.nichd.nih.gov/. July 15, 2013. Archived from the original on April 2, 2015. Retrieved March 14, 2015.
  5. ^ a b Vaiman D (2015). "Genetic regulation of recurrent spontaneous abortion in humans". Biomedical Journal. 38 (1): 11–24. doi:10.4103/2319-4170.133777. PMID 25179715.
  6. ^ Chan YY, Jayaprakasan K, Tan A, Thornton JG, Coomarasamy A, Raine-Fenning NJ (October 2011). "Reproductive outcomes in women with congenital uterine anomalies: a systematic review". Ultrasound in Obstetrics & Gynecology. 38 (4): 371–382. doi:10.1002/uog.10056. PMID 21830244. S2CID 40113681.
  7. ^ a b c d e Cite error: The named reference NIH2013Epi2 was invoked but never defined (see the help page).
  8. ^ a b c d e f Cite error: The named reference Ol2014 was invoked but never defined (see the help page).
  9. ^ Cite error: The named reference CarpSelmi2012 was invoked but never defined (see the help page).
  10. ^ a b "How do health care providers diagnose pregnancy loss or miscarriage?". www.nichd.nih.gov/. July 15, 2013. Retrieved March 14, 2015.
  11. ^ a b c "Is there a cure for pregnancy loss/miscarriage?". www.nichd.nih.gov/. October 21, 2013. Archived from the original on April 2, 2015. Retrieved March 14, 2015.
  12. ^ a b c d e "What are the treatments for pregnancy loss/miscarriage?". www.nichd.nih.gov. July 15, 2013. Archived from the original on April 2, 2015. Retrieved March 14, 2015.
  13. ^ a b Larsen EC, Christiansen OB, Kolte AM, Macklon N (June 26, 2013). "New insights into mechanisms behind miscarriage". BMC Medicine. 11 (1): 154. doi:10.1186/1741-7015-11-154. ISSN 1741-7015. PMC 3699442. PMID 23803387.
  14. ^ Messerlian C, Williams PL, Mínguez-Alarcón L, Carignan CC, Ford JB, Butt CM, et al. (November 1, 2018). "Organophosphate flame-retardant metabolite concentrations and pregnancy loss among women conceiving with assisted reproductive technology". Fertility and Sterility. 110 (6): 1137–1144.e1. doi:10.1016/j.fertnstert.2018.06.045. ISSN 0015-0282. PMC 7261497. PMID 30396558.
  15. ^ "Stillbirth: Overview". NICHD. September 23, 2014. Archived from the original on October 5, 2016. Retrieved October 4, 2016.
  16. ^ "What are the symptoms of pregnancy loss/miscarriage?". www.nichd.nih.gov/. July 15, 2013. Archived from the original on April 2, 2015. Retrieved March 14, 2015.
  17. ^ Tunçalp O, Gülmezoglu AM, Souza JP (September 2010). "Surgical procedures for evacuating incomplete miscarriage". The Cochrane Database of Systematic Reviews. 2010 (9): CD001993. doi:10.1002/14651858.CD001993.pub2. PMC 7064046. PMID 20824830.
  18. ^ Radford EJ, Hughes M (June 2015). "Women's experiences of early miscarriage: implications for nursing care". Journal of Clinical Nursing. 24 (11–12): 1457–1465. doi:10.1111/jocn.12781. PMID 25662397.
  19. ^ National Coordinating Centre for Women's and Children's Health (UK) (December 2012). "Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage". NICE Clinical Guidelines, No. 154. Royal College of Obstetricians and Gynaecologists. PMID 23638497. Archived from the original on October 20, 2013. Retrieved July 4, 2013.
  20. ^ Garrido-Gimenez C, Alijotas-Reig J (March 2015). "Recurrent miscarriage: causes, evaluation and management". Postgraduate Medical Journal. 91 (1073): 151–62. doi:10.1136/postgradmedj-2014-132672. PMID 25681385. S2CID 207022511.
  21. ^ Yu J, Yu S, Zhu L, Sun X, Lu B, Li J, et al. (August 30, 2022). "Is there an association between recurrent spontaneous abortion and mycoplasma infection?". The Journal of Infection in Developing Countries. 16 (8): 1302–1307. doi:10.3855/jidc.15134. ISSN 1972-2680. PMID 36099373. S2CID 252219683.
  22. ^ "Glossary | womenshealth.gov". womenshealth.gov. January 10, 2017. Retrieved September 11, 2017.Public Domain This article incorporates text from this source, which is in the public domain.