The term miscarriage refers to a pregnancy that is lost before 24 weeks of gestation. Miscarriage occurs after approximately 50 percent of conceptions.
In many cases it is not recognized because it happens very early on, within a fortnight of conception, and is interpreted as a late period. Miscarriage is clinically diagnosed in only 15 percent or so of pregnancies.Types of miscarriage: There are several types of miscarriage, and these are classified according to the manner in which they occur.These are:
Threatened Miscarriage: In this situation, bleeding occurs at some point during the first few months of pregnancy but there is minimal pain, the cervix remains closed and an ultrasound scan confirms viable pregnancy.In more than 90 percent of cases the pregnancy will continue normally and a repeat scan to check the fetal heart will provide reassurance for the mother.
Inevitable Miscarriage: This involves a considerable amount of bleeding and the cervix will be open. There are two types: Complete miscarriage in which the products of conception are completely expelled, incomplete miscarriage, in which some of the products of conception are retained.In rare cases, they will become infected and the infection may spread, causing peritonitis and septicemia, and lastly, delayed miscarriage is commonly diagnosed when an early pregnancy scan identifies a fetus but no fetal heart is seen on the monitor. In this case there are often very few symptoms to indicate that the baby has died.
Causes for Miscarriage: Over 50 percent of miscarriages in early pregnancy are a result of the baby having abnormal chromosomes. Less common are maternal factors, such as: Infection, for example, listeriosis, cytomegalovirus or rubella; an underlying medical disorder, for example, thyroid disease or systemic lupus erythematosus; smoking; alcohol; and late age of the mother.In rare cases, miscarriage is caused by a congenital abnormality of the uterus or cervix. A miscarriage in mid-pregnancy may be due to the cervix dilating unusually early, possibly caused by previous cervical surgery, for example, a large cone biopsy after abnormal smear tests.
Treatment: In some cases, miscarriage can be allowed to progress on its own with no further intervention. If treatment is required or requested, this can be either by the use of drugs to encourage the uterus to expel the products of conception or by an operation (called an evacuation of retained products of conception, or ERPOC).
Recurrent Miscarriage: This term is used when three or more consecutive miscarriages occur. This happens in 1 percent of women and will need further investigation to try to identify the underlying causes.The possible causes can be: genetic abnormality in either parent; abnormality of the uterus; chronic illness, for example, thyroid disease or diabetes; polycystic ovary syndrome; raised levels of testosterone or luteinizing hormone (LH); cervical incompetence; antiphospholid syndrome, is a very rare disorder in which antibodies from the mother are directed at the placenta, causing blood clotting and other damage.
Up to 80 percent of women who have recurrent miscarriage will go on to have a successful pregnancy with just supportive treatment, such as an early scan followed by serial scans for reassurance. Often no specific therapy is necessary. In the rare case of antiphospholid syndrome, evidence shows that taking aspirin and heparin early in pregnancy can improve the outcome of pregnancy.