Miscarriage (cont.)

Medical Author:

Vicken P Sepilian, MD

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical history: You will be asked questions about your pregnancy, such as the following:

• How far along is your pregnancy?
• When was your last normal period?
• How many times have you been pregnant?
• How many living children do you have?
• How many miscarriages have you had?
• Have you ever had an ectopic (tubal) pregnancy?
• How many abortions have you had?
• Were you using any sort of birth control when you got pregnant this time?
• Is this a planned pregnancy?
• Do you plan to keep this pregnancy?
• Have you had any prenatal care?
• Have you had any problems urinating?
• Have you had an ultrasound yet to show that the pregnancy is in the right place?
• Do you know your blood type?
• What medical problems do you have?
• What medications do you take every day?
• What herbs or other products do you take every day?

Physical exam: For the pelvic exam, the patient will lie on her back with the knees bent and the feet in stirrups.

• The patient may have a speculum exam. A metal or plastic device is put in your vagina and then opened, spreading the walls of the vagina apart so the health care professional can look right at the mouth of your womb. If a lot of blood or clots are present, the health care professional may use a clamp or gauze to remove them. The patient should not feel any pain during this part of the exam, although she may be embarrassed and uncomfortable.
• The patient may bleed from the vagina before, during, and even after a miscarriage. The health care professional will assess the opening of the entrance to the womb (called the os) and, depending on the findings, will be able to tell the patient more accurately which of the stages of miscarriage you might be experiencing.
• The health care professional may put gloved fingers in the vagina and feel the abdomen with the other hand. He or she can feel whether the mouth of the uterus is open, how big the uterus may be, and whether any signs of infection or tubal pregnancy exist. The size of the uterus may be smaller than expected for the fetus if the patient has already miscarried.

Lab tests: Pregnancy tests can be either urine tests or blood tests. A health care professional or emergency department doctor, if you go to the hospital with alarming symptoms, will act quickly to determine if you are pregnant.

• A urine pregnancy test along with blood samples will be sent to the laboratory to check for blood loss or anemia, blood type, and the level of the pregnancy hormone. This hormone is called human chorionic gonadotropin or hCG.
  • A number too low may suggest that the pregnancy is abnormal. No single number is "normal." A very low number (under 1,000) suggests an abnormal pregnancy, although it could just reflect an early stage of pregnancy.
  • A very high number (over 100,000) strongly suggests a normal living pregnancy. Most other hCG numbers by themselves do not help a lot but can be compared to another test done in two to three days to see if everything is developing normally.
• A complete blood count (CBC) may be ordered. If the patient has been bleeding a lot, she may be anemic (loss of too much blood) and need special care. If the patient has a fever, the white cell count may suggest she has an infection.
• If the patient does not know your blood type, this will also be checked.
• If the patient has symptoms of a urinary infection, a urine sample will be taken and examined.

Ultrasound: If a woman is pregnant, an ultrasound may be performed to look for evidence of a pregnancy within the uterus. If the radiologist, gynecologist, or emergency department doctor cannot find evidence of a pregnancy within the uterus, the patient will likely be evaluated further for a pregnancy that is outside the uterus. When the fertilized egg implants in the Fallopian tube, this is called a tubal or ectopic pregnancy.

• Your bladder has to be full for this test, so the patient will have to drink a lot of water, or the technician will give the woman fluid in the vein and ask she not to go to the bathroom until after the test is completed.
• The technician will put some cold jelly on the abdomen and press down with a probe to see the internal organs. The ultrasound technician may also use a vaginal probe inside the vagina to get a better look at the Fallopian tubes and ovaries. Neither of these studies should be painful.

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