Threatened Miscarriage

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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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• Threatened Miscarriage Overview
• Threatened Miscarriage Causes
• Threatened Miscarriage Symptoms
• When to Seek Medical Care
• Threatened Miscarriage Diagnosis
• Threatened Miscarriage Treatment
• Threatened Miscarriage Self-Care at Home
• Threatened Miscarriage Medications
• Threatened Miscarriage Surgery
• Threatened Miscarriage Follow-up
• Threatened Miscarriage Prevention
• Threatened Miscarriage Prognosis
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Any vaginal bleeding other than spotting during early pregnancy is considered a threatened miscarriage. (A miscarriage may also be referred to as a spontaneous abortion.) Vaginal bleeding is common in early pregnancy. About one of every four pregnant women has some bleeding during the first few months. About half of these women stop bleeding and have a normal pregnancy.

The bleeding and pain associated with threatened miscarriage are usually mild. In the best case, the cervical os (mouth of the womb) is closed. (A health care professional can determine if the cervical os is open by performing a pelvic exam.) Typically, no tissue has been passed from the womb. The womb and Fallopian tubes may be tender.

When a miscarriage is inevitable, the cervical os is open (dilated). Bleeding is often heavier, and abdominal pain and cramping often occur.

If a miscarriage is incomplete, the cervical os is open, and the pregnancy is being expelled. Ultrasound reveals some material that remains in the womb. Bleeding is heavy and abdominal pain is almost always present.

With a complete miscarriage, bleeding and abdominal pain have occurred but have usually stopped. Products of conception have been passed. The early fetus has been passed and was not alive. Ultrasound reveals an empty womb.

Although the actual cause of the miscarriage is frequently unclear, the most common reasons include the following:

• An abnormal fetus is almost always the cause of miscarriages during the first 3 months of pregnancy (first trimester). Problems in the genes cause an abnormal fetus and are found in more than half of miscarried fetuses. The risk of defective genes increases with the woman's age.
• Miscarriage during the fourth through sixth months of pregnancy (second trimester) is usually related to an abnormality in the mother rather than in the fetus.
  • Chronic illnesses, including diabetes, severe high blood pressure, kidney disease, lupus, and underactive or overactive thyroid gland, are frequent causes of a miscarriage. Prenatal care is important because it screens for some of these diseases.
  • Inadequate ovarian hormone production is one of the most common causes of a miscarriage.
  • Acute infections, including German measles, CMV (cytomegalovirus), mycoplasma ("walking" pneumonia) and other unusual germs, and severe emotional shock, can also cause miscarriage.
  • Diseases and abnormalities of the internal female organs can also cause miscarriage. Some examples are an abnormal womb, fibroids, poor muscle tone in the mouth of the womb, abnormal growth of the placenta (also called the afterbirth), and being pregnant with multiples.
  • Other factors, especially certain drugs, including excessive caffeine, alcohol, tobacco, and cocaine, may be the cause.

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