Doctor's Notes on Miscarriage
Miscarriage (also termed a spontaneous abortion) is the spontaneously end of pregnancy before the fetus can survive. Signs and symptoms of a miscarriage are vaginal bleeding (from small amounts to severe bleeding with blood clots and products of conception being passed out of the vagina such as tissue and/or a nonviable fetus) and abdominal pain that may radiate to the lower back, genitals, buttocks, and cramping. Most miscarriages usually occur before 20 weeks of pregnancy. The late signs and symptoms include the reduction of and ending of signs of pregnancy such as nausea, breast swelling and abdominal enlargement.
Miscarriage is caused by separation of the fetus and the placenta from the uterine wall. Examples of underlying causes of the fetal/placental separation are as follows: abnormal fetus (usually during the first three months of pregnancy), chronic or acute illnesses of the mother such as high blood pressure, diabetes, acute infections like German measles, fibroids, abnormal placental growth and development and drug use like alcohol abuse and cocaine use.
The risk of miscarriage increases the woman’s age, especially if she becomes pregnant and is older than 35 years of age.
If a women is having a spontaneous miscarriage, she will probably have vaginal bleeding, abdominal pain, and cramping.
- Bleeding may be only slight spotting, or it can be quite severe. A health care professional will ask about how much the woman has bled-usually the number of pads you've soaked through. She will also be asked about blood clots or whether she saw any tissue.
- Pain and cramping occur in the lower abdomen. They may occur on only one side, both sides, or in the middle. The pain can also go into the lower back, buttocks, and genitals.
- The woman may no longer have signs of pregnancy such as nausea or breast swelling/tenderness if she has experienced a miscarriage.
Miscarriage is caused by the separation of the fetus and placenta from the uterine wall. Although the actual cause of the miscarriage is frequently unclear, the most common reasons include the following:
- An abnormal fetus causes almost all miscarriages during the first three months of pregnancy (first trimester). Problems in the genes are responsible for an abnormal fetus and are found in more than half of miscarried fetuses. The risk of defective genes increases with the woman's age, especially if she is older than 35 years.
- 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.
- Acute infections, including German measles, CMV (cytomegalovirus), mycoplasma ("walking" pneumonia) and other unusual germs 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 alcohol, tobacco, and cocaine, may be related to miscarriage.
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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.