Doctor's Notes on Miscarriage
Miscarriage (also termed a spontaneous abortion) is the spontaneous 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 with a woman's age, especially if she becomes pregnant and is older than 35 years of age.
What Is the Treatment for a Miscarriage?
After being diagnosed as having a miscarriage, there are several treatments available. You and your doctor should discuss what treatment is best for you. The treatments are as follows:
- Allow expulsion of the non-viable embryonic tissue and associated tissues to occur naturally (may take 3-4 weeks).
- Medically induce expulsion (oral or vaginal medical method). The medication functions within about 24 hours to expel tissues from the uterus.
- With suction dilation and curettage (D&C), the doctor dilates your cervix and surgically removes tissue in the uterus.
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Dilation and Curettage (D&C)The dilation and curettage procedure (D&C). This is a safe procedure that a woman may need to have performed for a variety of reasons such as irregularbleeding, bleeding after menopause, uterine fibroids or polyps, or a treatment when the source is already known.
Ectopic PregnancyEctopic pregnancy is a condition in which a pregnancy develops inside of a Fallopian tube or outside of a woman's uterus. Causes and risk factors for ectopic pregnancy include previous Fallopian tube infections (pelvic inflammatory disease, Chlamydia, gonorrhea), previous surgery to the abdomen, use of fertility medications, prior tubal pregnancy, and use of an IUD. Symptoms of ectopic pregnancy include pelvic pain and vaginal bleeding. If you suspect you have an ectopic pregnancy, medical care should be sought urgently.
Pregnancy, BleedingBleeding during all phases of pregnancy may be dangerous, even though it can be caused by a large variety of factors. You should call your health care professional if you have any signs of vaginal bleeding during your pregnancy.
Threatened MiscarriageA threatened miscarriage is any vaginal bleeding other than spotting during early pregnancy. There may be causes for a threatened miscarriage such as an abnormal fetus, chronic illness of the mother, acute infections, and other factors (alcohol, tobacco, illegal drugs).
Vaginal Bleeding (Abnormal Vaginal Bleeding Between Periods)In women, abnormal vaginal bleeding when is when they are not on their period (menstruation). Symptoms of abnormal vaginal bleeding outside of your period include red blood on the underwear or pajamas, pelvic or abdominal pain, and excessive pain from menstruating, or if you are pregnant. Causes of abnormal vaginal bleeding include unbalanced hormones, during pregnancy, after trauma, uterine fibroids, menopause, and pelvic inflammatory disease (PID). Treatment for abnormal bleeding depends on the cause of the bleeding. Talk to your doctor or another healthcare professional if you have any abnormal vaginal bleeding.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.