What is a miscarriage?

Miscarriage is the loss of a pregnancy in the first 20 weeks. About 15 – 20% of pregnancy will end up in a miscarriage and majority of this occurs in the first trimester (in the first 12 weeks of pregnancy) The risk of having another miscarriage after 1 miscarriage is about 25%. The risk increases if you have 2 or more miscarriages.

What are the causes of a miscarriage?

There are several causes of miscarriage and the cause differ slightly between early (first trimester) and late (second trimester) miscarriages:
  • Chromosomal abnormalities in the baby. This is the most common cause in first trimester miscarriage.
  • Poor implantation in the uterus
  • chronic medical illness in the mother
  • Vaginal infections
  • Abnormalities of the uterus or weakness of the cervix (cervical incompetence)
  • Trauma to the mother

Who is at higher risk of having a miscarriage?

  • Age. Older women tend to have babies with chromosomal abnormalities leading to increasing risk of miscarriage
  • A history of previous miscarriages. A woman who have a history of 2 or more miscarriages or more are at increased risk of miscarriage.
  • Chronic medical disorders e.g poorly controlled diabetes, polycystic ovarian syndrome, autoimmune disorders e.g antiphospholipid syndrome
  • A history of birth defect or family history of congenital abnormalities
  • Uterine or cervical abnormalities
  • Smoking and alcohol consumption

What are the symptoms of a miscarriage?

  • Having vaginal bleeding especially if it is associated with lower abdominal pain.
  • Reducing symptoms of early pregnancy
  • Passing out of blood clots or tissue like material from the vagina
If you have any of the above symptoms, you should see you doctor as soon as possible.

What are the different types of miscarriages?

  • Threatened miscarriage: usually there is some minimal vaginal spotting / bleeding but the neck of the womb (cervix) is closed. If the fetal heart is seen, there is a good chance that the pregnancy will progress normally. Several studies have shown that treatment with a medication called dydrogesterone could possibly improve the outcome in patients with threatened miscarriage.1
  • Inevitable or incomplete miscarriage: there is lower abdominal pain associated with passing out of tissue like material vaginally. The neck of the womb (cervix) is dilated and opened. However, the product of conception is not totally expelled out from the uterus.
  • Complete miscarriage: there is lower abdominal pain associated with passing out of tissue like material vaginally. However, the product of conception (POC) is completely expelled out from the uterus. After the POC is completely expelled, the vaginal bleeding and abdominal pain usually settles down.
  • Missed miscarriage: the pregnancy did not developed. Your doctor will see a sac and the baby but no fetal heart is seen. Usually you will have no symptoms at all or minimal vaginal spotting with reducing of early pregnancy symptoms
  • Blighted ovum: Another type of miscarriage where when an ultrasound is done there is a sac seen in the womb but no evidence of fetal growth seen.
  • Septic miscarriage: infection associated with miscarriage.
  • Recurrent miscarriage: 3 or more consecutive miscarriages. You will need to seek an Obstetrician help to find out the cause. This occurs in about 1% of couples trying to conceive. There is evidence from clinical trials that treatment with dydrogesterone could reduce the risk of recurrent miscarriages. 2

How do you make a diagnosis of a miscarriage?

The diagnosis is usually made by history, clinical examination and ultrasound.

What is the treatment for a miscarriage?

This will depend on several factors such as how far along you are in pregnancy, presence of bleeding or infection and any underlying medical condition in the mother.
  • Expectant management: Wait for spontaneous miscarriage to occur naturally i.e on its own.
  • D&C: a planned D&C procedure once the diagnosis is confirmed
  • Medical termination: You will given some medication either to be taken orally or inserted vaginally to start or complete the miscarriage process.
You need to discuss with your doctor regarding what option will be best for you.
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1. Omar MH, Mashita MK, Lim PS, Jamil MA. Dydrogesterone in threatened abortion: pregnancy outcome. J Steroid Biochem Mol Biol 2005 Dec ; 97(5):421-5.
2. El Zibdeh MY. Dydrogesterone in the reduction of recurrent spontaneous abortion. J Steroid Biochem Mol Biol 2005; Dec 97(5): 426-30

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