What is a miscarriage?
What are the causes of a miscarriage?
- 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
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?
What is the treatment for a miscarriage?
- 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.