Spontaneous Abortion

Spontaneous Abortion

Definition

Spontaneous abortion refers to the loss of a fetus during pregnancy due to naturally occurring events, not elective or therapeutic abortion procedures, which a woman may choose to have done.

The term “miscarriage” is the spontaneous termination of a pregnancy before fetal development has reached 20 weeks.

 The medical term “abortion” refers to any terminated pregnancy, deliberately induced or spontaneous, although in common parlance it refers specifically to active termination of pregnancy.

Causes of Spontaneous Abortion First Trimester:

1. Chromosomal abnormalities

     • found in more than half of embryos miscarried in the first 13 weeks

     • happen by chance, have nothing to do with the parents, and are unlikely to recur

2. Progesterone deficiency

Second trimester:

1. Uterine malformation/abnormalities - uterine septum

     •up to 15% of pregnancy losses in the second trimester

2. Growths in the uterus (myomas)

3.  Cervical problems – cervical incompetence

4.  Problems with the umbilical cord and placenta

General risk factors

1.  Multiple pregnancies

2.  Serious systemic diseases of the mother such as diabetes, thyroid disease and severe hypertension

3.  Maternal infections – rubella (German measles) and Chlamydia

4.  Autoimmune disease–systemic lupus erythematosus (SLE)

 5.  Tobacco (cigarette) smoking – an increase in miscarriage is also associated with the husband being a smoker; a 4% increased risk for husbands who smoke less than 20 cigarettes/day, an 81% increased risk if 20 or more cigarettes/day.

6.  Cocaine use

7. Physical trauma

8.  Exposure to certain chemicals

9.  Obesity

10. High caffeine intake (>300 mg/day)

11. High levels of alcohol consumption

12. Use of NSAIDs (eg. Mefenamic acid, ibuprofen, etc)

13.  Women over age 35

14. Women with history of 3 or more prior miscarriages

Definition of terms:

 Threatened abortion: symptoms indicate a miscarriage is possible. Vaginal bleeding during early pregnancy without cervical dilation or change in cervical consistency. Ultrasound shows a continuing pregnancy.

Inevitable abortion: the symptoms cannot be stopped, and a miscarriage will happen. There is vaginal bleeding and dilatation of the cervix. Typically the bleeding is worse than with a threatened abortion and more cramps are present. No tissue has passed yet.

 Incomplete abortion: occurs when tissue has been passed, but some remains inside the uterus. It is associated with vaginal bleeding, dilatation of the cervical canal, and passage of products of conception. Ultrasound confirms that some products of conception are still present in the uterus.

Complete abortion: all of the products of conception are expelled. Typically, a history of vaginal bleeding, abdominal pain and passage of tissues exists. After the tissue passes, the pain subsides and the vaginal bleeding significantly diminishes. The ultrasound shows an empty uterus.

Missed abortion: when the embryo or fetus has died, but a miscarriage has not yet occurred. It is also referred to as delayed miscarriage. Symptoms exist except for absence of menses, the patient finds out that the pregnancy stopped earlier when a fetal heartbeat is not heard at the appropriate time. An ultrasound usually confirms the diagnosis.

Blighted ovum/anembryonic pregnancy /empty sac: a condition where the gestational sac develops normally while the embryonal part of the pregnancy is either absent of stops growing very early.

Septic abortion: occurs when the tissue from a missed or incomplete abortion becomes infected.

Recurrent miscarriage / recurrent pregnancy loss: medically termed habitual abortion, is the occurrence of 3 consecutive miscarriages.

Signs and symptoms

      • Low back pain or abdominal pain that is dull, sharp or cramping

     • Vaginal bleeding, with or without abdominal cramps

     • Tissue or clot-like material that passes from the vagina

However, about 20% of pregnant women have some vaginal bleeding during the first 3 months of pregnancy. Approximately half of these women have a miscarriage.

 Detection

The most common symptom of miscarriage is bleeding. Symptoms other than bleeding are not statistically related to miscarriage.

Miscarriage can be detected during an ultrasound exam, or through serial human chorionic gonadotropin (HCG) testing.

When to notify the health care provider?

Call your health care provider (an Ob-Gyn specialist or a midwife) in the following situations:

 1) If vaginal bleeding with or without cramping occurs anytime during pregnancy.

2) If you are pregnant and notice tissue or clot-like material passed vaginally (any such material should be collected and brought in for examination).

 Treatment options

If there is threat of miscarriage, you may be told to avoid or restrict some forms of exercise or you may need complete bed rest. Not having sexual intercourse is usually recommended until the warning signs have disappeared.

If remaining tissue does not naturally exit the body, the woman maybe closely monitored for up to 2 weeks. Surgery (dilatation and curettage) or medication may be needed to help the uterus eliminate the remaining contents.

After treatment, the woman usually resumes her normal menstrual cycle within a few weeks. Any further bleeding should be carefully watched. It is often possible to become pregnant immediately; however, it is recommended that women wait for one normal menstrual cycle before trying another pregnancy.

Psychological aspects   

Although a woman physically recovers from a miscarriage quickly, psychological recovery for patients in general can take a long time.

Aside from the feeling of loss, a sense of being understood by others is often important. People who have not experienced a miscarriage themselves may find it hard to empathize with what has occurred and how upsetting it may be. This may lead to unrealistic expectations of the parents’ recovery. The pregnancy and miscarriage are hardly mentioned anymore in conversation, often also because the subject is too painful. This can make the woman feel particularly isolated.

Interaction with pregnant women and newborn children is often also painful for parents who have experienced miscarriage. Sometimes this makes interaction with friends, acquaintances and family very difficult.

Interaction with pregnant women and newborn babies is often also painful for parents who have experienced miscarriage. Sometimes this makes interaction with friends, acquaintances and family very difficult.

Complications

Complications in the mother are rare. However, possible complications include infection or accumulation of clot without expulsion due to failure of the uterus to contract which may need to be surgically treated.

Occasionally, a meaty tissue is passed out and is mistaken for products of conception. In these cases, an ectopic pregnancy is defined as any gestation or pregnancy located outside of the uterus.

Patient education

      • The patient should be assured that one miscarriage does not put her at increased risk for another miscarriage. Her next pregnancy is likely to last to term if she is young and with no other risk factors.

      • The patient should return to the emergency department if any of the following symptoms occur:

             - Profuse vaginal bleeding

             - Severe pelvic pain

             - Temperature greater than 38°C

      • Patients may experience intermittent menstrual-like flow and cramps during the following week. The next menstrual period usually occurs in 4-5 weeks.

      • Patients may resume regular activities when able, but they should refrain from sexual intercourse and douching for approximately 2 weeks.

Related services offered in The Medical City

The Medical City has skilled medical professionals and an OR-DR complex fully equipped with facilities necessary in the management of any form of abortion.

Laboratory studies such as complete blood count, urinalysis, blood typing, DIC profile and HCG determination (both qualitative and quantitative) are available.

Imaging studies such as transvaginal ultrasound, color flow doppler velocimetry and 3D/4D imaging to rule out ectopic pregnancy are offered by the Women’s Health Care Center. 

Source :

Wikipedia and emedicine

Department of OB-GYN

The Medical City

Note:   This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.   If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.

For any questions, please contact any of our accredited physicians. Call the Center for Patient Partnership at (632) 988-1000 / (632) 988-7000 loc. 6444.