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Miscarriage: Causes, Symptoms Risk Factors, Diagnosis, Treatment & Prevention

Miscarriage is the most common type of pregnancy loss, and it can be a heartbreaking experience for a woman. There are many reasons that can cause a miscarriage. Miscarriages occur so early in pregnancy that sometimes a woman isn't even aware that she is pregnant.

In this article, we will explain what causes a miscarriage, its symptoms, risk factors and what medical care or support may be needed.

What Is A Miscarriage? [1]

Miscarriage, medically termed spontaneous abortion, is the loss of pregnancy (the loss of a foetus before it is developed enough to survive) before 20 weeks of pregnancy.

Studies show that about 10 to 26 per cent of all recognised pregnancies end in miscarriage. A miscarriage is most likely to occur within the first three months of pregnancy, which is estimated to be around 80 per cent. After 12 weeks of pregnancy, the risk of miscarriage reduces.

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What Causes A Miscarriage?

Chromosomal abnormalities - During the first three months, the most common cause of miscarriage is chromosomal abnormalities. Chromosomes are the tiny structures inside the body cells that carry genes. A miscarriage can occur when there is some abnormality in the chromosomes of a foetus, which causes the foetus to not develop normally. Chromosomal abnormalities might lead to intrauterine foetal demise, blighted ovum, molar pregnancy and partial molar pregnancy. According to the American Pregnancy Association, most chromosomal abnormalities occur due to a damaged egg or sperm cell or when a zygote divides [2].

Problems with the placenta - A placenta is a temporary organ that develops inside the uterus during pregnancy. It develops during pregnancy and sheds after the pregnancy ends. If a placenta grows abnormally, the blood supply from the mother to the foetus is stopped [3].

Weakened cervix - When the cervix (lower part of the uterus) is weakened, it can cause early pregnancy loss.

Other causes of miscarriage include:

• Infection [4]

• Hormonal problems.

• Maternal age [5]

• Maternal trauma.

• Obesity [6]

• High blood pressure [7].

• Uterine abnormalities.

• Implantation of the egg into the uterine lining does not occur properly.

• Exposure to radiation or toxic substances.

• Smoking and drinking alcohol [8]

• Severe kidney disease.

• Congenital heart disease.

• Disorders of the immune system.

• Uncontrolled diabetes.

• Thyroid disease.

• Malnutrition or poor diet [9]

• Certain medications.

Performing exercises or sexual intercourse doesn't cause a miscarriage. However, consult a doctor before trying out any exercises and ask which exercises are suitable for you.

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Types Of Miscarriage

Threatened miscarriage - If a pregnant woman has bleeding accompanied with cramping and a closed cervix, she may have had a threatened miscarriage [10].

Inevitable miscarriage - Bleeding and cramping with an open cervix during pregnancy.

Incomplete miscarriage - The body doesn't pass all the pregnancy tissues and there are some remainings present inside.

Complete miscarriage - When all the tissues have been passed out of the body.

Missed miscarriage - When the foetus has died, but the body doesn't expel the foetus or tissues during pregnancy [11].

Septic miscarriage - An infection in the uterus.

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Symptoms Of Miscarriage

• Light to heavy bleeding

• Cramps.

• Abdominal pain.

• Mild to severe back pain.

• Pelvic pain.

• Back pain.

• Weakness.

• Spotting.

• Fluid or tissue passing out from your vagina.

• Weight loss [12].

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Risk Factors Of Miscarriage

• Age (pregnancy after the age 40) [13]

• Two or more consecutive miscarriages before.

• Uncontrolled diabetes.

• Underweight or overweight in pregnant women.

• Trauma to the body.

• Having a lot of caffeine [14]

• Smoking [15]

• Alcohol and drug abuse.

• Exposure to radiation.

• Invasive prenatal tests.

• Uterine or cervical problems.

Women who are pregnant with twins or multiples can increase the risk of miscarriage, preterm birth or preeclampsia.

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Diagnosis Of Miscarriage

The tests used to diagnose a miscarriage are: [16]

Ultrasound test - The test is done to check the heartbeat of the foetus.

Pelvic exam - To see if your cervix has started to dilate.

Blood tests - To check whether the beta-human chorionic gonadotropin (hCG) and progesterone levels are normal.

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Treatment Of Miscarriage

The treatment depends on the type of miscarriage you have had.

• If you have had a complete miscarriage, no further treatment is required.

• Waiting for the miscarriage to happen naturally without treatment which is known as expectant management. You will be monitored by the doctors in the hospital for a few weeks.

• In medical management, medications are given to help in expelling the remaining tissues out of the body.

• In surgical management, a surgical procedure called dilation and curettage (D&C) is performed, wherein the cervix is dilated and any remaining foetal tissue is removed [17].

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Prevention Of Miscarriage

• Eat a nutritious diet.

• Avoid smoking and drinking during pregnancy.

• Maintain a healthy weight.

• Do not stress.

• Avoid contracting any infections.

• Limit caffeine consumption.

• Have prenatal vitamins daily as prescribed by the doctor.

• Get prenatal care when you are pregnant.

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After Miscarriage

Physical recovery - Physical recovery from a miscarriage usually takes only a few hours to a couple of days. In four to six weeks, you should start having normal periods. You may also experience symptoms such as spotting and abdominal discomfort after miscarriage.

Support - If you have had a miscarriage, give some time for yourself to heal emotionally. You can ask for support from your friends and family when you need it. If you are feeling depressed or guilty seek counselling from a therapist.

Trying to conceive again - If you are trying to conceive again, it is recommended to give your body some time to heal both physically and emotionally. Ask your doctor how long do you have to wait to get pregnant again.

Common FAQs

Q. How do I know if I had a miscarriage?

A. If you experience bleeding, pain and mild discomfort in the stomach, it may be a sign of miscarriage. Seek medical attention immediately.

Q. Can I get pregnant after a miscarriage?

A. Yes, you can get pregnant after a miscarriage. Check with your doctor about the timing of your next pregnancy.

Q. Is miscarriage painful?

A. Not all miscarriages are painful, but most pregnant women experience heavy bleeding and cramping which can be painful.

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