Sunday, December 28, 2014

Miscarriage

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Miscarriage
Multiple Responses:
1.
A miscarriage is the loss of a fetus before the 20th week of pregnancy. The medical term for a miscarriage is spontaneous abortion, but the condition is not an abortion in the common definition of the term.

According to the March of Dimes, as many as 50% of all pregnancies end in miscarriage -- most often before a woman misses a menstrual period or even knows she is pregnant. About 15% of recognized pregnancies will end in a miscarriage.

More than 80% of miscarriages occur within the first three months of pregnancy. Miscarriages are less likely to occur after 20 weeks gestation; these are termed late miscarriages.

What Are the Symptoms of a Miscarriage?
Symptoms of a miscarriage include:
  • Bleeding which progresses from light to heavy
  • Severe cramps
  • Abdominal pain
  • Fever
  • Weakness
  • Back pain
If you experience the symptoms listed above, contact your obstetric health care provider right away. He or she will tell you to come in to the office or go to the emergency room.

What Causes Miscarriage?
The causes of miscarriage are not well understood. Most  miscarriages that occur in the first trimester are caused by chromosomal abnormalities in the baby. Chromosomes are tiny structures inside the cells of the body which carry many genes. Genes determine all of a person's physical attributes, such as sex, hair and eye color, and blood type. Most chromosomal problems occur by chance and are not related to the mother's or father's health.

Miscarriages are also caused by a variety of other factors, including:
  • Infection
  • Exposure to environmental and workplace hazards such as high levels of radiation or toxic agents
  • Hormonal problems
  • Uterine abnormalities
  • Incompetent cervix (the cervix begins to widen and open too early, in the middle of pregnancy, without signs of pain or labor)
  • Lifestyle factors such as smoking, drinking alcohol, or using illegal drugs
  • Disorders of the immune system, including lupus
  • Severe kidney disease
  • Congenital heart disease
  • Diabetes that is not controlled
  • Thyroid disease
  • Radiation
  • Certain medications, such as the acne drug Accutane
  • Severe malnutrition
In addition, women may be at increased risk for miscarriage as they get older. Studies show that the risk of miscarriage is 12% to 15% for women in their 20s and rises to about 25% for women at age 40. The increased incidence of chromosomal abnormalities contributes to the age-related risk of miscarriage.

There is no proof that stress or physical or sexual activity causes miscarriage.

How Is a Miscarriage Diagnosed and Treated?
Your healthcare provider will perform a pelvic exam and an ultrasound test to confirm a miscarriage. If the miscarriage is complete and the uterus is empty, then no further treatment is usually required. Occasionally, the uterus is not completely emptied, so a dilation and curettage (D&C) procedure is performed. During this procedure, the cervix is dilated and any remaining fetal or placental tissue is gently removed from the uterus. As an alternative to a D&C, certain medications can be given to cause your body to expel the contents in the uterus. This option may be more ideal in someone who wants to avoid surgery and whose condition is otherwise stable.

If a miscarriage was not confirmed, but you had symptoms of a miscarriage, bed rest may be prescribed for several days, and you may be admitted to the hospital overnight for observation. Blood work to determine the amount of a pregnancy hormone (hCG) is checked to monitor the progress of the miscarriage.

When the bleeding stops, usually you will be able to continue with your normal activities. If the cervix is dilated, you may be diagnosed with an incompetent cervix and a procedure to close the cervix (called cerclage) may be performed if the pregnancy is still viable. If your blood type is Rh negative, your doctor may give you a blood product called Rh immune globulin (Rhogam). This prevents you from developing antibodies that could harm your baby as well as any of your future pregnancies.

Blood tests, genetic tests, or medication may be necessary if a woman has more than two miscarriages in a row (called repeated miscarriage). Some diagnostic procedures used to evaluate the cause of repeated miscarriage include endometrial biopsy (a procedure involving the removal of a small amount of tissue from the lining of the uterus for study under a microscope), hysterosalpingogram (an X-ray of the uterus and fallopian tubes), hysteroscopy (a test in which the doctor views the inside of the uterus with a thin, telescope-like device inserted through the vagina and cervix), and laparoscopy (a surgical procedure in which the doctor views the pelvic organs with a lighted device).

How Do I Know if I Had a Miscarriage?
Bleeding and mild discomfort are common symptoms after a miscarriage. If you have heavy bleeding, fever, chills, or pain, contact your healthcare provider right away. These may be signs of an infection.

Can I Get Pregnant Following a Miscarriage?
Yes. At least 85% of women who have miscarriages have subsequent normal pregnancies and births. Having a miscarriage does not necessarily mean you have a fertility problem. On the other hand, about 1%-2% of women may have repeated miscarriages (three or more). Some researchers believe this is related to an autoimmune response.

If you've had two miscarriages in a row, you should stop trying to conceive, use a form of birth control, and ask your healthcare provider to perform diagnostic tests to determine the cause of the miscarriages.

How Long Will I Have to Wait Before I Can Try Again?
Discuss the timing of your next pregnancy with your healthcare provider. Some healthcare providers recommend waiting a certain amount of time (from one menstrual cycle to 3 months) before trying to conceive again. To prevent another miscarriage, your healthcare provider may recommend treatment with progesterone, a hormone needed for implantation in the uterus.
Taking time to heal both physically and emotionally after a miscarriage is important. Above all, don't blame yourself for the miscarriage. Counseling is available to help you cope with your loss. Pregnancy loss support groups may also be a valuable resource to you and your partner. Ask your healthcare provider for more information about these resources.

Can a Miscarriage Be Prevented?
Usually a miscarriage cannot be prevented and often occurs because the pregnancy is not normal. If a specific problem is identified with testing, then treatment options may be available.
Sometimes, treatment of a mother's illness can improve the chances for a successful pregnancy.

2.
Miscarriage, is a term used for a pregnancy that ends on its own, within the first 20 weeks of gestation. The medical terms used to identify this potential complication or loss gives most women an uncomfortable feeling, so throughout this article we will refer to this type of threatened complication or pregnancy loss under 20 weeks as a miscarriage.

Miscarriage is the most common type of pregnancy loss, according to the American College of Obstetricians and Gynecologists (ACOG). Studies reveal that anywhere from 10-25% of all clinically recognized pregnancies will end in miscarriage. Chemical pregnancies may account for 50-75% of all miscarriages. This occurs when a pregnancy is lost shortly after implantation, resulting in bleeding that occurs around the time of her expected period. The woman may not realize that she conceived when she experiences a chemical pregnancy.

Most miscarriages occur during the first 13 weeks of pregnancy. Pregnancy can be such an exciting time, but with the great number of recognized miscarriages that occur, it is beneficial to be informed about miscarriage, in the unfortunate event that you find yourself or someone you know faced with one.

There can be many confusing terms and moments that accompany a miscarriage. There are different types of miscarriage, different treatments for each, and different statistics for what your chances are of having one. The following information gives a broad overview of miscarriage. This information is provided to help equip you with knowledge so that you might not feel so alone or lost if you face a possible miscarriage situation. As with most pregnancy complications, remember that the best person you can usually talk to and ask questions of is your health care provider.

Why Do Miscarriages Occur?
The reason for miscarriage is varied, and most often the cause cannot be identified. During the first trimester, the most common cause of miscarriage is chromosomal abnormality – meaning that something is not correct with the baby’s chromosomes. Most chromosomal abnormalities are the cause of a damaged egg or sperm cell, or are due to a problem at the time that the zygote went through the division process.
Other causes for miscarriage include (but are not limited to):
  • Hormonal problems, infections or maternal health problems
  • Lifestyle (i.e. smoking, drug use, malnutrition, excessive caffeine and exposure to radiation or toxic substances)
  • Implantation of the egg into the uterine lining does not occur properly
  • Maternal age
  • Maternal trauma
Factors that are not proven to cause miscarriage are sex, working outside the home (unless in a harmful environment) or moderate exercise.

What Are The Chances Of Having A Miscarriage?
For women in their childbearing years, the chances of having a miscarriage can range from 10-25%, and in most healthy women the average is about a 15-20%chance.
  • An increase in maternal age affects the chances of miscarriage
  • Women under the age of 35 yrs old have about a 15% chance of miscarriage
  • Women who are 35-45 yrs old have a 20-35% chance of miscarriage
  • Women over the age of 45 can have up to a 50% chance of miscarriage
  • A woman who has had a previous miscarriage has a 25% chance of having another (only a slightly elevated risk than for someone who has not had a previous miscarriage)

What Are The Warning Signs Of Miscarriage:
If you experience any or all of these symptoms, it is important to contact your healthcare provider or a medical facility to evaluate if you could be having a miscarriage:
  • Mild to severe back pain (often worse than normal menstrual cramps)
  • Weight loss
  • White-pink mucus
  • True contractions (very painful happening every 5-20 minutes)
  • Brown or bright red bleeding with or without cramps (20-30% of all pregnancies can experience some bleeding in early pregnancy, with about 50% of those resulting in normal pregnancies)
  • Tissue with clot like material passing from the vagina
  • Sudden decrease in signs of pregnancy

The Different Types Of Miscarriage:
Miscarriage is often a process and not a single event. There are many different stages or types of miscarriage. There is also a lot of information to learn about healthy fetal development so that you might get a better idea of what is going on with your pregnancy. Understanding early fetal development and first trimester development can help you to know what things your healthcare provider is looking for when there is a possible miscarriage occurring.

Most of the time all types of miscarriage are just called miscarriage, but you may hear your health care provider refer to other terms or names of miscarriage such as:
Threatened Miscarriage: Some degree of early pregnancy uterine bleeding accompanied by cramping or lower backache. The cervix remains closed. This bleeding is often the result of implantation.

Inevitable or Incomplete Miscarriage: Abdominal or back pain accompanied by bleeding with an open cervix. Miscarriage is inevitable when there is a dilation or effacement of the cervix and/or there is rupture of the membranes. Bleeding and cramps may persist if the miscarriage is not complete.

Complete Miscarriage: A completed miscarriage is when the embryo or products of conception have emptied out of the uterus. Bleeding should subside quickly, as should any pain or cramping. A completed miscarriage can be confirmed by an ultrasound or by having a surgical curettage (D&C) performed.

Missed Miscarriage: Women can experience a miscarriage without knowing it. A missed miscarriage is when embryonic death has occurred but there is not any expulsion of the embryo. It is not known why this occurs. Signs of this would be a loss of pregnancy symptoms and the absence of fetal heart tones found on an ultrasound.

Recurrent Miscarriage (RM): Defined as 3 or more consecutive first trimester miscarriages. This can affect 1% of couples trying to conceive.

Blighted Ovum: Also called an an embryonic pregnancy. A fertilized egg implants into the uterine wall, but fetal development never begins. Often there is a gestational sac with or without a yolk sac, but there is an absence of fetal growth.

Ectopic Pregnancy: A fertilized egg implants itself in places other than the uterus, most commonly the fallopian tube. Treatment is needed immediately to stop the development of the implanted egg. If not treated rapidly, this could end in serious maternal complications.

Molar Pregnancy: The result of a genetic error during the fertilization process that leads to growth of abnormal tissue within the uterus. Molar pregnancies rarely involve a developing embryo, but often entail the most common symptoms of pregnancy including a missed period, positive pregnancy test and severe nausea.

Treatment Of Miscarriage:
The main goal of treatment during or after a miscarriage is to prevent hemorrhaging and/or infection. The earlier you are in the pregnancy, the more likely that your body will expel all the fetal tissue by itself and will not require further medical procedures. If the body does not expel all the tissue, the most common procedure performed to stop bleeding and prevent infection is a dilation and curettage, known as a D&C. Drugs may be prescribed to help control bleeding after the D&C is performed. Bleeding should be monitored closely once you are at home; if you notice an increase in bleeding or the onset of chills or fever, it is best to call your physician immediately.

Prevention Of Miscarriage:
Since the cause of most miscarriages is due to chromosomal abnormalities, there is not much that can be done to prevent them. One vital step is to get as healthy as you can before conceiving to provide a healthy atmosphere for conception to occur.
  • Exercise regularly
  • Eat healthy
  • Manage stress
  • Keep weight within healthy limits
  • Take folic acid daily
  • Do not smoke

Once you find out that you are pregnant, again the goal is to be as healthy as possible, to provide a healthy environment for your baby to grow in:
  • Keep your abdomen safe
  • Do not smoke or be around smoke
  • Do not drink alcohol
  • Check with your doctor before taking any over-the-counter medications
  • Limit or eliminate caffeine
  • Avoid environmental hazards such as radiation, infectious disease and x-rays
  • Avoid contact sports or activities that have risk of injury

Emotional Treatment:

Unfortunately, miscarriage can affect anyone. Women are often left with unanswered questions regarding their physical recovery, their emotional recovery and trying to conceive again. It is very important that women try to keep the lines of communication open with family, friends and health care providers during this time.

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