What is Miscarriage?

Miscarriage is defined as the spontaneous loss of the foetus before it is able to survive on its own outside the womb. Miscarriage usually occurs within the first trimester of the pregnancy. It is a very common complication in early pregnancies.

Miscarriage can be a common complication, but it can have devastating effects on the minds of the parents.

Signs and Symptoms of Miscarriage:

The most common visible signs are slight to heavy bleeding from the vagina. But the other common symptoms are:

Dizziness, light-headedness

Discharge from the vagina

Tissue discharge from the vagina

Cramping and pain in the abdomen

It is advised to go visit your doctor if you experience any of the above signs and symptoms.

What causes a miscarriage?

Chromosomal Abnormalities: A lot of miscarriages are caused due to mismatched chromosomes. Some women who have experienced miscarriage over two times may learn through tests that there are chromosomal abnormalities that may not affect them but prevent them from getting pregnant.

Abnormalities in the Uterus: Sometimes, the uterus may be too hostile to house a foetus. It can be a genetic disorder or a non-genetic disorder like fibroids or cysts that can lead to a spontaneous abortion.

Hormones: Low levels of progesterone in the body can lead to problems with implantation of the foetus.

Obesity: Studies have shown that every 1 in 4 women who are obese before the conception lose the foetus to spontaneous abortion.

Drugs and Toxins: Consuming alcohol or smoking during the pregnancy is seen to increase the risk of miscarriages manifold. Also, women who are exposed to toxins present in plastic such as Bisphenol A are seen to undergo miscarriage more often than women who are not exposed to such toxic substances. Coffee can be consumed in moderate levels during pregnancy.

Infections: Infections including Mycoplasma can infect the uterine lining and unknowingly cause complications such as miscarriage. Women who have undergone multiple gynaecologic procedures are seen to be at increased risks.

Diabetes: When the diabetes becomes uncontrolled, it can increase the risks of miscarriage.

7 Most Common Causes Of Miscarriage

For a mother, a miscarriage is the last thing she would want to hear. It can pin her down psychologically, leading to trauma and stress in unfathomable measures. To understand miscarriage better: it is a condition wherein there is a loss of pregnancy within the first 22 weeks of getting pregnant. The primary symptom of a miscarriage is bleeding from the vagina. So if you experience vaginal bleeding during this phase, then consult a doctor for further guidance.

Why do they occur?
There are many reasons as to why a miscarriage may occur and no study has been able to put a finger on any one specific cause. Having said that, miscarriages are mainly caused due to the presence of unusual chromosomes in the baby. Chromosomes are genetic material that directs the growth and development of a baby. Chromosomes present in either excess numbers or less can hinder the development of the baby. If the miscarriage occurs during the second trimester (14th to 26th week), then it can be accrued to a health anomaly in the mother. A miscarriage may also occur because of a weak cervix as a weak cervix will not be able to hold a pregnancy. This condition is called cervical insufficiency and occurs when the woman is in her second trimester.

Is it possible to prevent them?
In most cases, miscarriages cannot be prevented. For women who have suffered multiple miscarriages, multiple medications might be required to help with their subsequent pregnancies. Following a healthy lifestyle is recommended as it can minimize the risk of a miscarriage. One must abstain from smoking and substance abuse and limit consumption of alcohol in order to keep the body in optimal condition. It is advised to maintain optimal weight levels and eat a well-balanced diet.

Post miscarriage
A miscarriage is a very traumatic experience for a mother to be; it can be emotionally debilitating. That is the reason counseling can help in times such as these. Start planning for a baby only once the symptoms have subsided and you have also had a period post the miscarriage. It is important to make sure that you are physically and emotionally ready to have a baby. Remember, a miscarriage doesn t mean the end of the world. One can enjoy a fully healthy and a successful pregnancy even after a miscarriage.

Miscarriage - Why it Happens?

Miscarriage refers to the spontaneous loss of the fetus before one completes the 20th week of pregnancy, taking into account the period from the conception to gestation.  It usually happens in the first trimester of the pregnancy; that is within the seventh and the twelfth week of conception. Recurrent miscarriage is when one suffers from multiple miscarriages in a row.

Possible Causes:

Abnormally-shaped Uterus: Some miscarriages, particularly late ones, are thought to happen because the uterus (womb) has an abnormal shape.
Polycystic Ovary Syndrome (PCOS): Women with this condition have many small cysts in their ovaries.They also tend to have hormonal problems, including high levels of insulin and male hormone in the blood, which can lead to recurrent miscarriage.
Infection: Some serious infections can cause or increase the risk of single miscarriages. These include toxoplasmosis, rubella, listeria and genital infection. But it is not clear whether infection plays a role in recurrent miscarriage.
Diabetes and Thyroid Problems: Uncontrolled diabetes and untreated thyroid problems can cause miscarriage. But well-controlled diabetes and treated thyroid problems do not cause recurrent miscarriage.
Risk Factors:
Your risk of recurrent miscarriage is higher if:

you and your partner are older; the risk is highest if you are over 35 and your partner over 40; 
you are very overweight. Being very underweight may also increase your risk.
Each new pregnancy loss increases the risk of a further miscarriage. But even after three miscarriages, most couples will have a live baby next time.

Testing After Recurrent Miscarriage:

If you have had three miscarriages in a row, you should be offered tests to try to find the cause. This should happen whether or not you already have one or more children. Testing is not usually offered after one or two early miscarriages (up to 14 weeks) because these are often due to chance. But you might be offered tests after two early miscarriages if you are in your late 30s or 40s or if it has taken you a long time to conceive.
If you had a late (second trimester) miscarriage, where your baby died after 14 weeks of pregnancy, you should be offered tests after this loss.

You can opt for blood tests to check for sticky blood syndrome or APS. Tests would look for antibodies that would help treat the condition. Antibodies are chemicals produced by the body to combat infections.
Get an examination done should the doctor suspect chromosomal abnormalities and in case it is diagnosed, both of you can consult a clinical genetics specialist for genetics counseling.
Your doctor will recommend an ultrasound scan to trace any type of abnormality that may make a pregnancy futile, for instance, a short or a fragile cervix.
Your hopes:

It is natural to pin your hopes on testing as the answer to your problems. But there are three reasons why it may not be the answer you re looking for:

A cause may not be found; when this happens your miscarriages are called  unexplained 
Even if a cause is found, it may not be treatable;
Treatment may not lead to a successful pregnancy. This can happen if a pregnancy miscarries for a different reason than the one being treated.

Understanding Miscarriages

Miscarriage is the early loss of foetus within 20 weeks of pregnancy. It is also known as  spontaneous abortion . According to research, about 8-20% of the pregnancies end in miscarriage. Out of the total number of miscarriages, 80% of them end within 12 weeks of pregnancy.

Types of Miscarriages and their Symptoms 

Threatened Miscarriage   As the term suggests, in this condition the process of miscarriage might have begun. This is the initial stage of the process. In threatened miscarriage, there is slight bleeding accompanied by cramps and pain in the lower back, which is usually mild. The cervix (the lower part of the uterus) remains closed. 
Inevitable and Incomplete Miscarriage   In these conditions, there is bleeding along with an open cervix. When there is dilatation and thinning of the cervix, miscarriage is inevitable. In incomplete miscarriage, part of the tissue comes out and a part remains inside the uterus. In inevitable and incomplete abortions, the bleeding and cramps are more severe. 
Complete Miscarriage   Complete miscarriage is when the embryo has completely emptied from the uterus. The pain and bleeding reduce once the foetus is expelled. This can be confirmed through ultrasound. 
Missed Miscarriage   In Missed miscarriage, there is no sign of the life of the embryo and there is no expulsion of the embryo. It can be detected from the absence of heartbeat of the embryo found on ultrasound. 
Recurrent Miscarriage   It happens when there are two or three miscarriages one after the other. It affects about 1% of the pregnancies. 
Risk Factors 

Increased maternal age i.e., women above 35 years. 
Excess or insufficient chromosome in embryo. 
Placenta is the organ which links mother and the baby for blood supply. Problem in the development of placenta can cause miscarriage. 
Excessive smoking and drinking during pregnancy. 
Obese women have higher risk of miscarriage. 
Long-term health conditions like high blood sugar, high blood pressure, liver disease etc.
Infections like rubella, malaria etc. 
Weakened cervix, which is the result of previous injury or surgery, can also result in miscarriage. 
What are the symptoms of a miscarriage? 

Bleeding or spotting can be one of the symptoms of miscarriage. It should be kept in mind that not all pregnant women who suffer from spotting or bleeding, end in miscarriage. 
Lower backache starts before or right after bleeding, which can be persistent or you could have cramps which may be mild or sharp and can feel like more of pelvic pressure. 
Missed miscarriages are detected through ultrasound when the doctor finds that there is no heartbeat of the embryo or when the uterus is not growing. 
What are the treatment options in miscarriage? 

Medical   In most of the cases, there are no specific drugs to stop a miscarriage from occurring. In some cases, certain hormonal preparations help. There is no point in prescribing medicines for prevention of miscarriage if there is heavy bleeding. 
Surgery   Dilatation and evacuation (D&E) is a simple operation which is done under general/local anaesthesia. In this operation, the cervical canal is dilated and contents present in the uterus are evacuated. There is no cutting involved as it happens through the vagina. The process needs only five to ten minutes, but the patient has to stay in the hospital for about 3-4 hours. 
This process is opted when: 

There is heavy bleeding. 
The patient suffers from missed miscarriage. 
What can you do to prevent miscarriage? 

Nothing much can be done to prevent miscarriage in most of the cases. However, following supportive measures may help: 

There should not be overexertion during pregnancy. Moderate amount of physical activity is permissible. 
One should have a well-balanced diet. Studies have shown that a diet loaded with fruits and veggies helps in overall well-being during pregnancy. One should limit the consumption of caffeine. 
Avoid smoking, alcohol and certain drugs to prevent miscarriage. 
Avoid stress and anxiety. 
Report to Doctor (preferably Obstetrician) as soon as any symptom related to miscarriage appears.

Miscarriage - Symptoms, Treatment and Prevention

Miscarriages are quite common these days. Couples who experience miscarriage have to go through an emotional trauma. They feel frustrated because of doubts and many unanswered questions along with the emotional trauma they face. While some women feel that they are a failure after experiencing a miscarriage, some others feel extremely guilty about it. Therefore, it is very important for couples to know about miscarriage. 

Here are the six most frequently asked questions about miscarriage that you must know:

How common is it for a miscarriage to happen?

This is definitely one of the most asked questions about miscarriage. According to most doctors, miscarriage is quite common. Unfortunately, one in four pregnancies can end in miscarriage. Therefore, everyone knows someone who has suffered a miscarriage.

What can be the symptoms of miscarriage?
This is the 2nd most common question asked about miscarriage. The symptoms of miscarriage vary from person to person. For most women, the symptoms noticed are bleeding and pain. As the pregnancy advances, more pain and more bleeding are noticed. The pains are similar to extremely bad menstrual cramps. However, doctors also agree that if a woman experiences some bleeding, it doesn t always imply that a miscarriage can happen.

What are the causes of miscarriage?
A woman s age is linked to miscarriage. If a woman is over 35, the risk of miscarriage rises. This is because cells do not divide properly as women age. The DNA of a man can also play a role in miscarriage.

How do doctors treat miscarriage?
About 75 % of miscarriages occur after the embryo gets embedded into the uterus. No treatment is required for this kind of miscarriage. Most miscarriages happen during the first 12 weeks of pregnancy. These miscarriages can be resolved through medication or surgery. The miscarriages that occur after the 12 weeks can be extremely traumatic for women.

What is the biggest misconception of miscarriage?
The most common misconception of miscarriage is that it can happen due to activities like exercise and sex.

What can be done to prevent a miscarriage?
People often ask this question to their doctors. Although there is no particular way to prevent a miscarriage, people should maintain a healthy lifestyle during pregnancy. Obesity, smoking and drug use can enhance the risk of miscarriage, and hence they should be avoided. 

Aforementioned are the six most asked questions about miscarriage. You should always talk to your doctor, if you face any complications or problems during pregnancy. It is important to clear your doubts about miscarriage. You should also try your best to maintain a healthy lifestyle.

Miscarriage - 6 Common Questions That Are Asked?

What is recurrent miscarriage?

If you have three or more miscarriages in a row, doctors call it recurrent miscarriage. If you have experienced recurrent miscarriage, your GP or midwife will refer you to a gynaecologist. Your gynaecologist will try to identify the reason for your losses.

Having miscarriage after miscarriage may leave you feeling utterly drained of hope. At times, it may be hard to keep trusting in the future. This experience affects every aspect of a woman s life from her mental and emotional health to her physical health and social well-being. 

If you can, try to draw comfort from the fact that most women who experience recurrent losses do go on to have a baby. This is especially the case if tests can find no reason for the losses. Six out of 10 women who have had three miscarriages will go on to have a baby in their next pregnancy.

Treatment of Recurrent Pregnancy Loss

Treatment for anatomic abnormalities of the uterus involves surgical restoration through removal of local lesions such as fibroids, scar tissue and endometrial polyps or timely insertion of a cervical cerclage (a stitch placed around the neck of the weakened cervix) or the excision of a uterine septum when indicated.

A thin endometrial lining has been shown to correlate with compromised pregnancy outcome. Often times this will be associated with reduced resistance to blood flow to the endometrium. Such decreased blood flow to the uterus can be improved through treatment with sildenafil (Viagra), Terbutaline and possibly aspirin.

Sildenafil (Viagra) Therapy Viagra has been used successfully to increase uterine blood flow. However, to be effective it must be administered starting as soon as the period stops up until the day of ovulation and it must be administered vaginally (not orally). Viagra in the form of vaginal suppositories given in the dosage of 25 mg four times a day has been shown to increase uterine blood flow as well as thickness of the uterine lining. To date, we have seen significant improvement of the thickness of the uterine lining in about 70% of women treated. Successful pregnancy resulted in 42% of women who responded to the Viagra. It should be remembered that most of these women had previously experienced repeated IVF failures.

Terbutaline this is a medication that relaxes the muscle in the uterine wall and so permits improved hormone delivery to the endometrium. The use of Terbutaline will often cause an increase in heart rate. It should not be prescribed to women who have irregular heart beats (arrhythmias), and women who have decreased cardiac reserve.

Aspirin this is an antiprostaglandin that improves blood flow to the endometrium. It is administered at a dosage of 81mg orally, daily from the beginning of the cycle until ovulation.

Selective Immunotherapy Using Intralipid, heparin, aspirin and corticosteroid

Many causes of pregnancy loss or failure can be treated with immunotherapy comprising combinations of aspirin and heparin and corticosteroids (dexamethasone or prednisone) and Intralipid (IL) to regulate increased NKa. Achievement of optimal success with Intralipid/corticosteroid therapy requires that the treatment be initiated well before ovulation takes place (about 7-14 days prior to anticipated implantation). Given the fact that only 10-15% of natural cycles (with or without the use of insemination and/or fertility drugs) will result in a pregnancy, it follows that repeated administration of Intralipid will be required in most cases before a pregnancy will occur. IVF achieves pregnancy rates that are often 2-3 times higher. This often makes IVF a treatment of choice in cases of immunologic recurrent pregnancy loss.

Role of IVF

Preimplantation genetic diagnosis (PGD) a procedure whereby the embryo can be tested for genetic or structural chromosomal abnormalities requires the use of IVF to select the best embryo(s) for transfer to the uterus. In cases of structural chromosomal (translocations) egg or sperm donation is often another option worth considering.

In those cases where due to intractable anatomical or alloimmune dysfunction IVF repeatedly is unsuccessful or is not an option, Gestational Surrogacy might represent the only recourse other than adoption.
If a couple with Recurrent Pregnancy Loss is open to all of the diagnostic and treatment options referred to above, a live birth rate of 70%   80% is ultimately achievable.

Recurrent Miscarriage - How to Deal With It?

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