Miscarriage

Miscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the
embryo or fetus is incapable of surviving, generally defined in humans at prior to 20 weeks of
gestation. Miscarriage is the most common complication of early pregnancy.[1]

Very early miscarriages—those that occur before the sixth week LMP (since the woman's Last
Menstrual Period)—are medically termed early pregnancy loss[2] or chemical pregnancy.[3]
Miscarriages that occur after the sixth week LMP are medically termed clinical spontaneous
abortion.[2]

In medical contexts, the word "abortion" refers to any process by which a pregnancy ends with
the death and removal or expulsion of the fetus, regardless of whether it is spontaneous or
intentionally induced. Many women who have had miscarriages, however, object to the term
"abortion" in connection with their experience, as it is generally associated with induced
abortions. In recent years there has been discussion in the medical community about avoiding the
use of this term in favor of the less ambiguous term "miscarriage".[4]

Labour resulting in live birth before the 37th week of pregnancy is termed "premature birth", even
if the infant dies shortly afterward. The limit of viability at which 50% of fetus/infants survive
longterm is around 24 weeks, with moderate or major neurological disability dropping to 50% only
by 26 weeks.[5] Although long-term survival has never been reported for infants born from
pregnancy shorter than 21 weeks and 5 days,[6] infants born as early as the 16th week of
pregnancy may sometimes live for some minutes after birth.[7]

A fetus that dies while in the uterus after about the 20–24th week of pregnancy is termed a
"stillbirth"; the precise gestational age definition varies by country. Premature births or stillbirths
are not generally considered miscarriages, though usage of the terms and causes of these events
may overlap.
Miscarriage-Pregnancy timeline.png

Miscarriage of a fetus is also called intrauterine fetal death (IUFT).

[edit] Forms and types

The clinical presentation of a threatened abortion describes any bleeding seen during pregnancy
prior to viability, that has yet to be assessed further. At investigation it may be found that the fetus
remains viable and the pregnancy continues without further problems. It has been suggested that
bed rest improves the chances of the pregnancy continuing when a small subchorionic hematoma
has been found on ultrasound scans.[8]

Alternatively the following terms are used to describe pregnancies that do not continue:

* An empty sac is a condition where the gestational sac develops normally, while the
embryonic part of the pregnancy is either absent or stops growing very early. Other terms for this
condition are blighted ovum and anembryonic pregnancy.
* An inevitable abortion describes where the fetal heart beat is shown to have stopped and the
cervix has already dilated open, but the fetus has yet to be expelled. This usually will progress to
a complete abortion.
* A complete abortion is when all products of conception have been expelled. Products of
conception may include the trophoblast, chorionic villi, gestational sac, yolk sac, and fetal pole
(embryo); or later in pregnancy the fetus, umbilical cord, placenta, amniotic fluid, and amniotic
membrane.
* An incomplete abortion occurs when tissue has been passed, but some remains in utero.[9]
* A missed abortion is when the embryo or fetus has died, but a miscarriage has not yet
occurred. It is also referred to as delayed or missed miscarriage.
The following two terms consider wider complications or implications of a miscarriage:

* A septic abortion occurs when the tissue from a missed or incomplete abortion becomes
infected. The infection of the womb carries risk of spreading infection (septicaemia) and is a
grave risk to the life of the woman.
* Recurrent pregnancy loss (RPL) or recurrent miscarriage (medically termed habitual abortion)
is the occurrence of three consecutive miscarriages. If the proportion of pregnancies ending in
miscarriage is 15%,[10] then the probability of two consecutive miscarriages is 2.25% and the
probability of three consecutive miscarriages is 0.34%. The occurrence of recurrent pregnancy
loss is 1%.[10] A large majority (85%) of women who have had two miscarriages will conceive
and carry normally afterwards.

The physical symptoms of a miscarriage vary according to the length of pregnancy:[11]

* At up to six weeks only small blood clots may be present, possibly accompanied by mild
cramping or period pain.
* At 6 to 13 weeks a clot will form around the embryo or fetus, and the placenta, with many
clots up to 5 cm in size being expelled prior to a completed miscarriage. The process may take a
few hours or be on and off for a few days. Symptoms vary widely and can include vomiting and
loose bowels, possibly due to physical discomfort.
* At over 13 weeks the fetus may be easily passed from the womb, however the placenta is
more likely to be fully or partially retained in the uterus, resulting in an incomplete abortion. The
physical signs of bleeding, cramping and pain can be similar to an early miscarriage, but
sometimes more severe and labour-like.

[edit] Causes

Miscarriages can occur for many reasons, not all of which can be identified. Some of these
causes include genetic, uterine or hormonal abnormalities, reproductive tract infections, and
tissue rejection.
[edit] First trimester
A complete spontaneous abortion at eight weeks gestational age

Most clinically apparent miscarriages (two thirds to three-quarters in various studies) occur during
the first trimester.[12][13]

Chromosomal abnormalities are found in more than half of embryos miscarried in the first 13
weeks. A pregnancy with a genetic problem has a 95% probability of ending in miscarriage. Most
chromosomal problems happen by chance, have nothing to do with the parents, and are unlikely
to recur. Chromosomal problems due to a parent's genes is, however, a possibility. This is more
likely to have been the cause in the case of repeated miscarriages, or if one of the parents has a
child or other relatives with birth defects.[14] Genetic problems are more likely to occur with older
parents; this may account for the higher miscarriage rates observed in older women.[15]

Another cause of early miscarriage may be progesterone deficiency. Women diagnosed with low
progesterone levels in the second half of their menstrual cycle (luteal phase) may be prescribed
progesterone supplements, to be taken for the first trimester of pregnancy.[14] However, no study
has shown that general first-trimester progesterone supplements reduce the risk of miscarriage,
[16] and even the identification of problems with the luteal phase as contributing to miscarriage
has been questioned.[17]
[edit] Second trimester

Up to 15% of pregnancy losses in the second trimester may be due to uterine malformation,
growths in the uterus (fibroids), or cervical problems.[14] These conditions may also contribute to
premature birth.[12]
One study found that 19% of second trimester losses were caused by problems with the umbilical
cord. Problems with the placenta may also account for a significant number of later-term
miscarriages.[18]