What is a miscarriage?

Causes and Symptoms

Approximately 15 to 20 percent of all known pregnancies will end in miscarriage. Furthermore, it is estimated that 50 to 75 percent of all fertilized eggs fail to implant in the uterus—a situation generally unknown to the woman. The likelihood of a miscarriage drops during the pregnancy’s duration: approximately 10 percent in the first four weeks after implantation, 5 percent for the next six weeks, and 3 percent for the following eight weeks. (The stillbirth rate is approximately 1 percent.)

The symptoms of a threatened abortion may include spotting of blood, which may turn into heavier bleeding; cramping, possibly accompanied by lower back pain; and vaginal discharge of tissue, clots, or pinkish fluid. A completed miscarriage may also demonstrate changes in pregnancy signs, such as nausea and breast sensitivity. A hormonal sign of a threatened abortion is the failure of human chorionic gonadotropin (hCG) levels to double every two days.

There are three conditions where a woman experiences a miscarriage and the developing child is missing in the sac. About 30 percent of miscarriages before the eighth gestational week are blighted ova, as an embryo has failed to develop. Complete molar pregnancies arise when a sperm (or two) fertilize an egg that has lost its genes. The resulting development of pregnancy tissues—absent the developing child—usually leads to the symptoms of a miscarriage in the first several gestational weeks, but expulsion of the placenta may not occur. Because of the higher likelihood of residual disease (including cancer) in the abnormal tissue if any is left behind, surgical removal of the molar tissue is often warranted. Women who have aborted a molar pregnancy are advised to not get pregnant again for a year, and then they must be closely monitored for subsequent pregnancies, as they are at increased risk for further abnormalities that can become malignant. Finally, a woman may have a recognized pregnancy yet not realize that she was actually pregnant with twins and that one died. This is called “vanishing twin syndrome.”

Analyses reveal the probability of the most common causes of miscarriages: 50 to 60 percent, genetic abnormalities; 10 to 15 percent, defects in the uterus (such as double or septal uterus) or the cervix (such as incomplete closure); and 10 to 15 percent, hormonal (such as low progesterone or thyroxin) and/or immune disorders (such as lupus or antiphosphid antibody syndrome). A woman’s poor health, history of disease (such as endometriosis), history of miscarriages, and advanced age (a 50 percent miscarriage rate for women forty-five and older) also increase the probability of a miscarriage. Recent studies have indicated that the presence of bacterial vaginosis is associated with late-onset miscarriages and preterm deliveries. The presence of the bacteria known as beta strep in the mother’s birth canal is tied to preterm labor when it goes untreated. Lifestyle choices that can compromise a successful pregnancy may involve the abuse of substances such as caffeine, cocaine, or nicotine; the contraction of sexually transmitted diseases (STDs), such as chlamydia, human immunodeficiency virus (HIV), or human papillomavirus (HPV); or exposure to harmful agents, such as radiation.

Treatment and Therapy

Little can be done to stop a miscarriage in the first two months of pregnancy, though some effective interventions are possible in later gestational periods. Magnesium sulfate is effective in combating preeclampsia (high blood pressure during pregnancy) and premature labor contractions. A cervical stitch (cerclage) can rectify an incompetent cervix (premature dilation). Most medical efforts, however, are directed toward the prevention of future miscarriages—the treatment of disease, lifestyle changes, RhO shots for Rh problems—and recovery from the present miscarriage. For example, medications to reduce the risk of miscarriage include antibiotics, which treat or prevent infections, and aspirin and similar medications that treat blood-clotting issues. Surgical procedures are also used to prevent miscarriages by treating certain uterine problems, such as uterine fibroids and a weakened cervix.

There are two aspects of recovery from a miscarriage. The physical part involves the natural or artificial removal of pregnancy tissue—either chemically, as with pitocin, or surgically, as with dilation and curettage (D & C)—and the establishment of a new menstrual cycle. A typical physical recovery ranges from a few days to a few weeks for the miscarriage itself and one to two months after the miscarriage for the next period. Women are usually advised to wait one to two normal periods before trying to conceive again. Most women trying to conceive will be successful within six months of the miscarriage.

The psychological recovery may take longer than the physical recovery. Social support, good mental health prior to the miscarriage, deeper religious faith, and successful grieving (mourning, not denying, the loss and then moving forward in life) are some of the factors correlated with a better psychological recovery. Support groups exist for individuals who have suffered miscarriage, stillbirth, or infant death. Similar groups exist to provide support to individuals who are pregnant after the loss of an earlier pregnancy. Such support is essential in decreasing anxiety.

Perspective and Prospects

Until the latter half of the twentieth century, miscarrying women received little satisfaction from the medical community. In fact, many of the drugs introduced in the mid-twentieth century, such as diethylstilbestrol (DES) and its numerous estrogenic cousins, caused more harm than good. However, by the latter part of the twentieth century significant progress was made in diagnosing and preventing miscarriages.

In the early twenty-first century, three avenues of research appear to be promising. Studies are revealing certain genetic predispositions for miscarriages, such as the low production of nitric oxide, resulting in less blood to the uterus. Miscarriages are also being linked to autoimmune disorders and hormonal deficiencies. Use of hormone injections to women who are found to have a hormonal imbalance can help to prevent miscarriage. Finally, assisted reproductive technologies offer intriguing possibilities, such as the ethically controversial opportunity to screen preimplantation embryos for chromosomal abnormalities. In these and other areas of research, new hopes are being raised for old griefs.

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