Miscarriage, also known as abortion end of pregnancy spontaneously before 23 weeks of gestation.
Types of Miscarriage
1. Threatened Miscarriage: Symptoms of miscarriage (Bleeding or spotting along with cramps)but the cervix remains closed. Close follow-up is needed for the rest of the pregnancy.
2. Incomplete Miscarriage: Bleeding along with cramps and fetal tissue passes, but some remain in the uterus.
3. Complete Miscarriage: End of pregnancy with heavy vaginal bleeding and all fetal tissues pass out.USG confirms that it’s a complete miscarriage.
4. Missed Miscarriage: There are no symptoms of miscarriage, but a scan confirms that the fetus does not have a heartbeat but is present in the uterus.
5. Recurrent Miscarriage: Three or more consecutive miscarriages.
Miscarriage Causes:
1. Abnormal numbers of Chromosomes:- when egg and sperm fuse and genetic material is not formed 46 chromosomes normally are more prone to miscarriage in the first trimester.
2. Hormonal imbalance:-pregnancy is a game of hormones if progesterone and estrogen levels are not achieved the pregnancy may not continue.
3. Uterine abnormalities: abnormal shape or structure of the uterus alter.
4. Infections: Bacterial or viral infections or exposure to TORCH causes miscarriage.
5. Chronic disease (SLE, Antiphospholipid syndrome, diabetes, chronic Kidney disease, thyroid disease
- Not the Cause of Miscarriages
- Intercourse
- Cxercises
- hx of taking OCPs before pregnancy
- Working woman
Risk Factors
1. Age Factors: More maternal age more risk for miscarriage)
2. Weight: Underweight and overweight both are the causes of miscarriage
3. Incompetent Cervix: A short cervix is the cause of miscarriages in the first or second trimester.
4. Lifestyle Factors: Smoking, excessive alcohol consumption, drug abuse, and severe malnutrition.
5. Hx of Miscarriages: If 2-3 times hx of miscarriages then you need health professionals for proper diagnosis to know about the cause of miscarriages.
Symptoms
1. Bleeding through the vagina may b light or HMB
2. Cramp or severe pain in the lower abdomen.
3. Increase body temperature and increase heartbeat
4. Decreased pregnancy symptoms: Decreased morning sickness or breast tenderness and nausea vomiting
Treatment
Expectant Management:
Closely monitor the patient so that The body passes tissue naturally.
Medical Management
Medications to help the fetal tissue pass out through the body
Tab misoprostol dose is according to the patient’s condition and body weight.
Surgical Management:-
Dilation and curettage (D&C): Surgically remove tissue.
Psychological Support:
1. Counselling: Seek professional help to process emotions.
2. Support Groups: online or WhatsApp app groups join contact with others.
3. Self-Care: Prioritize physical and emotional well-being.
Prevention:
1. Preconception care: Consult with a healthcare professional before conceiving.
If there is a habitual miscarriage then two weeks before planning to conceive instructions are to take Aspirin 81 mg QD and heparin 5000 units Sq BD for any APA-positive or SLE-positive.
2. Prenatal Care: Regular prenatal visits and monitoring are needed during pregnancy blood pressure, sugar levels and healthy weight gain are closely monitored.
3. Healthy lifestyle: maintaining a healthy weight balanced and healthy diet exercising regularly avoiding harmful substances(alcohol, smoking, drugs)