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Miscarriage

Miscarriage (also called spontaneous abortion) occurs when a pregnancy ends naturally before the fetus is developed enough to survive outside the uterus. About 20 percent of all pregnancies end in miscarriage, usually during the first 8 weeks. During a miscarriage, the developing fetus and the placenta separate from the inner wall of the uterus. This separation may occur because of a developmental or genetic defect in the fetus or because the placenta is not attached properly to the uterus. More than half of miscarriages result from a chromosome abnormality (see page 955) in the fetus. Other causes of miscarriage include an abnormally shaped uterus, scar tissue in the uterus, or fibroids (see page 867), all of which can interfere with a fertilized egg’s ability to implant in the membrane that lines the inside of the uterus. Often the cause of a miscarriage is unknown. It is rare for miscarriages to result from falls or other injuries because the fetus is well protected inside the uterus.

Symptoms

The first symptom of a threatened, or possible, miscarriage early in a pregnancy is slight bleeding from the vagina. If the miscarriage occurs later in the pregnancy, the bleeding can range from a few drops of blood to a heavy flow. The bleeding may start with no warning or may be preceded by a brownish discharge. A threatened miscarriage is often painless.

If the fetus has died, a miscarriage is usually unavoidable (called an inevitable miscarriage). An inevitable miscarriage is usually accompanied by cramping pain in the lower abdomen or back. The pain can be either dull and constant or sharp and intermittent. If you pass any solid tissue from your vagina, save it in a jar to bring to your doctor for examination. The doctor can tell by looking at the tissue if you have eliminated all of the fetus and placenta. He or she will also send the tissue to a laboratory for microscopic examination to try to determine the cause of the miscarriage.

If any parts of the fetus or placenta remain in the uterus, it is called an incomplete miscarriage. If a miscarriage is incomplete, you may have constant or intermittent bleeding and pain for several days. If an incomplete miscarriage is not diagnosed, the bleeding can continue and the tissue left in the uterus can become infected.

WARNING!

Vaginal Bleeding During Pregnancy

Notify your doctor if you have vaginal bleeding at any time during your pregnancy. Bleeding can be a sign of a serious problem. In early pregnancy, about 20 percent of women have some slight vaginal bleeding, or spotting, such as when the fertilized egg implants in the uterus.

Notify your doctor, call 911 or your local emergency number, or go to a hospital emergency department immediately if you have any vaginal bleeding in the last 6 months of your pregnancy. Bleeding can indicate a miscarriage or an ectopic pregnancy. Vaginal bleeding (sometimes called antepartum hemorrhage) after the 20th week of pregnancy, usually in the last 3 months, affects fewer than 2 out of 100 women and may indicate the onset of preterm labor (see page 529), a burst varicose vein, damage to the cervix, placenta previa (see page 527), partial or complete separation of the placenta from the wall of the uterus (placental abruption; see page 527), or another serious complication.

In rare cases, a fetus dies in the uterus but the woman has no symptoms of miscarriage (called a missed miscarriage). Although you do not have symptoms of a miscarriage in a missed miscarriage, you will no longer experience any of the symptoms of pregnancy. Missed miscarriages are often discovered on a prenatal visit when the doctor notices that the uterus has not increased in size.

Keeping a Kick Chart

An active fetus is usually a healthy fetus. Your doctor may ask you to keep a record of how active your fetus is with a kick chart. He or she may give you a chart (or you can make a chart yourself) to log the movements of your fetus for a day or two. He or she will ask you to record the kicks at the time