miscarriages

Miscarriage, also called spontaneous abortion in medical terminology, refers to the natural loss of a pregnancy before viability. In common terms, this usually means before 20 weeks gestation; most occur in the first trimester. It is distinct from stillbirth, which occurs later in pregnancy or at birth.

Miscarriage is relatively common. Estimates suggest that about 10-20% of recognized pregnancies end in miscarriage, and the total rate may be higher when including very early losses. Most miscarriages are due to chromosomal abnormalities in the fetus. Other risk factors include advanced maternal age, uterine or cervical problems, smoking, obesity, uncontrolled diabetes, and autoimmune conditions.

While many miscarriages have no identifiable cause, factors such as chromosomal abnormalities, uterine defects, incompetent cervix, hormonal problems, infections, and certain medications can contribute. Diagnosis is usually based on clinical symptoms (vaginal bleeding, cramps) and ultrasound findings, with serial measurements of hCG to track pregnancy viability. A normal ultrasound and rising hCG reduce suspicion of miscarriage.

Management depends on gestational age, clinical status, and patient preference. Options include expectant management (allowing passage of tissue), medical treatment with misoprostol, or surgical removal (vacuum aspiration). Most women have a normal future pregnancy. The risk of another miscarriage is higher after a previous loss, and evaluation for recurrent miscarriage is considered after multiple consecutive losses.

Miscarriage can cause sadness, grief, and anxiety. Medical care should address physical and emotional needs, and support services are available. Women should seek prompt care for heavy bleeding, severe pain, fever, or signs of infection.