Spontaneous Abortion (SAB) or miscarriage is the term used for a pregnancy that ends on its own, within the first 20 weeks of gestation.

SAB is the medical term, which some women often find has a negative feeling. So Miscarriage or Early Pregnancy Loss (EPL) is used.

There are many different terms that describe miscarriage, e.g. Early Pregnancy Loss (EPL), Spontaneous Abortion (SAB) or vaginal bleeding. There are different types of miscarriage, different treatments for each and a whole mired of statistics to show you the level of risk. What ever your circumstances, this is written to give you an overview of information. The best source of advice and information will always be your Health Care Professional.

Most miscarriages occur before the 12 or 13^th week of pregnancy. Approximately 10-25% of pregnancies will end in miscarriage. Many women will loss the pregnancy in the very early stages (just after implantation) without knowing it. Before 8 weeks the baby is referred to as an embryo and after 8 weeks it is a foetus.

Causes

Most early miscarriages are caused by a chromosomal abnormality. This means that during development the feotus has not grown correctly, this is often due to a faulty egg or sperm. The cause of this is unknown. When the egg starts to divide and develop, (once it has been fertilised by the sperm), it doesn’t develop correctly. The body knows when the foetus is not developing and we then miscarry. These issues are not caused by either parent and do not mean that you are unhealthy or couldn’t have a successful pregnancy in the future. There are other issues which we will look in Infrequent Conditions.

Other Causes

• Lifestyle – Drug Use, Alcohol, Smoking etc
• Hormonal Issues or Immune System Challenges.
• Mothers over the age of 35 years.
• Any deep life or emotional traumas
• Infection or Infectious Diseases
• Underlying uncontrolled disease e.g. Diabetes.
• Any uterine or cervical problems, e.g. a short cervix.

As mentioned above, women who are 35 years or over are at increased risk of miscarriage, in fact a 20% risk. At 40 years the risk increases to 40% and by the age of 45 years it can be as high as 80%.

Women who have had 2 or more miscarriages have been shown to have an increased risk of further events. Although having one miscarriage does not put you at any further a risk than a woman who has miscarried at all.

There is some debate over other possible contributors e.g. caffeine. Again it is best to speak with your Health Care Professional if you think you could be at increased risk.

Subscribe to the Walk With Jude Newsletter for some of the latest research, including placenta function as a cause of miscarriage.

Warning Signs of Miscarriage

There are some general signs and symptoms of miscarriage, if you have any of the below you need to contact a doctor immediately.

• Brown or bright red vaginal bleeding, with or without cramping. It is important to use a sanitary pad and not a tampon to be able to assess the amount of bleeding.  Also refrain from sexual intercourse during this time.
• Cramps or low back ache, similar to, or more intense than a period. Abdominal pain that is dull, sharp or cramping.
• Contractions, these are more painful than period cramping and can last for sometime. You will need to note the frequency for you medical consultation.
• A feeling that the signs of pregnancy are decreasing e.g. less nausea or breast tenderness.
• Tissues with clots passing from the vagina. This is another reason to use a sanitary pad and the physician may want to assess the contents.
• Some women who miscarry can develop an infection in their uterus. If you have any symptoms of fever, chills, body ache or an unusual discharge you must seek medical help.

One of the most obvious and worrisome signs of a possible miscarriage is always bleeding. To put this into perspective, the incidence of vaginal bleeding is quite high in the first 3 months at around 20-30%. As many as 50% of women go on to have a normal birth. Most miscarriages can’t be prevented, as this is the body’s way of recognising that something is wrong. Bleeding during the first 3 month can be caused by various reasons, from implantation bleeding to types of infection to intercourse.

Bleeding in later pregnancy can be a sign of possible issues. During the later part of pregnancy the issues can range from:

Placental Abruption

This bleeding is caused by the placental coming away from the uterus wall. This detachment happens completely at labour, but causes bleeding during the pregnancy. You will notice some bleeding some stomach pains if this is happening.

Placenta Previa

In this care the placenta is lying low in the uterus, close to or completely over the cervix. This occurs in 1 in 200 pregnancies and requires immediate medical care. You may notice some bleeding, but not necessarily any pain.

What to do

The most important thing you can do is to see a health care professional. If necessary you may need to go to an emergency department.

The main goals will be to stop or prevent any further bleeding and to reduce the risk of infection. You may be monitored for some time and will likely undergo an ultrasound to detect any foetal heart beat, blood tests and a pelvic examination.

The doctor will want to know:

• When was your last period?
• When did your symptoms begin?
• How long have your symptoms lasted and how heavy is the bleeding compared to your normal period?
• Do you have any other medical conditions?
• Have you miscarried before?

If you are early in your pregnancy, it is likely that your body will take care of the miscarriage completely. If not, you will need to have some medical intervention to ensure that all of the pregnancy has gone. A D&C (Dilatation and Curettage) will be performed at the earliest opportunity to remove all pregnancy tissue and reduce the risk of infection. This usually requires hospitalization with local or general anaesthetic. During the procedure the cervix will be dilated and the remaining tissue and blood will be removed. This is usually a very short. You may be asked to take antibiotics for a few days afterwards. There is no specific after care, except rest and watching for any signs of infection. You may experience some bleeding afterwards.

Probably the most important next step will be to find yourself a place to grieve. Please see the Walk With Jude Programme or our resources page.

Prevention

As the cause for most miscarriages remains unknown, there is little you can do to prevent it. Most physicians advise waiting some time before becoming pregnant again. This will give you the opportunity to recover physically and emotionally.

Remaining health is going to be a good start. Taking care of your diet and exercise, no smoking and managing stress will all help to put you in the best possible shape.

If you do decide to try again, remember this is your decision and needs to happen in your own time. If you become pregnant it will be important to see a physician straight away and discuss how you can reduce your risk of miscarriage, but still live a normal life.

If you have had recurrent miscarriages, most countries will start to do testing after the third. Again you need to speak with your physician.