Miscarriage, also known in medical terms as a spontaneous abortion, is an end to pregnancy resulting in the loss and expulsion of an embryo or fetus from the womb before it can survive independently. Miscarriage before six weeks of gestation is defined as biochemical loss by ESHRE. Once ultrasound or histological evidence shows that a pregnancy has existed, the term used is clinical miscarriage, which can be "early" (before 12 weeks) or "late" (between 12 and 21 weeks). Spontaneous fetal termination after 20 weeks of gestation is known as a stillbirth. The term miscarriage is sometimes used to refer to all forms of pregnancy loss and pregnancy with abortive outcomes before 20 weeks of gestation. The most common symptom of a miscarriage is vaginal bleeding, with or without pain. Tissue and clot-like material may leave the uterus and pass through and out of the vagina. Risk factors for miscarriage include being an older parent, previous miscarriage, exposure to tobacco smoke, obesity, diabetes, thyroid problems, and drug or alcohol use. About 80% of miscarriages occur in the first 12 weeks of pregnancy (the first trimester). The underlying cause in about half of cases involves chromosomal abnormalities. Diagnosis of a miscarriage may involve checking to see if the cervix is open or sealed, testing blood levels of human chorionic gonadotropin (hCG), and an ultrasound. Other conditions that can produce similar symptoms include an ectopic pregnancy and implantation bleeding. Prevention is occasionally possible with good prenatal care. Avoiding drugs (including alcohol), infectious diseases, and radiation may decrease the risk of miscarriage. No specific treatment is usually needed during the first seven to 14 days. Most miscarriages will be completed without additional interventions. Occasionally the medication misoprostol or a procedure such as vacuum aspiration is used to remove the remaining tissue. Women who have a blood type of rhesus negative (Rh negative) may require Rho(D) immune globulin. Pain medication may be beneficial. Feelings of sadness, anxiety or guilt may occur following a miscarriage. Emotional support may help with processing the loss. Miscarriage is the most common complication of early pregnancy. Among women who know they are pregnant, the miscarriage rate is roughly 10% to 20%, while rates among all fertilisation is around 30% to 50%. In those under the age of 35, the risk is about 10% while in those over the age of 40, the risk is about 45%. Risk begins to increase around the age of 30. About 5% of women have two miscarriages in a row. Recurrent miscarriage (also referred to medically as recurrent spontaneous abortion or RSA) may also be considered a form of infertility.
Terminology Some recommend not using the term "abortion" in discussions with those experiencing a miscarriage to decrease distress. In Britain, the term "miscarriage" has replaced any use of the term "spontaneous abortion" for pregnancy loss and in response to complaints of insensitivity towards women who had suffered such loss. An additional benefit of this change is reducing confusion among medical laymen, who may not realize that the term "spontaneous abortion" refers to a naturally occurring medical phenomenon and not the intentional termination of pregnancy. The medical terminology applied to experiences during early pregnancy has changed over time. Before the 1980s, health professionals used the phrase spontaneous abortion for a miscarriage and induced abortion for a termination of the pregnancy. By the 1940s, the popular assumption that an abortion was an intentional and immoral or criminal action was sufficiently ingrained that pregnancy books had to explain that abortion was the then-popular technical jargon for miscarriages. In the 1960s, the use of the word miscarriage in Britain (instead of spontaneous abortion) occurred after changes in legislation. In the late 1980s and 1990s, doctors became more conscious of their language about early pregnancy loss. Some medical authors advocated a change to the use of miscarriage instead of spontaneous abortion because they argued this would be more respectful and help ease a distressing experience. The change was being recommended in Britain in the late 1990s. In 2005, the European Society for Human Reproduction and Embryology (ESHRE) published a paper aiming to facilitate a revision of nomenclature used to describe early pregnancy events. Most affected women and family members refer to miscarriage as the loss of a baby, rather than an embryo or fetus, and healthcare providers are expected to respect and use the language that the person chooses. Clinical terms can suggest blame, increase distress, and even cause anger. Terms that are known to cause distress in those experiencing miscarriage include:
abortion (including spontaneous abortion) rather than miscarriage, habitual aborter rather than a woman experiencing recurrent pregnancy loss, products of conception rather than baby, blighted ovum rather than early pregnancy loss or delayed miscarriage, cervical incompetence rather than cervical weakness, and evacuation of retained products of conception (ERPC) rather than surgical management of miscarriage. Using the word abortion for an involuntary miscarriage is generally considered confusing, "a dirty word", "stigmatized", and "an all-around hated term". Pregnancy loss is a broad term that is used for miscarriage, ectopic, and molar pregnancies. The term foetal death applies variably in different countries and contexts, sometimes incorporating weight, and gestational age from 16 weeks in Norway, 20 weeks in the US and Australia, 24 weeks in the UK, to 26 weeks in Italy and Spain. A foetus that died before birth after this gestational age may be referred to as a stillbirth.
Signs and symptoms Signs of a miscarriage include vaginal spotting, abdominal pain, cramping, fluid, blood clots, and tissue passing from the vagina. Bleeding can be a symptom of miscarriage, but many women also have bleeding in early pregnancy and do not miscarry. Bleeding during the first half of pregnancy may be referred to as a threatened miscarriage. Of those who seek treatment for bleeding during pregnancy, about half will miscarry. Miscarriage may be detected during an ultrasound exam or through serial human chorionic gonadotropin (HCG) testing.
Risk factors
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