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Miscarriage Booklet

Miscarriage booklet

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Miscarriage (specifically repeat first trimester)

A miscarriage is a pregnancy that ends spontaneously before 20 weeks of pregnancy, when the fetus has no chance of living independently outside the womb.

Brief Summary

Extensive details on miscarriage are contained within the free downloadable booklet - Understanding Miscarriage

Discontinuation of pregnancy due to natural or interventional means.

About the Condition

After 20 weeks, pregnancy loss is considered a stillbirth. A pregnancy is most vulnerable during weeks 7 to 13 and repeated first-term miscarriages most commonly occur during this timeframe. Once the egg (ovum) is fertilized, the corpus luteum (yellow body) in the ovary secretes ever increasing levels of the hormone progesterone to maintain the pregnancy until the placenta is large enough to take over production. This is the critical period for sustainability of the pregnancy and the danger time if progesterone production from the corpus luteum does not keep pace with the requirements of the growing fetus. If the placenta does not produce sufficient progesterone to pick up the progesterone shortfall from the corpus luteum the placenta will become unstable and begin to breakdown resulting in miscarriage.

Most repeat first-trimester miscarriages (week 5-13) are due to progesterone deficiency as a result of corpus luteal insufficiency. The corpus luteum forms after the egg is released and produces the hormone progesterone in ever-increasing amounts to support the developing embryo until around week 13 when the matured placenta produces much greater quantities of progesterone.

Next page: Symptoms of Miscarriage

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For women

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Downloadable Resources

Symptoms of Miscarriage

A sign is something you can objectively see or measure, like vomiting or a fever. A symptom is something only you feel and report.

If you are pregnant and develop any of these signs and symptoms, go to the nearest Emergency Room immediately:

  • Bright red or brownish bleeding from the vagina, which may be painless
  • Passing clots or tissue
  • Painful contractions every 5 to 20 minutes apart
  • Leaking clear fluid from the vagina (not urine from the bladder)

If you are pregnant and develop any of these signs and symptoms, phone your doctor as soon as possible:

  • Back pain
  • Abdominal cramps
  • White or blood-tinged mucous from the vagina
  • Loss of pregnancy signs, like abdominal and breast swelling
  • Fever over 101ºF or 38.33ºC, especially if accompanied by chills (rigors)

If your doctor is unavailable, ask for the obstetrician on call (locum tenens) or go to the nearest hospital Emergency Room immediately. If you have a high fever, take acetaminophen/paracetamol (Tylenol®/Panadol®) to reduce it, because prolonged high fever damages the fetus. The ER doctor can update your obstetrician when your condition has stabilized.

An ectopic pregnancy occurs in the fallopian tubes instead of the uterus. Often, the affected woman’s first pregnancy test will be positive, and then repeat tests will be negative, although the woman still has other pregnancy symptoms. If you have an ectopic pregnancy (tubal pregnancy), then your symptoms will be more dramatic than most:

  • Bright red, spotty vaginal bleeding
  • Abdominal pain that increases in severity as the tube nears rupture
  • Referred shoulder pain
  • Dizziness
  • Fainting
  • Mass on the sides of the uterus (adnexal mass) instead of within the uterus
  • Uterus that is smaller than expected for the stage of pregnancy
  • Urge to move the bowels

Go to the nearest Emergency Room immediately. Ectopic pregnancy is life-threatening for the mother. You must have surgery performed on the ruptured fallopian tube to stanch the bleeding.

If you have painless, bright red bleeding in your second or third trimester that stops and recurs again days or weeks later, you may have placenta previa. The placenta partly or completely grew over the opening to the birth canal.

On rare occasions, you may be unable to get medical attention immediately. If bleeding occurs and you cannot get to your doctor’s office right away, try these easy steps to control bleeding:

  • Bed rest.
  • Drink several salty liquids, like V8, tomato juice, or bouillon soup. Good fluid balance will help keep you from getting dizzy.
  • Take one or two 200 mg tablets of ibuprofen every 4 to 6 hours. Avoid taking aspirin, because it is an anticoagulant and could worsen your bleeding. Ibuprofen will lessen your cramps by decreasing prostaglandins and reduce the blood flow 25% to 30%.
  • Take one 300 mg tablet of ferrous gluconate or iron equivalent per day to prevent anemia.

The paramedics, triage nurse, ER doctor and obstetrician must all ask you how much blood you have lost. Try to be patient with their repetitive questions, as they are tracking your progress over time.

Next page: Causes of Miscarriage

ProFeme® 10

ProFeme 10 progesterone cream packaging

For women

ProFeme® 10% Progesterone Cream is specifically designed for use in women with declined or lowered progesterone levels.

Downloadable Resources

Causes of Miscarriage

Repeated miscarriages can result from problems with: Implantation; genetics; immune disorders; physiology; hormones; toxin exposure; lifestyle; trauma; the mother’s age; and infections. The fetus is abnormal in 70% of miscarriages.

Implantation problems mean the couple conceives but the fertilized egg cannot implant safely in the uterus for a full-term pregnancy.

A miscarriage that occurs in the first trimester of pregnancy (Day 1 to Week 12) is most likely to be caused by a genetic disorder with the fetus. For example, Turner’s syndrome is a genetic disorder that terminates 98% of affected pregnancies in the first trimester.

Late miscarriage in the second trimester (4 to 6 months) can happen from problems with the immune system or physiological problems. Examples of immune system problems are:

  • Rh incompatibility, where the mother is Rh negative and the father and fetus are Rh positive. The mother’s antibodies attack the fetus as a foreign invader.
  • Antiphospholipid antibodies that cause clots in the placenta. Between 10% and 15% of repeat miscarriages are caused by these antibodies, and the fetus often grows into the second trimester.
  • Lupus, where the woman’s overactive immune system attacks her body. ANA antibodies are present in the bloodstream.
  • Faulty fetal-blocking antibodies that cannot protect the baby from the mother’s immune system when the parents’ DNA is too similar.

Multiple miscarriages will likely occur at exactly the same time each pregnancy, usually before Week 12.

Examples of physiological (mechanical) problems are:

  • Uterine fibroid tumors – Although they are benign (non-cancerous), fibroids can crowd out a pregnancy. Submucosal fibroids act like an IUD contraceptive to prevent the egg from implanting in the uterus.
  • Ectopic (tubal) pregnancy – In 2% of pregnancies, the egg does not implant in the uterus, but stays in the fallopian tube, which ruptures when the embryo outgrows it.
  • Incompetent cervix – In 1 out of every 100 pregnancies, the mother has a weak cervix due to a previous difficult delivery or miscarriage, or cervical surgery, D&C termination, birth defect, or exposure to the synthetic hormone DES (Diethylstilbestrol). The cervix is weak and opens before the fetus can survive outside the mother’s body, usually in the second trimester (Weeks 13 to 27 of pregnancy) or third trimester (Weeks 28 to delivery). One-quarter of babies lost in the second trimester are due to incompetent cervix.
  • Placenta previa – The placenta grows over the cervical opening and will tear in the second trimester. Progesterone deficiency is a hormonal problem where the pregnancy cannot be sustained past the tenth week without progesterone supplements.

Diagnosis

Tests: Any abnormal result in the following tests may indicate a possible cause of miscarriage: S.ANA, S.anti-DNA antibodies, S. ENA, cardiolipin antibodies, factor V Leiden antibodies, B.LE cells, S.LH, parental karyotype, TFT, GTT, vaginal swab M/C/S, hysterosalpingogram.

Next page: Treatment and Prevention of Miscarriage

ProFeme® 10

ProFeme 10 progesterone cream packaging

For women

ProFeme® 10% Progesterone Cream is specifically designed for use in women with declined or lowered progesterone levels.

Downloadable Resources

Treatment for Miscarriage

The paramedic will make you bed rest quietly and may give you medications to stop your uterus from contracting under the direction of the Emergency Room physician at the base hospital by phone. Bring all prescription drugs, herbs, and supplements you are taking with you to the hospital. Be honest with the ER doctor if you drink heavily or use street drugs. Your doctor may consult with a pharmacist to find out if your miscarriage could be the result of a drug interaction.

The nurse or midwife will record your vital signs (height, weight, blood pressure and temperature). If you have been bleeding excessively, the nurse will take your pulse twice:

  • First when you have been lying down quietly for 5 minutes
  • Second when you have been standing fairly still for 1-3 minutes

The maximum amount your pulse should increase when standing is 20 beats per minute. If you have bled so much that your blood volume is depleted, it will increase more. You may require intravenous fluids (IV), antibiotics and a blood transfusion.

You will require a vaginal exam by a doctor or midwife. You must recline on the examination couch while your doctor inserts a clean clamp (speculum) to hold your vagina open and shines a bright light on your perineum to see well. If you have not had a pap smear in the past year, the doctor scrapes your cervix with a wooden Popsicle stick, smears the sample on a slide, and sends it to the Pathology Lab for expert examination.

Some miscarriages are inevitable. Remember, if your membranes break and you go into labour, that a baby can only survive outside the uterus if it weighs at least 500 grams (1.10 pounds) and is at least 24 weeks old.

If you have a molar pregnancy, remember that a proper fetus does not form, and the cellular mass cannot survive outside your body. Your uterus is more likely filled with clusters of bubbles. Your doctor will likely suggest a cervical dilatation and evacuation with suction (D&E) to remove the products of conception by the end of your first trimester (Week 12 of pregnancy). In 2-3% of molar pregnancies, the moles may develop into a cancer called choriocarcinoma which can spread to distant parts of the body and require methotrexate and limited cancer chemotherapy.

A miscarriage is often treatable if it is addressed immediately. Not every woman who spots during the first trimester has a miscarriage; 20% of women who spot bring the pregnancy to full term (40 weeks). If you are pregnant and spot or bleed visit your doctor or the nearest Emergency Department at an obstetric hospital as soon as possible. Bring any tissue you pass with you in a clean container. The lab can test the tissue for many abnormalities to pinpoint your problem.

Prevention of Miscarriage

Subfertile women who do fall pregnant may not be able to sustain the pregnancy past the tenth week. Progesterone is the hormone that supports a pregnancy. Before conceiving, a woman prone to miscarriage can try a low dose of natural progesterone cream from days 12 to 26 of her cycle until the pregnancy is confirmed.

If spotting occurs at week 6 or 7 of pregnancy, a high dose of 100 to 200 mg progesterone cream is applied twice or three times daily. Often, women use natural progesterone cream until the baby is full term (40 weeks of gestation).

Next page: Further Information about Miscarriage

ProFeme® 10

ProFeme 10 progesterone cream packaging

For women

ProFeme® 10% Progesterone Cream is specifically designed for use in women with declined or lowered progesterone levels.

Downloadable Resources

Download our Booklet

Downloading our booklets is FREE.

Topics discussed in the Understanding Miscarriage booklet include:

  • In this information booklet topics discussed include:
  • What is miscarriage?
  • What does not cause miscarriage?
  • When is a miscarriage not a miscarriage?
  • Why does miscarriage occur?
  • Who develops miscarriage?
  • How often does a miscarriage happen?
  • Can I avoid a miscarriage?
  • What are the signs and symptoms of miscarriage?
  • How is miscarriage classified?
  • How is miscarriage treated?
  • How is surgery performed?
  • What are the complications of a miscarriage?

Progesterone for Women FAQ's

ProFeme® 10

ProFeme 10 progesterone cream packaging

For women

ProFeme® 10% Progesterone Cream is specifically designed for use in women with declined or lowered progesterone levels.

Downloadable Resources

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