Signs and Symptoms: You may feel signs of pregnancy, but when your doctor performs an ultrasound, he or she finds an empty gestational sac or cannot confirm a heartbeat. A missed miscarriage , or a missed abortion, occurs when a fetus implants, but fails to develop. Signs and Symptoms: You may continue to feel signs of pregnancy if the placenta still releases hormones.
Or, you may notice signs of pregnancy fade. Some women may experience some vaginal discharge and cramping, but many have no symptoms of miscarriage. A threatened miscarriage refers to vaginal bleeding that occurs during the first 20 weeks of pregnancy. It does not necessarily mean your pregnancy will end in a miscarriage — around half of threatened miscarriages result in a live birth.
Signs and Symptoms: Other symptoms of threatened miscarriage include lower back pain and abdominal cramps. If you have experienced unexplained bleeding during pregnancy, your doctor will want to perform an examination. Cervix Dilation: In a threatened miscarriage, the cervix will remain closed.
However, if an examination reveals the cervix has opened, a miscarriage is much more likely. Inevitable miscarriage refers to unexplained vaginal bleeding and abdominal pain during early pregnancy. Spontaneous abortion: expectant management, medical treatment or surgical evacuation.
Expectant management of incomplete, spontaneous first-trimester miscarriage: outcome according to initial ultrasound criteria and value of follow-up visits. Nielsen S, Hahlin M. Expectant management of first-trimester spontaneous abortion. Management of spontaneous miscarriage in the first trimester: an example of putting informed shared decision making into practice.
Randomised trial comparing expectant with medical management for first trimester miscarriages. Br J Obstet Gynaecol. Expectant medical or surgical treatment of spontaneous abortion in first trimester of pregnancy? A pooled quantitative literature evaluation. J Am Board Fam Pract. Medical management of missed abortion: a randomized clinical trial [published correction appears in Obstet Gynecol ;].
Obstet Gynecol. Expectant management of missed miscarriage. Incomplete miscarriage: a randomized controlled trial comparing oral with vaginal misoprostol for medical evacuation.
Hum Reprod. Expectant management versus surgical evacuation in first trimester miscarriage: health-related quality of life in randomized and non-randomized patients. A comparison of the psychologic impact and client satisfaction of surgical treatment with medical treatment of spontaneous abortion: a randomized controlled trial.
Patient preferences for management of first-trimester incomplete spontaneous abortion. Determinants of depressive symptoms in the early weeks after miscarriage. Am J Public Health. Major depressive disorder in the 6 months after miscarriage. Controlled prospective study on the mental health of women following pregnancy loss. Am J Psychiatry.
Thapar AK, Thapar A. Psychological sequelae of miscarriage: a controlled study using the general health questionnaire and the hospital anxiety and depression scale. Speraw SR. The experience of miscarriage: how couples define quality in health care delivery. J Perinatol. Lee C, Slade P. Miscarriage as a traumatic event: a review of the literature and new implications for intervention. J Psychosom Res. Coordinator of the series is Eric Henley, M.
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Next: Hemoptysis: Diagnosis and Management. Oct 1, Issue. Management of Spontaneous Abortion. C 5 Transvaginal ultrasound should be performed in the first trimester of pregnancy when incomplete abortion is suspected and is extremely reliable in identifying intrauterine products of conception.
C 7 , 8 Expectant management should be considered for women with incomplete spontaneous abortions. A 17 — 22 , 24 When misoprostol Cytotec is used to treat women with a missed spontaneous abortion, it should be given vaginally rather than orally. B 27 Patients who have had a spontaneous abortion should be given the opportunity to choose a treatment option. B 28 A mcg dose of Rh o D immune globulin Rhogam should be administered to Rh-negative patients who have a threatened abortion or have completed a spontaneous abortion.
C 5 Physicians should be alert to the development of psychologic symptoms that frequently occur following spontaneous abortion e.
Diagnosis Threatened abortion is defined by vaginal bleeding in a woman with a confirmed pregnancy. Abdominal or vaginal ultrasound may be done to check the baby's development and heartbeat, and the amount of your bleeding.
When a miscarriage occurs, the tissue passed from the vagina should be examined. This is done to determine if it was a normal placenta or a rare condition known as a hydatidiform mole. It is also important to find out whether any pregnancy tissue remains in the uterus. In rare cases an ectopic pregnancy can look like a miscarriage. If you have passed tissue, ask your provider if the tissue should be sent for genetic testing.
This can be helpful to determine if a treatable cause of miscarriage is present. If the pregnancy tissue does not naturally leave the body, you may be closely watched for up to 2 weeks. Surgery suction curettage, D and C or medicine may be needed to remove the remaining contents from your womb. After treatment, women usually resume their normal menstrual cycle within 4 to 6 weeks.
Any further vaginal bleeding should be carefully monitored. It is often possible to become pregnant immediately. It is suggested that you wait one normal menstrual cycle before trying to become pregnant again. An infected abortion may occur if any tissue from the placenta or fetus remains in the uterus after the miscarriage. Symptoms of an infection include fever, vaginal bleeding that does not stop, cramping, and a foul-smelling vaginal discharge.
Infections can be serious and need immediate medical attention. Women who lose a baby after 20 weeks of pregnancy receive different medical care. This is called premature delivery or fetal demise. This needs immediate medical attention. Evacuation usually involves suction curettage Instrumental evacuation In the US, abortion of a previable fetus is legal, although state-specific restrictions eg, mandatory waiting periods, gestational age restrictions exist.
The later the uterus is evacuated, the greater the likelihood of placental bleeding, uterine perforation by long bones of the fetus, and difficulty dilating the cervix.
These complications are reduced by preoperative use of osmotic cervical dilators eg, laminaria , misoprostol , or mifepristone RU If complete abortion is suspected, uterine evacuation need not be done routinely. After an induced or spontaneous abortion, parents may feel grief and guilt. They should be given emotional support and, in most cases of spontaneous abortions, reassured that their actions were not the cause. Formal counseling is rarely indicated but should be made available.
Confirm spontaneous abortion and determine its type based on clinical criteria, ultrasonography, and quantitative beta-hCG. Determining the cause may require extensive evaluation of both parents. Some causes can be treated. Overt and poorly controlled chronic disorders eg, hypothyroidism, hyperthyroidism, diabetes mellitus, hypertension.
During pregnancy, risk is increased because Venous capacitance Venous or arterial thrombi may occur. The pathophysiology is The association with hereditary thrombotic disorders is less clear but does not appear to be strong, except for possibly factor V Leiden mutation. Placental causes include preexisting chronic disorders that are poorly controlled eg, systemic lupus erythematosus [SLE], chronic hypertension.
Chromosomal abnormalities Overview of Chromosomal Anomalies Chromosomal anomalies cause various disorders. Anomalies that affect autosomes the 22 paired chromosomes that are alike in males and females are more common than those that affect sex chromosomes Evaluation for recurrent pregnancy loss should include the following to help determine the cause:.
Genetic evaluation Genetic Evaluation Genetic evaluation is part of routine prenatal care and is ideally done before conception. The extent of genetic evaluation a woman chooses is related to how the woman weighs factors such as Screening for hereditary thrombotic disorders is no longer routinely recommended unless supervised by a maternal-fetal medicine specialist.
Some causes of recurrent pregnancy loss can be treated. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The Manual was first published in as a service to the community.
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