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A miscarriage occurs when a woman is pregnant and her womb expels the unborn child. It results from natural causes within the first 20 weeks of pregnancy.

What is going on in the body?

• breast tenderness
• nausea
• fatigue

A miscarriage starts when the womb begins to contract. This causes cramping and discomfort. It may also cause vaginal spotting or bleeding. A miscarriage is complete when the contents of the womb are expelled. When no fetal tissue remains, the cervix will close. The uterus will shrink in size. The bleeding will slow and then stop.

What are the signs and symptoms of the condition?

• low back pain
• passage of some tissue or clots from the vagina
• pelvic or abdominal cramping
• vaginal bleeding or spotting

What are the causes and risks of the condition?

An unborn child that fails to develop or is abnormal in some way is the most likely cause of a miscarriage that occurs in the first trimester of pregnancy.

• an abnormal-shaped uterus
• clottin disorders which cause the placenta to not function well and cause the death of the unborn child (called "thrombophilias")
• autoimmune disorders, in which the woman's body creates antibodies to its own tissue, including the unborn child
• bacterial infections, such as the sexually transmitted disease Chlamydia
• certain diseases and conditions, including diabetes or hypothyroidism
• a prematurely dilating cervix (called "cervical incompetence"), a condition in which the cervical opening from the womb does not stay closed through the whole pregnancy
• cocaine use
• drinking liquids, such as coffee, or eating foods, such as chocolate, that contain caffeine
• exposure to pesticides, chemicals, or other toxins
• noncancerous tumors in the uterus, (called fibroids)
• hormonal disorders, such as a low level of the female hormone progesterone
• polycystic ovary syndrome, a condition in which abnormal hormone levels cause growths within the ovary
• posttraumatic stress disorder, also called PTSD, which may occur after a major traumatic event
• TORCH infections in the first trimester of pregnancy (TORCH is an acronym for a group of infectious agents: Toxoplasmosis, Other infections (such as hepatitis B, syphilis, and herpes zoster), Rubella, Cytomegalovirus, and Herpes simplex virus)

• illegal drugs or alcohol
• herbs, high-dose vitamins or dietary supplements
• over-the-counter medicines
• prescription medicines

What can be done to prevent the condition?

Not all miscarriages can be prevented. But taking certain actions can help. Several months before pregnancy and during the entire pregnancy, a woman should follow these guidelines.

• Avoid alcohol and caffeine.
• Stay away from pesticides, and chemical solvents such as paint thinners
.
• Avoid all medicines unless recommended by the doctor. This includes those sold over-the-counter, prescriptions, and herbal remedies.
• Eat a diet rich in folic acid and take multivitamins.
• Maintain good control of diseases such as diabetes and hypothyroidism
.
• Notify the doctor of any other risk factors, such as PTSD.
• Report any symptoms of sexually transmitted disease to the doctor
.
• Stop smoking

If a woman has had infertility tests for imbalanced hormones or low prgesterone levels, the doctor may screen her for hormone problems in the first trimester. If a problem is found, hormone treatments can be prescribed.

How is the condition diagnosed?

A blood or urine test will be done to confirm that a pregnancy exists. The level of the pregnancy hormone HCG may be checked several times over a period of days or weeks. Rising levels suggest that the unborn child is growing. Levels that fall or stay steady suggest a malformed or dying unborn child.

• a complete blood count, called CBC, if the woman is bleeding heavily
• a pelvic exam to see if the cervix is open and whether there is any tissue from the unborn child in the vagina or the cervix
• a pregnancy ultrasound to check for any movement from the unborn child and heartbeat and to rule out an ectopic pregnancy, which occurs when the egg implants outside the uterus
• a progesterone level to find out if enough of the hormone is being made to maintain the pregnancy
• a white blood cell count to rule out infection

What are the long-term effects of the condition?

The long-term effects of a miscarriage vary. There are many myths about what causes miscarriage. A woman (and even the father of the baby) may feel anxiety, fear, and guilt if she (or he) believes she did something to cause the miscarriage. She and the father of the baby should discuss feelings or worries such as these with her doctor.

What are the risks to others?

A miscarriage is not contagious. It poses no risk to others.

What are the treatments for the condition?

Some providers suggest that a woman try to collect any tissue that passes from her vagina so it can be checked at a medical lab.

• antibiotics to prevent infection
• dilation and curettage, or D&C, a procedure to remove any tissue remaining in the uterus
• medicines to help the uterus contract so that bleeding stops
• Rh immune globulin, if the mother's blood is Rh-negative

Sometimes, the woman may have an incomplete miscarriage. This means some tissue stays in the uterus. To avoid infection, a procedure called a D&C will be done. The D&C helps empty the uterus.

What are the side effects of the treatments?

A D&C may be complicated by bleeding, infection, and allergic reaction to anesthesia. Antibiotics and medicines to help the uterus contract may cause rash, upset stomach, abdominal cramps, and allergic reaction.

What happens after treatment for the condition?

• any other new or worsening symptoms
• continued heavy bleeding
• a fever
• cramps that get worse or pain that won't go away

Birth control should be used if the woman does not want to get pregnant again. If a future pregnancy is desired, the couple may try to conceive again after 2 to 3 months. They have an 85% chance of having a successful, full-term pregnancy after 1 year.

How is the condition monitored?

A woman's doctor may do weekly blood tests to follow the HCG level until it is nearly zero. This ensures that the pregnancy has ended. Sometimes tests are done on the fetal tissue to learn about its genetic makeup. If a woman has had one or more miscarriages, her doctor may recommend a complete evaluation to look for causes.