Early Miscarriage (First Trimester Loss of Pregnancy)

Miscarriage brings about not only the termination of pregnancy but also a sense of loss for would-be parents. It is normal for a woman to feel extreme sadness and sometimes even guilt at being unable to continue the pregnancy. However, it is important to remember that a miscarriage is nature’s way of ending a pregnancy that is not viable. It should not detract from the fact that a future pregnancy is possible which may be carried to term.

What is an early miscarriage?

Miscarriage (spontaneous abortion) is a pregnancy which terminates on its own before completing 20 weeks. It is also defined as the delivery of a fetus weighing 500 grams (18 ounces) or less at which stage the baby is unable to survive outside the uterus. An early miscarriage is the unintentional termination of pregnancy before 12 weeks as opposed to a late pregnancy that occurs after 12 weeks of pregnancy.

While it can be traumatic for a pregnant women, early miscarriages are not uncommon. More than 20% of pregnancies end in miscarriage (early pregnancy loss) and in most cases they occur in the first trimester (first 3 months) of pregnancy. It is believed that this is a conservative estimate as many women may not report early miscarriages or are not even aware of being pregnant when a miscarriage occurs.

Read more on about miscarriage.

There are several terms that are used to refer to miscarriages. Many people associated the term abortion with an induced abortion, which is intentional termination of pregnancy (also known as a medical or surgical abortion). However, this is untrue. There are many types of abortions, both intentional and unintentional.

Complete abortion

In this case, all the products of conception (the fetus, placenta and membranes) are expelled from the uterus.

Incomplete abortion

Some of the products of conception, but not all, are expelled from the uterus.

Threatened abortion

Bleeding through the vagina may indicate that there is a chance of this pregnancy ending in a miscarriage, but in most cases the danger can be averted and it goes on to continue as a normal pregnancy.

Inevitable abortion

There may be signs of an impending abortion such as bleeding through the vagina with abdominal cramps and in this case the pregnancy cannot be saved.

Missed abortion

Despite death of the fetus, the products of conception are still retained within the uterus. This type of miscarriage may not be obvious immediately. It may be suspected when there is loss of pregnancy symptoms and can be confirmed by ultrasonography.

Infected abortion

There is infection within the uterus or products of conception after a miscarriage.

Recurrent abortion

Also known as habitual abortion is when three consecutive pregnancies end in spontaneous abortion.

Causes of Early Miscarriage

Most miscarriages are associated with abnormal products of conception due to some chromosomal abnormalities (genetic defects), such as in a molar pregnancy. A molar pregnancy is an abnormal form of pregnancy where the uterus may not contain a fetus or placenta but is occupied by a hydatidiform mole which resembles a bunch of grapes. A blighted ovum is where there is a pregnancy sac within the uterus but it does not contain a fetus.

An ectopic pregnancy is where the fertilized egg is implanted in some other area instead of the uterus, usually in the fallopian tube. This is a medical emergency and requires immediate professional medical care. However, it is important to understand that no specific cause of a miscarriage can be found in a large number of cases. As previously stated, it is not uncommon for 1 in 5 pregnancies to result in miscarriage often for no identifiable reason.

Risk Factors

The following factors may cause a miscarriage in some women.

  • Pelvic infection
  • Defects in the mother’s reproductive system such as abnormalities of the uterus or cervical incompetence.
  • Immunological factors
  • Hormonal problems
  • Systemic diseases such as diabetes, hypertension (high blood pressure) or thyroid problems.
  • Injury  to the pregnant uterus, either accidental or as a result of physical abuse. Indirect injury may also be caused by surgery (such as appendectomy) or electric shock.
  • History of previous miscarriages.
  • Cigarette smoking, alcohol and drug abuse.
  • Increased risk in older women, especially over the age of 35.
  • Infectious diseases such as rubella (German measles).
  • Prenatal genetic tests such as amniocentesis or chorionic villus sampling.

How Do You Know If You Miscarried?

It is not uncommon for women to find out that they were pregnant and miscarried when visiting a doctor for an intermenstrual bleed (bleeding between periods). Sometimes women may mistaken this bleed for an early period, especially if there is a history of irregular menses. It also not uncommon for awoman to never know that she was pregnant and miscarried, especially in the first few weeks of pregnancy.

Symptoms

These are some of the signs and symptoms that may be present depending on the type of miscarriage (abortion).

  • In threatened abortion, the symptoms may be mild such as slight vaginal bleeding or abdominal cramping. On pelvic examination, the doctor will find a closed cervical os.
  • In inevitable abortion, there is likely to be persistent and severe bleeding along with low back pain and severe abdominal cramps, which may not be reduced even with pain relievers. Rupture of membranes may cause a gush of fluid to come out of the vagina. On examination, the cervical os will be found to be open and dilated and some products of conception may be visible or felt.
  • In incomplete abortion, there will be persistent and severe bleeding but abdominal pain and cramps are less. Some products of conception are expelled by the uterus but some are still retained within it.
  • In complete abortion, since all the products of conception have come out, bleeding gradually becomes less and pain eventually ceases.
  • In missed abortion, pain is less likely to be present. There may be a brownish vaginal discharge but the os is closed. A missed abortion may be suspected if there is loss of symptoms of pregnancy or a decrease in size of the uterus.
  • In infected abortion, there is likely to be fever, chills, foul-smelling vaginal discharge, pelvic discomfort and often pain.

Read more on abnormal vaginal bleeding.

Warning Signs

If pregnant women have any of the following signs then immediate medical attention is necessary.

  • Spotting or vaginal bleeding, even if there is no pain.
  • Slight vaginal bleeding with low back pain.
  • Severe bleeding with abdominal pain or cramping.
  • Passage of some clot-like tissues or products of conception.
  • No pain or bleeding but passage of a gush of fluid from the vagina.

Complications of a Miscarriage

Immediate and long term complications include:

  • Severe and prolonged bleeding may become life-threatening due to excessive blood loss.
  • Shock
  • Infection
  • Infertility
  • Perforation of the uterus while doing a D & C.
  • Injury to the bladder or intestines.
  • Depression or other emotional problems.

Treatment of Early Miscarriage

A threatened abortion can be treated by bed rest, avoiding intercourse and mild sedatives to prevent it from progressing to a miscarriage. Drugs containing progesterone may be of some benefit. However, if a miscarriage has occurred then one or more of the following treatments has to be considered.

  • D & C (dilatation and curettage) is done to ensure removal of all the products of conception from the uterus.
  • Blood transfusion may be necessary for excessive blood loss.
  • Rh immunoglobulin should be administered to Rh negative women after miscarriage, if indicated.
  • Control of infection by antibiotics, if necessary.
  • Emotional support and counselling.

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