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DESCRIPTION
Miscarriage (spontaneous abortion) is premature termination of a pregnancy before the fetus can survive outside of the uterus, usually 20 weeks or earlier. Habitual miscarriage is three or more consecutive spontaneous losses of a non-viable fetus.
MoonDragon's Pregnancy Information: Intrauterine Fetal Demise (Stillborn)
FREQUENT SIGNS & SYMPTOMS
A woman has miscarried 3 or more times, usually without a history of any normal birth.
Uterine cramps.
Vaginal bleeding from slight to heavy.
Many miscarriages are only "threatened," and the pregnancy continues to term. Symptoms may be the same for threatened miscarriages as for those in progress.
CAUSES
Genetic abnormalities, which may be hereditary or spontaneous, resulting an abnormal or defective fetus.
Problems in the immune system.
An "allergy" to mate's sperm.
Uterine abnormalities (polyps, fibroids, congenital defects or duplications of the female genital tract) that prevent the fertilized egg from growing normally.
Incompetent cervix (inability of the cervix to hold the pregnancy) in some cases of second trimester losses.
Infections.
Hormonal abnormalities, such as defective corpus luteum function (luteal phase defect).
Connective tissue disease (systemic lupus erthematosus, antiphospholipid syndrome).
Untreated chronic medical conditions (e.g., severe hypertension, diabetes mellitus, hyperthyroidism or hypothyroidism).
RISK INCREASES WITH
Medical history of endocrine diseases, such as diabetes mellitus, hyperthyroidism or hypothyroidism. Illness that lowers immune system resistance. Recent serious illness.
Severe Stress.
Nutritional deficiencies, poor diet.
Smoking, alcohol and/or drug abuse. Exposure to harmful chemicals that harm the fetus.
PREVENTIVE MEASURES
Prevention of another miscarriage in a future pregnancy will depend in part on the diagnosis and treatment of any underlying problem.
When pregnancy occurs, seek early prenatal care from your midwife or health care provider, schedule more frequent prenatal visits and follow recommended medical advice carefully.
Eat normal, well-balanced diet. See Nutrition Information for more help with your prenatal diet.
Don't drink alcohol, smoke cigarettes or use recreational drugs.
Don't use any medications, including non-prescription drugs without medical advice. Always consult with your midwife or health care provider before using any medication, herbal remedy or nutritional supplement during pregnancy.
EXPECTED OUTCOME
In about half of the couples, the cause is undetermined, but even without treatment, there is 60% chance of a future successful pregnancy. It is not a hopeless situation in these cases.
The prognosis for a successful pregnancy can range from 30 to 90%, depending on the cause of the repetitive miscarriages. Multiple factors may be involved in some couples.
Feelings of loss and grief are common. Feelings of guilt may also be present. If these persist, seek professional psychological help.
POSSIBLE COMPLICATIONS
Inability to carry a pregnancy to term.
Uterine infection, signaled by fever, chills and aching.
Hemorrhaging from other body parts.
"Incomplete" abortion, in which some placenta or fetal tissue remains in the uterus, or missed abortion, in which the fetus dies but remains in the uterus.
TREATMENT
GENERAL MEASURES
To aid in finding a cause for the miscarriages, a variety of medical tests will be recommended. These include blood and chromosomal studies of both parents and maternal hormone studies. Physical examinations of the mother will determine any anatomical problems: x-ray imaging of the uterus and fallopian tubes (hysterosalpingography), laparoscopy, hysteroscopy (examination of internal organs with a special instrument with a lighted tip).
In some cases, medical studies of the aborted material are helpful.
Surgical procedures on the uterus or cervix may be required to correct any abnormalities.
If a serious genetic factor is found in either parent, other fertility options may be considered, such as artificial insemination (for paternal defect) or fertilization of a donor egg by the father's sperm (for maternal defect).
Repeated miscarriages are very difficult psychologically for both parents. Seek psychotherapy if needed. Support groups are available in some communities.
Additional information available from: Alliance of Genetic Support Groups
35 Wisconsin Circle, Suite 440
Chevy Chase, MD 20815
4301 Connecticut Avenue, NW, #404
Washington, DC 20008-2304
(202) 966-5557
FAX: (202) 966-8553
(800) 336-GENE -- helpline only
e-mail: info@geneticalliance.org
website: www.geneticalliance.org
or
National Center for Education in Maternal and Child Health
2000 15th Street North, Suite 701
Arlington, VA 22201
(703) 524-7802
website: www.ncemch.org
For a threatened miscarriage, follow your midwife's or health care provider's orders. Bed rest at home is often enough to stabilize the pregnancy (depending on the cause). Bleeding is occasionally severe requiring hospitalization and blood transfusion as indicated.
Following a miscarriage:
- Expect a small amount of vaginal bleeding or spotting for 8 to 10 days. Don't use tampons for 2 to 4 weeks.
- Wait through 2 or 3 normal menstrual cycles before attempting to become pregnant.
- Surgery ( D & C -- dilation and curettage, or D & E -- dilation and extraction) to remove any remaining tissue or a dead fetus may be needed.
- Psychotherapy or grief counseling for the patient and her partner my be helpful.
MEDICATION
Medicines will be prescribed for any hormonal deficiencies diagnosed (thyroid dysfunction, progesterone deficiency, or diabetes mellitus).
Antibiotics will be prescribed if infection is confirmed.
Immunologic abnormalities may require special therapy.
Medicines as required to treat any systemic disorder, such as hypertension or kidney disease.
With a subsequent pregnancy, prenatal vitamins and folic acid will usually be prescribed.
Oxytocin to control bleeding in some women.
Pain medication may be prescribed.
Blood transfusions for severe blood loss.
An Rh-negative female may be given RhoD (immune globulin) to prevent developing Rh Antibodies.
ACTIVITY
Normally, there are no restrictions, but it is cause dependent. Some curtailment of activities may be recommended for future pregnancies.
For a threatened miscarriage: Rest in bed until symptoms disappear. Avoid sexual intercourse until the outcome is known. See Bed Rest Links above.
After a miscarriage: Reduce activity and rest often during the next 48 hours.
DIET
Unless cause is due to nutritional deficiencies, no special diet may be recommended. For a threatened miscarriage: Drink fluids only, if bleeding and cramping are severe.
BENEFICIAL DIETARY SUPPLEMENTS TO PREVENT MISCARRIAGE (depending on cause)
Raspberry helps strengthen the uterus and may be taken as a tea.
False Unicorn helps strengthen the uterus.
Wild Yam helps improve hormonal balance for maintaining pregnancy.
Prenatal Vitamin Supplements provide general nutrition, which is very important for fetal development and to support pregnancy.
Folic Acid helps prevent birth defects and supports pregnancy.
Vitamin C with Bioflavonoids strengthens blood vessels.
Vitamin E helps balance hormones.
Herbal Remedies: Miscarriage Prevention Products
Herbal Remedies: Vitamin E Products
Wise Woman Herbal For The Childbearing Year By Susun S. Weed, Janice Novet
HERBAL SUGGESTIONS TO PREVENT MISCARRIAGE (depending on cause)
Black haw and crampbark are the two herbs most commonly used by European physicians, Native Americans and modern herbalists to calm the uterus.
Mountain Rose Herbs, Bulk Herbs B: Black Haw Bulk Herbs
Mountain Rose Herbs, Bulk Herbs C: Cramp Bark Bulk Herbs
Red raspberry has a long history of use in pregnancy for threatened miscarriage. Standard dosage: 2 capsules three times daily.
Mountain Rose Herbs, Bulk Herbs R: Red Raspberry Leaf Bulk Herbs
False unicorn is prized by herbalists for its adaptogenic effect on the ovaries (normalizes function).
Herbal Remedies: False Unicorn Products
False Unicorn Tincture, 100% Organic, 2 fl. oz.
Miscarriage Tincture (Helps Prevent), 100% Organic, 2 fl. oz.
Wild yam (dioscorea villosa) may benefit those women who are threatening miscarriage due to stimulation to the adrenal glands as well as the antispasmodic effects of the herb.
Herbal Remedies: Wild Yam Products
Mountain Rose Herbs, Bulk Herbs W: Wild Yam Bulk Herbs
AFTER A MISCARRIAGE
After a miscarriage: No special diet. However, if you have had significant bleeding, you may become anemic. You should follow a proper diet used to treat anemia.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
Any of the following occurs:
- Following a medical procedure; pain, swelling, redness, drainage or bleeding develops in the surgical area.
- New or unexplained symptoms develop. Drugs used in treatment may cause side effects.
Midwife: Checklist to Assist Grieving Parents
For Parents: Grieving For Parents - A Way To Heal - Loss of a Baby
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