Early Pregnancy loss

Early Pregnancy loss

What is early pregnancy loss?

The loss of a pregnancy during the first 13 weeks of pregnancy (the first trimester) is called early pregnancy loss, miscarriage, or spontaneous abortion.

How common is early pregnancy loss?

Early pregnancy loss is common. It happens in about 10% of known pregnancies.

What causes early pregnancy loss?

About one half of cases of early pregnancy loss are caused by a random event in which the embryo receives an abnormal number of chromosomes. Chromosomes are the structures inside cells that carry genes. Most cells have 23 pairs of chromosomes for a total of 46 chromosomes. Sperm and egg cells each have 23 chromosomes. During fertilization, when the egg and sperm join, the two sets of chromosomes come together. If an egg or sperm has an abnormal number of chromosomes, the embryo also will have an abnormal number. Development will not occur normally, sometimes resulting in loss of the pregnancy.

Are there certain activities that cause early pregnancy loss?

Some women worry that they have done something to cause their pregnancy loss. Working, exercising, having sex, or having used birth control pills before getting pregnant do not cause early pregnancy loss. Morning sickness does not cause early pregnancy loss. Some women who have had an early pregnancy loss believe that it was caused by a recent fall, blow, or even a fright. In most cases, this is not true.

Smoking, alcohol, and caffeine also have been studied as causes of early pregnancy loss. Some research suggests that smoking increases the risk, while other research suggests that it does not. Alcohol use in the first trimester may slightly increase the risk of early pregnancy loss, but the research is not clear. In any case, it is best to avoid smoking and drinking alcohol during pregnancy. Consuming 200 mg or less of caffeine a day (the amount in two cups of coffee) does not appear to increase the risk of early pregnancy loss.

Are some women at higher risk of early pregnancy loss than others?

The likelihood of early pregnancy loss occurring increases as a woman gets older. Early pregnancy loss occurs in more than one third of pregnancies in women older than 40 years.

What are the signs and symptoms of early pregnancy loss?

Bleeding and cramping are the most common symptoms of early pregnancy loss. A small amount of bleeding and cramping in early pregnancy is relatively common. Bleeding often stops on its own, and the pregnancy continues normally. Bleeding and cramping also can be signs of other pregnancy problems, such as ectopic pregnancy. If you have any of these signs or symptoms, contact your obstetrician–gynecologist (ob-gyn) or other member of your health care team.

How is early pregnancy loss diagnosed?

If you have signs and symptoms of early pregnancy loss, you most likely will have a physical exam. Your obstetrician will ask you questions about when the bleeding started, how much you are bleeding, and whether you have pain or cramping. An ultrasound exam may be done to check whether the embryo is still growing in the uterus or to detect the presence of a heartbeat. You may have a test to measure the level of human chorionic gonadotropin (hCG) in your blood. This substance is made by the developing placenta. A low or decreasing level of hCG can mean loss of the pregnancy. Several ultrasound exams and hCG tests may be necessary to confirm that pregnancy loss has occurred.

If I experience early pregnancy loss, will I have to get treatment?

When a pregnancy is lost, some of the pregnancy tissue may remain in the uterus. This tissue needs to be removed. There are several ways this can be done. If the situation is not an emergency, you can help choose the type of treatment. The available options have similar risks, which include infection and heavy bleeding. The risk of serious complications, regardless of the type of treatment, is very small.

If your blood type is Rh negative, you also likely will receive a shot of Rh immunoglobulin after an early pregnancy loss. Problems can arise in a future pregnancy if you are Rh negative and the fetus is Rh positive. These problems can be prevented by giving Rh immunoglobulin after a pregnancy loss.

What nonsurgical options are available to treat early pregnancy loss?

If you do not show any signs of an infection, one option is to wait and let the tissue pass naturally. This usually takes up to 2 weeks, but it may take longer in some cases. Another option is to take medication that helps expel the tissue.

What can I expect if I have nonsurgical treatment?

You will have bleeding. The bleeding usually is heavier than a menstrual period and lasts for a longer time. Cramping pain, diarrhea, and nausea also can occur. Your ob-gyn may prescribe pain medication. You may pass tissue in addition to bleeding. With an early pregnancy loss, the pregnancy tissue resembles a blood clot. It does not look like a baby. An ultrasound exam or blood tests for hCG usually are done afterward to confirm that all of the tissue has been expelled. If it has not, you may need to have surgical treatment.

What surgical options are available to treat early pregnancy loss?

Surgery is recommended if you have signs of an infection, heavy bleeding, or other medical conditions. One surgical option is called vacuum aspiration. In this procedure, a thin tube attached to a suction device is inserted into the uterus to remove the tissue. The procedure may be performed in your doctor’s office. Local anesthesia is used. You also may be given medication to help you relax. Another option is called dilation and curettage (D&C). In a D&C, the cervix is dilated (opened), and an instrument is used to remove the pregnancy tissue. A D&C usually is done in an operating room or surgical center. General anesthesia or regional anesthesia may be used.

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