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Miscarriage
Classification and external resources
ICD-10 O03.
ICD-9 634
MedlinePlus 001488
eMedicine topic list
MeSH D000022

Miscarriage or spontaneous abortion is the natural or spontaneous end of a pregnancy at a stage where the prenate is incapable of surviving, generally defined in humans at a gestation of prior to 20 weeks. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings O00-O99 - Pregnancy, Childbirth and the Puerperium (O00-O08 Pregnancy with Abortive outcome ( Ectopic The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female Prenatal development is the process in which an embryo or fetus (or foetus) gestates during Pregnancy, from fertilization Gestation is the carrying of an Embryo or Fetus inside a Female Viviparous Animal. Miscarriage is the most common complication of early pregnancy. [1] The medical term "spontaneous abortion" is used in reference to miscarriages because the medical term "abortion" refers to any terminated pregnancy, deliberately induced or spontaneous, although in common parlance it refers specifically to active termination of pregnancy.

Contents

Terminology

Very early miscarriages - those which occur before the sixth week LMP (since the woman's Last Menstrual Period) are medically termed early pregnancy loss[2] or chemical pregnancy. Gestational age is usually considered to be the age of an Embryo or Fetus (or newborn infant from the first day of the woman's last menstrual period (LMP [3] Miscarriages that occur after the sixth week LMP are medically termed clinical spontaneous abortion. [2]

In medical contexts, the word "abortion" refers to any process by which a pregnancy ends with the death and removal or expulsion of the fetus, regardless of whether it's spontaneous or intentionally induced. An Many women who have had miscarriages, however, object to the term "abortion" in connection with their experience, as it is generally associated with induced abortions. In recent years there has been discussion in the medical community about avoiding the use of this term in favor of the less ambiguous term "miscarriage. "[4]

Labour resulting in live birth before the 37th week of pregnancy is termed "premature birth," even if the infant dies shortly afterward. Premature birth (also known as preterm birth) is the Birth of a Baby before the standard period of Pregnancy is completed The limit of viability at which 50% of fetus/infants survive longterm is around 24 weeks, with moderate or major neurological disability dropping to 50% only by 26 weeks. The limit of viability is the Gestational age at which a prematurely born Fetus / Infant has a 50% chance of longterm survival outside its mother's A fetus (or foetus or fœtus) is a developing Mammal or other Viviparous Vertebrate, after the Embryonic stage and [5] Although long-term survival has never been reported for infants born from pregnancy shorter than 21 weeks and 5 days,[6] infants born as early as the 16th week of pregnancy may sometimes live for some minutes after birth. [7]

A fetus that dies while in the uterus after about the 20-24th week of pregnancy is termed a "stillbirth"; the precise gestational age definition varies by country. A stillbirth occurs when a Fetus which has died in the Uterus or during labor or delivery exits a Woman 's body Premature births or stillbirths are not generally considered miscarriages, though usage of the terms and causes of these events may overlap.

Forms and types

The clinical presentation of a threatened abortion describes any bleeding seen during pregnancy prior to viability, that has yet to be assessed further. At investigation it may be found that the fetus remains viable and the pregnancy continues without further problems. It has been suggested that bed rest improves the chances of the pregnancy continuing when a small subchorionic hematoma has been found on ultrasound scans. Bed rest is a Doctor's prescription to spend a longer period of time in bed A hematoma, or haematoma, is a collection of Blood outside the blood vessels generally the result of Hemorrhage, or more specifically Internal bleeding [8]

Alternatively the following terms are used to describe pregnancies that do not continue:

The following two terms consider wider complications or implications of a miscarriage:

Causes

Miscarriages can occur for many reasons, not all of which can be identified.

First trimester

Most clinically apparent miscarriages (two thirds to three-quarters in various studies) occur during the first trimester. [11][12]

Chromosomal abnormalities are found in more than half of embryos miscarried in the first 13 weeks. A pregnancy with a genetic problem has a 95% chance of ending in miscarriage. Most chromosomal problems happen by chance, have nothing to do with the parents, and are unlikely to recur. [13] Genetic problems are more likely to occur with older parents; this may account for the higher miscarriage rates observed in older women. [14]

Another cause of early miscarriage may be progesterone deficiency. Progesterone is a C-21 Steroid Hormone involved in the Female Menstrual cycle, Pregnancy (supports Gestation Women diagnosed with low progesterone levels in the second half of their menstrual cycle (luteal phase) may be prescribed progesterone supplements, to be taken for the first trimester of pregnancy. The luteal phase (or secretory phase) is the latter phase of the Menstrual cycle (in humans and a few other animals or the Estrous cycle (in other [13] However, no study has shown that general first-trimester progesterone supplements reduce the risk of miscarriage,[15] and even the identification of problems with the luteal phase as contributing to miscarriage has been questioned. [16]

Second trimester

Up to 15% of pregnancy losses in the second trimester may be due to uterine malformation, growths in the uterus (fibroids), or cervical problems. A uterine malformation is the result of an abnormal development of the Mullerian duct (s during Embryogenesis. Uterine fibroids (singular Uterine Fibroma) ( leiomyomata, singular leiomyoma) are Benign Tumors which grow from the muscle layers of In Medicine, cervical incompetence is a condition in which a pregnant woman's Cervix begins to dilate (widen and efface (thin before [13] These conditions may also contribute to premature birth. Premature birth (also known as preterm birth) is the Birth of a Baby before the standard period of Pregnancy is completed [11]

One study found that 19% of second trimester losses were caused by problems with the umbilical cord. In placental Mammals the umbilical cord (also called the birth cord or funiculus umbilicalis) is the connecting cord from the developing Embryo Problems with the placenta may also account for a significant number of later-term miscarriages. The placenta is an Ephemeral organ present in placental Vertebrates, such as Eutherial Mammals and Sharks during Gestation [17]

General risk factors

Pregnancies involving more than one fetus are at increased risk of miscarriage. [13]

Uncontrolled diabetes greatly increases the risk of miscarriage. Women with controlled diabetes are not at higher risk of miscarriage. Because diabetes may develop during pregnancy (gestational diabetes), an important part of prenatal care is to monitor for signs of the disease. Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood Prenatal care refers to the medical care recommended for women before and during Pregnancy. [13]

Polycystic ovary syndrome is a risk factor for miscarriage, with 30-50% of pregnancies in women with PCOS being miscarried in the first trimester. Polycystic ovary syndrome abbreviated PCOS or PCO (also known clinically as Stein-Leventhal syndrome, Sclerocystic ovary syndrome, Hyperthecosis Two studies have shown treatment with the drug metformin to significantly lower the rate of miscarriage in women with PCOS (the metformin-treated groups experienced approximately one-third the miscarriage rates of the control groups). Metformin ( INN; trade names Glucophage, Riomet, Fortamet, Glumetza, Obimet, Dianben, Diabex, [18] However, a 2006 review of metformin treatment in pregnancy found insufficient evidence of safety and did not recommend routine treatment with the drug. [19]

High blood pressure and certain illnesses (such as rubella and chlamydia) increase the risk of miscarriage. Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated Rubella, commonly known as German measles, is a Disease caused by Rubella virus [13]

Tobacco (cigarette) smokers have an increased risk of miscarriage. [20] An increase in miscarriage is also associated with the father being a cigarette smoker. [2] The husband study observed a 4% increased risk for husbands who smoke less than 20 cigarettes/day, and an 81% increased risk for husbands who smoke 20 or more cigarettes/day.

Severe cases of hypothyroidism increase the risk of miscarriage. Hypothyroidism is the disease state in humans and animals caused by insufficient production of Thyroid hormone by the Thyroid gland. The effect of milder cases of hypothyroidism on miscarriage rates has not been established. Certain immune conditions such as autoimmune diseases greatly increase the risk of miscarriage. Autoimmunity is the failure of an organism to recognize its own constituent parts as self, which results in an immune response against its own cells and tissues [13]

Cocaine use increases miscarriage rates. [20] Physical trauma, exposure to environmental toxins, and use of an IUD during the time of conception have also been linked to increased risk of miscarriage. An intrauterine device ( intra meaning within, and uterine meaning of the Uterus) is a Birth control device placed [21]

Correlations

Several factors have been correlated with higher miscarriage rates, but whether they cause miscarriages is debated. No causal mechanism may be known, the studies showing a correlation may have been retrospective (beginning the study after the miscarriages occurred, which can introduce bias) rather than prospective (beginning the study before the women became pregnant), or both.

Nausea and vomiting of pregnancy (NVP, or morning sickness) are associated with a decreased risk of miscarriage. Morning sickness, also called Nausea, Vomiting of Pregnancy ( emesis gravidarum or NVP) or pregnancy sickness Several mechanisms have been proposed for this relationship, but none are widely agreed on. [22] Because NVP may alter a woman's food intake and other activities during pregnancy, it may be a confounding factor when investigating possible causes of miscarriage.

One such factor is exercise. A study of over 92,000 pregnant women found that most types of exercise (with the exception of swimming) correlated with a higher risk of miscarriage prior to 18 weeks. Increasing time spent on exercise was associated with a greater risk of miscarriage: an approximately 10% increased risk was seen with up to 1. 5 hours per week of exercise, and a 200% increased risk was seen with over 7 hours per week of exercise. High-impact exercise was especially associated with the increased risk. No relationship was found between exercise and miscarriage rates after the 18th week of pregnancy. The majority of miscarriages had already occurred at the time women were recruited for the study, and no information on nausea during pregnancy or exercise habits prior to pregnancy was collected. [23]

Caffeine consumption has also been correlated to miscarriage rates, at least at higher levels of intake. Caffeine is a bitter white crystalline Xanthine Alkaloid that acts as a Psychoactive Stimulant Drug and a mild Diuretic A 2007 study of over 1,000 pregnant women found that women who reported consuming 200 mg or more of caffeine per day experienced a 25% miscarriage rate, compared to 13% among women who reported no caffeine consumption. 200 mg of caffeine is present in 10 oz (300 mL) of coffee or 25 oz (740 mL) of tea. This study controlled for pregnancy-associated nausea and vomiting (NVP or morning sickness): the increased miscarriage rate for heavy caffeine users was seen regardless of how NVP affected the women. About half of the miscarriages had already occurred at the time women were recruited for the study. [24] A second 2007 study of approximately 2,400 pregnant women found that caffeine intake up to 200 mg per day was not associated with increased miscarriage rates (the study did not include women who drank more than 200 mg per day past early pregnancy). [25]

Prevalence

Determining the prevalence of miscarriage is difficult. In Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given Many miscarriages happen very early in the pregnancy, before a woman may know she is pregnant. Treatment of women with miscarriage at home means medical statistics on miscarriage miss many cases. [26] Prospective studies using very sensitive early pregnancy tests have found that 25% of pregnancies are miscarried by the sixth week LMP (since the woman's Last Menstrual Period). Gestational age is usually considered to be the age of an Embryo or Fetus (or newborn infant from the first day of the woman's last menstrual period (LMP [27][28] Clinical miscarriages (those occurring after the sixth week LMP) occur in 8% of pregnancies. [28]

The risk of miscarriage decreases sharply after the 10th week LMP, i. e. when the fetal stage begins. A fetus (or foetus or fœtus) is a developing Mammal or other Viviparous Vertebrate, after the Embryonic stage and [29] The loss rate between 8. 5 weeks LMP and birth is about two percent; loss is “virtually complete by the end of the embryonic period. "[30]

The prevalence of miscarriage increases considerably with age of the parents. One study found that pregnancies from men younger than twenty-five years are 40% less likely to end in miscarriage than pregnancies from men 25-29 years. The same study found that pregnancies from men older than forty years are 60% more likely to end in miscarriage than the 25-29 year age group. [31] Another study found that the increased risk of miscarriage in pregnancies from older men is mainly seen in the first trimester. [32] Yet another study found an increased risk in women, by the age of forty-five, on the order of 800% (compared to the 20-24 age group in that study), 75% of pregnancies ended in miscarriage. [33]

Detection

The most common symptom of a miscarriage is bleeding;[34] bleeding during pregnancy may be referred to as a threatened abortion. Of women who seek clinical treatment for bleeding during pregnancy, about half will go on to have a miscarriage. [26] Symptoms other than bleeding are not statistically related to miscarriage. [34]

Miscarriage may also be detected during an ultrasound exam, or through serial human chorionic gonadotropin (HCG) testing. Human chorionic gonadotropin ( hCG) is a Glycoprotein Hormone produced in Pregnancy that is made by the Embryo soon after conception Women pregnant from ART methods, and women with a history of miscarriage, may be monitored closely and so detect a miscarriage sooner than women without such monitoring. Assisted reproductive technology ( ART) is a general term referring to methods used to achieve Pregnancy by artificial or partially artificial means

Several medical options exist for managing documented nonviable pregnancies that have not been expelled naturally.

Management

Blood loss during early pregnancy is the most common symptom of both miscarriage and of ectopic pregnancy. An ectopic pregnancy is a Complication of pregnancy in which the fertilized Ovum is implanted in any tissue other than the uterine wall Pain does not strongly correlate with miscarriage, but is a common symptom of ectopic pregnancy. [34] In the case of concerning blood loss, pain, or both, transvaginal ultrasound is performed. Obstetric sonography (ultrasonography is the application of Medical ultrasonography to Obstetrics, in which ultrasound is used to visualize the Embryo If a viable intrauterine pregnancy is not found with ultrasound, serial βHCG tests should be performed to rule out ectopic pregnancy, which is a life-threatening situation. Human chorionic gonadotropin ( hCG) is a Glycoprotein Hormone produced in Pregnancy that is made by the Embryo soon after conception [35][36]

If the bleeding is light, making an appointment to see one's doctor is recommended. If bleeding is heavy, there is considerable pain, or there is a fever, then emergency medical attention is recommended to be sought.

No treatment is necessary for a diagnosis of complete abortion (as long as ectopic pregnancy is ruled out). In cases of an incomplete abortion, empty sac, or missed abortion there are three treatment options:

Pathology

When looking for gross or microscopic pathologic symptoms of miscarriage, one looks for the products of conception. Pathology (from Greek grc πάθος pathos, "fate harm" and grc -λογία -logia) is the study and Controversy over the beginning of pregnancy usually occurs in the context of the Abortion debate Microscopically, these include villi, trophoblast, fetal parts, and background gestational changes in the endometrium. Villus ( Latin: "shaggy hair" plural villi) can refer to Intestinal villus. Trophoblasts (from Greek threphein: to feed and blastos: germinator are cells forming the outer layer of a Blastocyst, which provide nutrients The endometrium is the inner membrane of the Mammalian Uterus. Genetic tests may also be performed to look for abnormal chromosome arrangements. A chromosome is an organized structure of DNA and Protein that is found in cells.

Psychological aspects

Although a woman physically recovers from a miscarriage quickly, psychological recovery for parents in general can take a long time. People differ a lot in this regard: some are 'over it' after a few months, others take more than a year. Still others may feel relief or other less negative emotions.

For those who do go through a process of grief, it is often as if the baby had been born but died. Grief is a multi-faceted response to loss Although conventionally focused on the emotional response to loss it also has physical cognitive behavioral social and philosophical How short a time the fetus lived in the womb may not matter for the feeling of loss. From the moment pregnancy is discovered, the parents can start to bond with the unborn child. When the child turns out not to be viable, dreams, fantasies and plans for the future are disturbed roughly.

Besides the feeling of loss, a lack of understanding by others is often important. People who have not experienced a miscarriage themselves may find it hard to empathize with what has occurred and how upsetting it may be. Empathy is the capacity to recognize or understand another's state of mind or Emotion. This may lead to unrealistic expectations of the parents' recovery. The pregnancy and miscarriage are hardly mentioned anymore in conversation, often too because the subject is too painful. This can make the woman feel particularly isolated.

Interaction with pregnant women and newborn children is often also painful for parents who have experienced miscarriage. Sometimes this makes interaction with friends, acquaintances and family very difficult. [39]

ICD10 codes

  • Habitual abortion
  • Incomplete abortion
  • Missed abortion
  • Threatened abortion

N96
O03. 0-O06. 4
O02. 1
O20. 0

Notes

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    Early Pregnancy Loss (Miscarriage). Pregnancy-bliss. co. uk. The Daily Telegraph (2007). Retrieved on 2007-07-20. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1304 - Wars of Scottish Independence: Fall of Stirling Castle - King Edward I of England takes the last rebel stronghold
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  9. ^ MedlinePlus (2004-10-25). MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library "MMIV" redirects here For the Modest Mouse album see " Baron von Bullshit Rides Again " Events 1147 - The Portuguese, under Afonso I, and Crusaders from England and Flanders conquer Lisbon after a Abortion - incomplete. Medical Encyclopedia. Retrieved on 2006-05-24. Year 2006 ( MMVI) was a Common year starting on Sunday of the Gregorian calendar. Events 1218 - The Fifth Crusade leaves Acre for Egypt. 1276 - Magnus Ladulås is crowned
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See also

External links

Childbirth (also called labour, birth, partus or parturition) is the culmination of a Human Pregnancy or A stillbirth occurs when a Fetus which has died in the Uterus or during labor or delivery exits a Woman 's body Sudden antenatal death syndrome or SADS is a term used to describe the sudden Death of a Fetus when the cause cannot be explained Premature birth (also known as preterm birth) is the Birth of a Baby before the standard period of Pregnancy is completed The Open Directory Project ( ODP) also known as dmoz (from directory

Dictionary

miscarriage

-noun

  1. An accidental termination of a pregnancy.
  2. A spontaneous abortion.
  3. A failure to properly execute a plan or achieve the expected ideals.
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