Miscarriage is the spontaneous loss of a pregnancy before the 20th week, in most of the cases, it occured before the 12th week of pregnancy. Common symptoms are:
- Vaginal spotting or bleeding
- Pain or cramping in your abdomen or lower back
- Fluid or tissue passing from your vagina
It is important to note that having one or two symptoms does not confirm the miscarriage. In fact, the majority of pregnant women also experience some extend of vaginal spotting or bleeding in the first trimester and they still go on to have successful pregnancies.
There is also silent miscarriage, also known as a missed abortion. It occurs when a fetus is no longer alive, but the body does not recognize the pregnancy loss. As a result, the placenta may continue to release hormones, so women may continue to experience signs of pregnancy. Missed abortion is often diagnosed during medical check up, when a fetal heart beat is absent and/or an underdeveloped fetus is shown in ultrahang sound. In this case, many women may or may not experience these above symptoms so the news can come as a complete shock.
Causes of miscarriage
Abnormal genes or chromosomes:
About 50 % of miscarriages are associated with extra chromosomes, or missing chromosomes, or abnormalities of chromosomes. Chromosome problems can result from errors occur as the embryo divides and grows, or problems inherited from the parents. In the former case, it can explain why even both parents have normal chromosome analysis, the embryo’s abnormal chromosomes still can happend.
Chromosomal abnormalities might lead to no embryo is formed, or it stop develope and die, or the abnormality of the placenta which cause the death of the fetus.
The placenta is the essential organ linking the mother’s blood supply to her baby. If there’s a problem with the development of the placenta, it can also lead to a miscarriage.
It includes bleeding defects and thrombophilic defects, which are more common. In this case there are thrombosis of early placental vessels which can happend in any trimester. The earlier the pregnancy, the smaller the placental and uterine vessels and therefore the greater chance to form thrombus inside vessels. Once the placenta vessels are blocked, there is no adequate blood and nutrition supply for the fetus and cause its death. Treatment of the common procoagulant defects consists of preconception low-dose aspirin, followed by the addition of low-molecular-weight heparin. (3)
Maternal health conditions
In a few cases, a mother’s health condition might lead to miscarriage, especially when these problems are not under medical control. Examples include:
- Polycystic ovary syndrome (PCOS)
- Uncontrolled Diabetes
- Pelvic Infections
- Hormonal problems
- Uterus or cervix problems
- Thyroid disease
Can these activities cause miscarriage?
There are often questions provoke whether these activities can cause miscarriage or not. In fact, there are no scientific evidence to prove that they are the reason of miscarriage:
- Exercise: swimming, cycling, running. However, always discuss with your GP what type and amount of exercise is suitable for you during pregnancy
- Sexual intercourse.
- Working, provided that you’re not exposed to harmful chemicals or radiation. Discuss with your GP about working environmental condition and risks.
- Travelling by air
- Eating spicy food
Risk factors of miscarriage
- Age: Age is clearly an influence factor of miscarriage. Women older than age 35 have a higher risk of miscarriage than younger women. According to statistics, the risk of miscarriage at age 35 is 20%, at age 40 is 40-50%, and at age 45 it’s already 80%.
- Previous miscarriages: Women who have had two or more consecutive miscarriages are at higher risk of miscarriage. After one miscarriage, the risk of another was increased by half, after two, the risk doubled, and after three consecutive miscarriages, the risk was four times greater(4).
- Chronic diseases: hypertension, heart diseases, autoimmune diseasese, diabetes, etc, are risk of miscarriage.
- Uterine or cervical problems: uterine abnormalities,weak cervical tissues, cervical polyps, uterine fibroids, myoma might increase the risk of miscarriage.
- Smoking, heavy alcohol and illicit drugs consumption.
- Weight: Underweight or overweight has been linked with an increased risk of miscarriage.
- Exposure to harmful chemicals or radiation.
- Some invasive prenatal tests.
Prevention of miscarriage:
In general, the most effective prevention focus on dismissing any cause of the problem. However, it is very often that the cause of miscarriage is unknown to both doctors and parents. if the miscarriage is caused by abnormal chromosome, there’s nothing you can do to prevent it. If not, then prevent miscarriage is to minimize any risk factors, or rather get rid of them. Taking good care of yourself and have medical check regularly is the best you can do to prevent miscarriage:
- Follow regular prenatal care.
- Avoid smoking, drinking alcohol and illicit drug use. Limit caffeine intake: A recent study found that drinking more than two coffee a day appeared to be associated with a higher risk of miscarriage.
- Keep propriate body weight. Eat healthy.
- Avoid stress situations
- Sleep enough.
- Take a daily multivitamin and mineral supplements.
- Keep chronic diseases under medical control (1)
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(4) Risk of miscarriage linked strongly to mother’s age and pregnancy history, British Medical Journal, March 20, 2019, doi: https://doi.org/10.1136/bmj.l869