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To an outsider a miscarriage may appear as a bit of bad luck soon to be got over, but to the couple involved the loss of the pregnancy, even at a very early stage, may be utterly devastating and the miscarriage may have profound and prolonged emotional effects on them as the following comments illustrate: In the days that followed (the miscarriage) I grew to feel such failure, having let down my husband and my family who could have enjoyed a child or grandchild if I had been able to carry him / her properly if my body had functioned the way it was supposed to. (web) Many people are unaware how frequently miscarriages occur. Approximately one in four women who become pregnant will have one or more miscarriages. (Lachelin, V) The terms miscarriage and abortion are used interchangeably by doctors to mean the loss of a pregnancy from the uterus before 20 weeks gestation. Pregnancy loss after 20 weeks gestation is referred to as a stillbirth. Spontaneous abortion indicates that the abortion occurred naturally and that it was not induced. Legally and medically, spontaneous abortion is distinguished from stillbirth by the size and / or age of the aborts. Although the exact definition of aborts varies from state to state, the term is generally applied to a fetus of less than 20 weeks gestation and / or weighing less than 500 grams (1 lb. , 1 oz. ). (McBride, 1 - 2) It is estimated that between 25 - 50 % of conceptions spontaneously abort.
The true incidence of spontaneous miscarriage is very difficult to determine for a variety of reasons. It is clear that many miscarriages will occur before a menstrual period has been missed and thus without the woman ever knowing that she had conceived. Many other women have a suspicion that they were pregnant and aborted, but are not certain. A late, heavy, painful period is often what is experienced in a mid-first trimester spontaneous abortion. (Lachelin, 33) The major symptoms of a spontaneous abortion are abdominal cramps and bleeding from the vagina, sometimes with clots and / or bits of tissue. Early warning signs can also include pain in the lower back. It is important to realize that approximately 20 % of pregnant women experience some vaginal bleeding during the first trimester.
Less than half of these women experience a spontaneous abortion. (web) To be certain that a miscarriage occurred, the woman must have a blood pregnancy test immediately after the symptoms and a pelvic ultrasound. The blood test confirms the pregnancy in its earliest stages, and the ultrasound confirms that there is no longer an embryo. Alternatively, if there is a large clot or piece of tissue, it can be analyzed in the lab to see whether or not it is an embryo. (web) There are six categories of recognized spontaneous abortion: threatened, inevitable, incomplete, complete, missed, and septic (Lachelin, 2 - 3). The diagnosis of threatened abortion should be considered when vaginal bleeding occurs within the first 20 weeks of pregnancy. In threatened abortion, the cervical os remains closed and there is no passage of tissue.
The physician can do little to prevent fetal loss. However, strict bed rest and the avoidance of sexual intercourse can sometimes prevent the loss. (McBride, 5) An inevitable abortion diagnosis is given when the patient has the symptoms of threatened abortion, but the internal os is open. Progression to complete abortion is inevitable within hours or days. The survival of the fetus is impossible. (McBride, 5) Complete abortion means that all the products of conception the fetus, placenta, and amniotic shave been expelled from the uterus, and that the uterus is empty and curettage is not necessary.
Very early miscarriages, before 7 weeks gestation, are usually complete. (Lachelin, 2) Incomplete abortion implies that only some of the products of conception have been expelled and that some remain in the uterus. This means that there is a risk of further bleeding and of infection, and that curettage is required. (Lachelin, 2) Retention of the products of conception for more than three weeks after fetal demise is considered a missed abortion. (McBride, 6) When a temperature of at least 100. 4 degrees Fahrenheit complicates any of the previously mentioned types of spontaneous abortion, the diagnosis may be septic abortion in the absence of any other source of fever. Septic abortion is most commonly associated with intrauterine fetal demise and prolonged rupture of membrane. (McBride, 7) The cause of most spontaneous abortions is fetal death due to fetal growth abnormalities, not caused by the mother. In a study of 1, 000 women admitted with the diagnosis of abortion, almost 62 percent of the fetal specimens were found to have developmental abnormalities incompatible with life, including both embryonic and placental abnormalities. (McBride, 2) Another major cause of spontaneous abortion is chromosomal abnormalities. Chromosomal abnormalities were found in at least 50 percent of the fetal specimens from spontaneous abortions, compared with approximately seven percent of the specimens from all conceptions.
Many of these chromosomal abnormalities are believed to be spontaneous mutations. (McBride, 2) There are also maternal factors that may contribute to the occurrence of spontaneous abortion. The risk for spontaneous abortion is increased as women age. The risk is about 10 % for women in their 20 s, and skyrockets to 50 % for women in their mid- 40 s. This means that a significant portion of thirty something pregnancies will end this way.
Certain health conditions, such as diabetes, thyroid dysfunction, and hormone deficiencies, may also contribute to the occurrence of spontaneous abortion. Untreated thyroid deficiency may account for six of every 100 second-trimester miscarriages. In a study of 9, 400 pregnant women, researchers found that those with elevated levels of thyroid-stimulating hormone have a four times greater risk of second-trimester miscarriage. (Kaas, 1) Spontaneous abortion has been associated with numerous external factors, including drugs, anesthetics, radiation, and obstetric or surgical interventions. Smoking, caffeine intake, and alcohol use have also been reported to increase the incidence of spontaneous abortion. (McBride, 3 - 4) In the last couple of years, the use of caffeine in pregnancy has been widely studied. There is some evidence from controlled studies that a high intake of caffeine during early pregnancy increases the risk of miscarriage, but this has not been universally accepted (Scialli, 1). In a recent study, the Karolinska Institute found that daily intake of at least 500 mg of caffeine equivalent to about three 8 -ounce cups of coffee can double a nonsmokers risk of miscarriage in the first trimester (Caffeine, 1).
The conservative approach is to advise women to limit their intake to less than three cups of coffee or the equivalent in the first trimester. It is also reasonable to counsel women who are trying to conceive to restrict their caffeine intake. (Scialli, 1) It's helpful for women who experience miscarriage to seek out other women who have gone through pregnancy loss as well. There are several support groups for women who have miscarried once or twice. Some women may have more severe reactions to pregnancy loss than others. These reactions may include sleep disturbances, psychosomatic illness, worsening of a previous illness, irritability, and avoiding social contact particularly friends with children or friends who are pregnant.
A good therapist can help women work through some of these feelings, which are valid and common under these circumstances. (web) Although it is possible to become pregnant immediately after a spontaneous abortion, it is usually recommended to wait for one or two normal menstrual cycles before attempting another pregnancy. Some studies have found that not waiting to conceive again may increase the risk of another spontaneous abortion. (web) A report published in the British Medical Journal states that women who experience a stillbirth or late-term miscarriage should wait a year before conceiving again. It was found that a one-year period allows women to recover emotionally from the loss, making them less likely to experience anxiety and depression in a subsequent pregnancy. (Timing, 1) Most women who miscarry either once or twice do go on to have normal pregnancies and deliveries. The odds of having a miscarriage tend to increase exponentially with each recurrent miscarriage. In general, with no past history of miscarriage, a womans odds of having one are about 12 %.
After one miscarriage, the odds remain at about 12 %. After two miscarriages in a row, the odds of having another are 27 %; after three in a row, the odds jump up to 36 %; and after four miscarriages in a row, the odds skyrocket to 60 %. Because of this, it's important for the woman to stop trying after two consecutive miscarriages to be evaluated for factors causing pregnancy loss. (web) Works Cited Caffeine Linked to Miscarriage. Family Practice News. 1 March 2001.
Estronaut: A Forum for Womens Health. Online. World Wide Web. 12 November 2001. Available: web Kaas, Jennifer.
Thyroid Miscarriage Clue. Prevention. June 2001. Lachelin, Gillian C. L. Miscarriage: The Facts.
New York: Oxford, 1985. McBride, Wayne Z. Spontaneous abortion. American Family Physician.
January 1991. Scialli, Anthony. Caffeine. Family Practice News. 1 April 2000. The Miscarriage Association.
Online. World Wide Web. 12 November 2001. Available: web Timing Pregnancy After Miscarriage. Clinician Reviews. October 1999. WebMD Health.
Online. World Wide Web. 14 November 2001. Available: web
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Research essay sample on Second Trimester Pregnant Women
