Miscarriage (Spontaneous Abortion)

Introduction:

miscarriage is the loss of your products of conception before the twentieth week of pregnancy. The loss of products of conception after 20 weeks is called a stillbirth. About 20-30% of women bleed or have cramping at some time during the first 20 weeks of pregnancy and half of these women have a spontaneous miscarriage. About 85% of spontaneous abortions occur in the first trimester and tend to have fetal causes; those occurring in the second trimester are more likely to have maternal causes.

Etiology: 

  • Abnormalities in embryo or foetus.
  • Inadequate level of maternal hormones needed to assure fetal viability

  • Maternal factors:

    • Autoimmune disorders
    • Systemic disease: e.g.Diabetes Mellitus, Thyroid disorders, Coeliac disease, Polycystic ovarian syndrome
    • Blood Dyscrasias
    • Nutritional, e.g. vitamin deficiencies (especially vitamin D)
    • Maternal chromosomal anomalies, e. g. Translocations, deletions
    • Incompetent, amputated or lacerated cervix
    • Uterine Abnormalities
    • acute infections
    • Specific viral illnesses, e. g. Rubella, herpes, cytomegalovirus, toxoplasmosis
    • Severe emotional shock
    • Physical trauma.

Classification

  • Early- Loss of fetus before 12 weeks of pregnancy.
  • Late-Loss of the fetus between 12 and 20 weeks of preg.
  • spontaneous- Loss of foetus without induction or instrumentation.
  • Induced- termination of pregnancy for medical or elective reasons
  • Therapeutic- Termination of pregnancy to preserve the woman life or health or because of foetal malformations incompatible with life.
  • Threatened- Any vaginal bleeding or lower abdominal cramping in the first 20 weeks of pregnancy.
  • Inevitable- Bleeding or rupture of the membranes accompanied by pain and dilation of the cervix.
  • Incomplete- Expulsion of part of the products of conception.
  • Complete- Expulsion of all the products of conception.
  • Habitual- Three or more consecutive spontaneous abortions.
  • Missed- Prolonged delay in the expulsion of a dead fetus.
  • Septic- Infection of the contents of the uterus before, during or after a spontaneous abortion.
 

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