Introduction
Hello everyone, I am Dr. Sneha Deshpande, working as a Senior Consultant at Mom Story by Sahyadri Hospital, Shastrinagar, Pune. Today, we will discuss a very sensitive topic: miscarriage. So, what is a miscarriage? A miscarriage is the spontaneous loss of a pregnancy before 20 weeks. Today, we’ll focus on first-trimester miscarriages, which occur before 12 weeks of pregnancy. We will cover the causes, prevention, diagnosis, and treatment options.
Causes of Miscarriage
The most common cause of miscarriage, accounting for about 60% of cases, is chromosomal abnormalities. Pregnancy is formed by 23 chromosomes from the male partner and 23 chromosomes from the female partner. Sometimes, mutations occur in this process, leading to a pregnancy that is incompatible with life. Nature’s rule is “survival of the fittest.” If the pregnancy is healthy, nature will try to nurture and sustain it. However, if the pregnancy is unhealthy, it may result in a miscarriage or the cessation of the heartbeat.
Other Causes of Miscarriage
Medical Disorders During Pregnancy:
Diabetes: If blood sugar levels are not properly controlled during pregnancy, especially if HbA1c is more than 7, the risk of a poor pregnancy outcome increases significantly.
Hypertension: High blood pressure, especially if unmanaged or if medications unsafe for pregnancy are used, can increase the risk of miscarriage.
Thyroid Disorders: Both hyperthyroidism and hypothyroidism, if not well controlled, can lead to miscarriage.
Other Disorders: Conditions like seizure disorders, chronic kidney diseases, and certain lifestyle factors can affect pregnancy outcomes.
Body Mass Index (BMI): Maintaining a normal BMI (18.5 to 22.5) is crucial for a successful pregnancy. Both undernutrition and overnutrition can sometimes lead to miscarriage.
Occupational Hazards: Exposure to radiation or heavy metals like lead and mercury can increase the risk of miscarriage.
Advanced Maternal Age: Pregnancies occurring after 35 years of age carry a higher risk of miscarriage. Therefore, it is advisable to plan a family before 30, though career goals often make this difficult.
Substance Abuse: Chronic smoking, alcohol consumption, and drug addiction can lead to recurrent miscarriages. It is important to modify your lifestyle before planning a pregnancy.
Symptoms of Miscarriage
Most miscarriages are known as “silent miscarriages” because they may not present any symptoms. You might discover it during a routine scan when no heartbeat is detected. Other signs may include repeated spotting or bleeding, brownish discharge, abdominal pain, or a sudden regression of pregnancy symptoms such as breast tenderness or nausea. In some cases, you may pass clots or tissue.
Diagnosis and Treatment
Diagnosis:
Miscarriage is primarily diagnosed through ultrasonography and a blood test called serum beta-hCG. If the beta-hCG levels show a declining trend, miscarriage is confirmed.
Treatment Options:
If you are experiencing heavy bleeding, a sonography is done to check if the miscarriage is complete. If all pregnancy tissue has passed, no further procedure is required.
If some tissue remains, treatment options include a surgical procedure called dilation and evacuation (D&E) or the use of medication to expel the remaining tissue.