Categories Of Miscarriage
Miscarriage is divided into six primary categories. Which category a woman fits into dictates the care she will need to receive. If miscarriage is threatened, then measures to prevent miscarriage are appropriate and may be effective, whereas if miscarriage is inevitable, preventative measures will not be effective and supportive care and appropriate medical care for safely completing the miscarriage are warranted.
The term threatened abortion is used when there is vaginal bleeding prior to 20 weeks gestation. This may be accompanied by abdominal aching or cramping. Upon vaginal examination, the cervix is found undilated. Incidence is 25% of pregnant women experiencing some quantity of vaginal bleeding; of these, 50% ultimately miscarry. When there is threatened abortion caused by a number of factors, including hormonal dysregulation or vaginal infection, for example, preventative strategies sometimes may avert a miscarriage; however, in the case of a nonvi-able fetus, miscarriage eventually progresses to inevitable abortion.
In inevitable abortion, there is both bleeding and lower abdominal cramping, accompanied by some degree of cervical dilatation. Bleeding may range from minimal to severe and even life threatening. Inevitable miscarriage should not be treated with strategies to prevent miscarriage; rather, confirmation that the baby is no longer alive should be obtained and, support for miscarriage completion should be provided. Most women miscarry spontaneously without complications or need for physical support, although emotional support may still be needed.
An incomplete abortion involves vaginal bleeding, cramping (contractions), cervical dilatation, and incomplete passage of the products of conception. A woman experiencing incomplete abortion frequently describes passage of clots or pieces of tissue, and reports vaginal bleeding. The cramping may be rhythmic or labor-like, although less intense than a full-term labor. At this point, the baby has already died and has either been passed or is part of the retained tissue. Treatment focuses on helping the woman to complete the miscarriage process by expelling any retained tissue, and emotional and physical healing.
With complete abortion, all of the uterine contents of pregnancy are expelled, after which cramping and bleeding subside, the cervix returns to an undilated state, and the uterus begins to involute. Other symptoms of pregnancy disappear, and a pregnancy test will yield a negative result. Only emotional support is generally required.
Missed abortion refers to a fetus that has died but is retained in the uterus, often with no signs of ensuing miscarriage. This condition may persist for several weeks before miscarriage spontaneously commences. In some cases, it will not commence without assistance. Left untreated beyond approximately 4 weeks, missed abortion can lead to serious maternal infection and rarely, disseminated intravascular coagulopathy (DIC) in the mother, which can be fatal. Medical care must be consulted.
Habitual (or Recurrent) Abortion
Habitual (or recurrent) abortion refers to a history of repeated miscarriage, defined as three or more successive pregnancy losses. Habitual miscarriage suggests the need for medical evaluation of a couple and ongoing care for what may be chronic problems (e.g., hormonal dysregulation, infection, etc.). Of women who experience a first miscarriage, only 1% experiences a second miscarriage; however, for women who have never had a live and birth who have had two or more miscarriages, the risk of subsequent miscarriage is in excess of 40%.