Miscarriage is one of the most common forms of pregnancy loss. It has been estimated that up to 50 percent of all pregnancies will end in miscarriage, though many of these are pregnancies that the mother was not even aware of. Miscarriage is generally defined as the loss of a pregnancy prior to twenty weeks of gestation.

Many miscarriages occur very early in the pregnancy — sometimes so early that you may not have even known you were pregnant. Perhaps you thought your period was just a bit late or a bit heavy. This can be a sign of a very early miscarriage.

There are several types of miscarriage. Spontaneous miscarriage, also called spontaneous abortion, means that your body completed the process and the uterus is empty. Incomplete or partial miscarriage could be a miscarriage in progress or one that has stopped prior to being completed. You may require a minor surgical procedure called a dilation and curettage (D&C) to help expel the rest of the uterine contents. There is also the threatened miscarriage, which is where you experience bleeding and/or cramping at any point early in pregnancy up to 20–22 weeks. Typically since there is nothing that can be done to truly stop a miscarriage that is destined to be, you are told to watch for escalating signs of miscarriage (more bleeding, cramping, etc.). This crisis is over when you are either out of the danger zone datewise or you cease having the symptoms.

Treatment

If a miscarriage is threatening, you will be asked to come into the doctor's office or emergency room for evaluation. You will have your blood drawn to check your hormone levels, particularly your hCG levels (the pregnancy hormone). This test might be repeated to help determine if your pregnancy is viable. It will usually be repeated in forty-eight- to seventy-two-hour increments.

You might be given an ultrasound depending on how far along you are. An ultrasound can reveal roughly what state your pregnancy is in and whether or not that matches your dates by your period. Sometimes you can see your baby's heart beating. This is generally considered a good sign. If a heartbeat is not seen, a follow-up ultrasound will be scheduled.

This waiting game is a time of not knowing, and therefore very stressful. You may feel and act pregnant, but are not sure as to what is happening within you. Sometimes the symptoms of pregnancy are more difficult for you to deal with because of the uncertainty. At the follow-up ultrasound, the doctors will be looking for signs of growth and fetal development to judge viability.

Causes of Miscarriage

Many things can cause miscarriage. It can be related to a decrease in hormone levels, particularly progesterone. It can be caused by a chromosomal abnormality in the baby. However, rest assured that exercising, falls, car accidents, arguments, negative thoughts, and the like do not typically cause miscarriage.

Chromosomes

Chromosomal problems are one of the most common causes of miscarriage, comprising over half of all miscarriages. It may be a case of problems with the number of chromosomes, the structure of the chromosomes, or even the genetic material that they carry. Random, chance problems are the usual cause of genetic problems; however, there are times when some genes are repeatedly passed on that can contribute to multiple pregnancy losses. A genetics specialist should test you and your partner if it is suspected that you are repeatedly passing on chromosomal problems.

Abnormalities of the Uterus

Abnormalities of the uterus can be something that you're born with, like a double uterus or a uterus that is divided by a wall (septate). Some women also have problems with fibroids, growths that can occur any place in the uterus. The good news is that the majority of these problems can be dealt with prior to conception through surgery, thus increasing your chances of a healthy pregnancy.

Hormonal Imbalance

Hormonal imbalance can be a problem for some women, usually known as a luteal phase defect, where there is not enough progesterone to sustain a pregnancy. Treatment is usually given in the form of hormones prior to the luteal phase to cause your body to increase the amount of progesterone it makes, or in the form of progesterone supplements during the luteal phase.

Progesterone therapy has been wildly popular, and many women and practitioners swear by this form of treatment. However, there are also those who have not found it to be beneficial. The studies available are really inconclusive. A look at the potential risks and benefits is advisable for those considering it.

Immunity Differences

Sometimes your body will treat the baby as a foreign body and attack it rather than accept it. This is caused by attacking cells called “natural killer” (NK) cells. When this happens the mother's body rejects the baby and a miscarriage ensues. There are certain blood tests that can help determine if this is your problem. Treating a high natural killer cell issue is done with a procedure called intravenous immunoglobulin therapy (IVIG). These treatments are very expensive. They can cost upward of $1,000 per treatment and are rarely covered by insurance. Fertility specialists cannot even agree among themselves on whether or not IVIG therapy is beneficial.

Underlying Factors

Generally a healthy mother, even with a history of chronic illness, can have a successful pregnancy. Usually the key to this pregnancy is diagnosis and control of the underlying factors. Some will have no effect on the pregnancy, while others require monitoring. Here is a list of some of the potential problems:

Diabetes

Heart disease

Kidney disease

High blood pressure

Thyroid disease

Infections

Exposures to certain chemicals, drugs, and X-rays have the potential to cause repeated miscarriages. Some of these factors are work related, while others may be related to your lifestyle. Factors like drinking and smoking (first- and secondhand) do have an impact on pregnancy, for both partners.

How do I know if the chemicals I work with are safe?

Your employer should be able to provide you a list of all the products and chemicals with which you work. If there are no warning labels on the chemicals or products, you can try calling the manufacturer of the products. When in doubt, contact organizations like www.safemotherhood.org.

When miscarriage occurs, you may try to look back and see if you can spot a cause so that you might prevent future miscarriages. More often than not, this is simply not possible. Testing is usually not done for your first or second miscarriage. Typically, repeated miscarriage will be suspected after your third loss in a row. If you suspect you might have potential problems prior to your third loss, ask your practitioner about testing early.

• Pregnancy Loss
• Bleeding in Pregnancy