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Miscarriage, also known as spontaneous abortion, is defined as spontaneous termination of pregnancy before 20 weeks of gestation. It is a common condition, occurring in about 10 to 20% of pregnancies. The risk of miscarriage increases with advancing maternal age.
Miscarriage is a process that can be divided into 4 stages according to the signs & symptoms and investigation findings.
A threatened miscarriage is the first stage.
Vaginal bleeding is the commonest symptom in this stage. Bleeding occurs without cervical dilation or changes in the cervical consistency.
Usually, there is no significant pain in this stage.
However, mild abdominal cramps may occur.
Cervical os is closed in a threatened abortion.
Ultrasound scan shows an intrauterine pregnancy.
Threatened miscarriages commonly occur in the first trimester.
Inevitable miscarriage is the second stage.
It is associated with vaginal bleeding and cervical dilation.
Typically, vaginal bleeding is worse than a threatened miscarriage.
No tissues are passed through the vagina during this period.
On ultrasound scan, the products of conception are located in the lower part of the uterus.
Third stage is the incomplete miscarriage.
It is associated with vaginal bleeding, dilation of the cervical canal, and passage of the products of conception.
Usually, vaginal bleeding is heavy, and the abdominal cramps are more intense.
Ultrasound scan might show the remaining products of conception in the uterus.
Fourth and final stage is the complete miscarriage.
Patient will reveal a history of vaginal bleeding, abdominal pain, and passage of tissue. After all the tissue has been passed, abdominal pain will subsides, and vaginal bleeding diminishes.
Examination will reveal some blood in the vaginal vault, and a closed cervical os.
There is no tenderness in the uterus, cervix, adnexa, or abdomen.
Ultrasound scan will show an empty uterus.
Sometimes, a miscarriage may not follow all these stages. Such miscarriages are called missed miscarriages.
A missed miscarriage is a non viable intra uterine pregnancy that has been retained within the uterus without spontaneous abortion. No vaginal bleeding, abdominal pain, passage of tissue, or cervical changes are present.
Commonest cause for miscarriages is genetic defects in the fetus.
Maternal factors contributing to miscarriages include the following.
Advanced maternal age.
Structural abnormalities in the reproductive system, including congenital uterine defects, uterine fibroids, and cervical incompetence.
Hormonal imbalances.
Active infections, including rubella, cytomegalovirus infection, toxoplasmosis, listeria infection, HIV infection, dengue, and brucellosis.
Polycystic ovarian syndrome.
Uncontrolled diabetes mellitus.
Renal disease.
Untreated thyroid disease.
High blood pressure.
And external factors such as smoking, alcoholism, cocaine, and high caffeine intake.
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