Miscarriage Signs and Symptoms, Diagnosis, Treatment, Outlook
Signs and Symptoms of Miscarriage
The signs and symptoms will depend upon the type of abortion.
- In threatened abortion, the symptoms may be mild such as slight bleeding or abdominal cramping. On pelvic examination, the doctor will find a closed cervical os.
- In inevitable abortion, there is likely to be persistent and severe bleeding along with low back pain and severe abdominal cramps, which may not be reduced even with pain relievers. Rupture of membranes may cause a gush of fluid to come out of the vagina. On examination, the os will be found to be open and much dilated and some products of conception may be visible or felt.
- In incomplete abortion, there will be persistent and severe bleeding but abdominal pain and cramps are less. Some products of conception are expelled by the uterus but some are still retained within it.
- In complete abortion, since all the products of conception have come out, bleeding gradually
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becomes less and pain ceases too.
- In missed abortion, pain is unlikely. There may be a brownish vaginal discharge but os is closed. A missed abortion may be suspected if there is loss of symptoms of pregnancy or a decrease in size of the uterus.
- In infected abortion, there is likely to be fever, chills,
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foul-smelling vaginal discharge, and pelvic discomfort or pain.
What are the Warning Signs of a Miscarriage?
If you have any of the following signs you should call your doctor –
- Spotting or vaginal bleeding, even if there is no pain.
- Slight bleeding with low back pain.
- Severe bleeding with abdominal pain or cramping.
- Passage of some clot-like tissues or products of conception.
- No pain or bleeding, but passage of a gush of fluid from the vagina.
How is a Miscarriage Diagnosed?
- The doctor will diagnose a case of miscarriage by carefully listening to the history and by doing a physical examination, including a pelvic examination.
- Ultrasonography will help in a definite diagnosis.
- Blood tests – complete blood count (CBC), WBC, blood typing and Rh.
- Qualitative and quantitative HCG (human chorionic gonadotropin).
Complications of a Miscarriage
Immediate and long term complications include -
- Severe and prolonged bleeding may become life-threatening due to excessive blood loss.
- Perforation of the uterus while doing a D & C.
- Injury to the bladder or intestines.
- Depression or other emotional problems.
Prevention of Miscarriage
- In most cases, miscarriage cannot be prevented, where either the cause is unknown or there is some genetic defect.
- Proper antenatal care and advice and treatment of diseases such as diabetes, hypertension or thyroid problems.
- Avoiding exposure to infectious diseases such as rubella.
- Cerclage procedure in case of incompetent cervix. Stitches are put in the cervix to prevent it from opening too early. The stitches are removed at time of delivery.
- Treating any other causative factor if identified.
- Abstaining from smoking, alcohol and drug abuse.
- Careful assessment and monitoring of women who have recurrent abortion. Starting vitamins and folic acid from at least 3 months before conception may be tried. 3 months spacing between pregnancies is also advisable.
Treatment of Miscarriage
- A threatened abortion can be treated by bed rest, avoiding intercourse and mild sedatives to prevent it from progressing to a miscarriage. Drugs containing progesterone may be of some benefit but opinion is divided about that.
- D & C (dilatation and curettage) is done to ensure removal of all the products of conception from the uterus.
- Blood transfusion may be necessary for excessive blood loss.
- Rh immunoglobulin should
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be give to Rh negative women after miscarriage, if indicated.
- Control of infection by antibiotics, if necessary.
- Observation for further bleeding.
- Examination of the expelled tissue to ensure complete evacuation of the uterus and to rule out hydatidiform mole.
- Emotional support.
Chances of a normal pregnancy occurring after a miscarriage are very good.
There is no reason why you cannot try for another pregnancy after a miscarriage, although a spacing of one month is suggested.
In case of recurrent abortion, a spacing of 3 months between pregnancies is advisable.