Miscarriages are common. Between 15 and 20 percent or more of confirmed pregnancies end in miscarriage. It is possible that as many as 75 percent of conceptions are lost, but most occur before a woman misses her period or realizes that she is pregnant.

It is estimated that more than 80 percent of miscarriages happen during the first 12 weeks of pregnancy.

What Causes Miscarriage?

The most frequent cause of miscarriage is chromosomal abnormalities. These are not generally inherited genetic defects, rather they are due to some sort of chromosome defect that occurred during the time of conception. Chromosomal abnormalities are found in about half of all spontaneous abortions for which medical treatment is given.

Other causes of miscarriage include:

• hormonal imbalances
• maternal health problems
• infection
• immune disorders
• trauma
• smoking
• drug use
• exposure to toxic substances
• failure of the fertilized embryo to implant correctly
• disorders of the cervix
• abnormalities of the uterus

Miscarriage is not caused by exercising, sexual intercourse, heavy lifting, working, sudden fright, nausea or vomiting (even if severe). Miscarriage is also unlikely to be caused by a fall or injury unless it is serious and life threatening.

What are the Signs and Symptoms of Miscarriage?

The symptoms of miscarriage include:

Vaginal bleeding- one quarter of pregnant women will have bleeding during pregnancy . Of those, about 50 percent will have a miscarriage.

• Cramping
• low back pain
• abdominal pain

If you have vaginal bleeding that continues for more than 24 hours, moderate or heavy bleeding, or bleeding that is accompanied by abdominal pain, cramping or fever, or if you pass tissue from your vagina contact your health care provider.

How is a Miscarriage Diagnosed?

Your health care provider will perform a pelvic exam and possibly an ultrasound and blood test.

What are the Different Types of Miscarriages?

• Threatened Miscarriage- A threatened miscarriage is when there is bleeding during the first half of pregnancy. This bleeding occurs while the cervix is closed. Bleeding may last for days or weeks. There may be cramping or not. Twenty percent of pregnant women will have bleeding in early pregnancy and will not miscarry. In the case of a threatened miscarriage your health care provider may recommend bed rest, although activity has not been proven to cause miscarriage.
• Inevitable Miscarriage- In an inevitable miscarriage, there is a rupture of membranes, the cervix dilates, and blood clots and tissue pass through the vagina.
• Incomplete Miscarriage- An incomplete miscarriage occurs when part of the pregnancy passes and part remains in the uterus. Bleeding and cramping will likely continue until the miscarriage is complete. Bleeding may be heavy.
• Missed Miscarriage- A missed miscarriage is when an embryo has died but has not been expelled from the uterus. Often times there are no symptoms and it can be several weeks before it may be discovered.
• Habitual Miscarriage- Habitual miscarriage is usually defined as 3 or more first trimester miscarriages.
• Ectopic Pregnancy- Ectopic pregnancy occurs when the fertilized egg attaches outside of the uterus
• Molar Pregnancy- Molar pregnancy occurs when an abnormal mass develops inside the uterus instead of a growing baby.

How is a Miscarriage Treated?

In the situation of a threatened abortion, it may be treated with bed rest.

If it is early in your pregnancy, and you have a miscarriage, your healthcare provider may monitor your condition to see if your body expels the pregnancy on its own. If your body does not expel all of the tissue, or if there is excessive bleeding, your health care provider may recommend a D&C procedure.

How Can I Prevent a Miscarriage?

Unfortunately, there is not much that can be done to prevent a miscarriage. Most miscarriages are due to chromosomal abnormalities, which are a chance occurrence.

The most important thing that you can do to prevent a miscarriage is to take care of your body. Eat a healthy diet, get plenty of exercise and fresh air. Manage your stress levels, and do not engage in smoking, drinking, or drug use.

If you are pregnant or planning to become pregnant, be sure that you are taking a prenatal vitamin or a folic acid supplement.

What are the Chances of a Successful Future Pregnancy?

The majority of women who have miscarriages will have a later successful pregnancy. Even women who have had 3 or more miscarriages in a row still have a 70 to 85 percent chance of carrying a future full-term pregnancy.

It is advisable in many cases to wait 3 months following a miscarriage before trying to conceive again. Talk with your health care provider to find out what may be best for you.

Grieving for a Lost Pregnancy

Miscarriage is often an event that can be difficult to come to terms with. You and those close to you may be feeling a variety of intense emotions. Grief is normal and natural. The loss of a pregnancy, even if it was only a few weeks along, can bring with it a wide variety of feelings which can be overwhelming.

Please know that the loss of a pregnancy is never anyone’s fault. Your chances of having a future healthy baby are very high.

Your grieving process may include feeling shock, denial, guilt, anger, and depression.

Your partner and family may be grieving also, but it a different way. Everyone handles loss in their own way.

If you are having difficulty coping with your feelings, talk to someone, or seek the help of a professional such as a therapist, counselor, or support group to help you get through your grief process.

What Causes Oligohydramnios?

Low amniotic fluid levels can be caused by a variety of conditions, including premature rupture of membranes, intrauterine growth restriction, birth defects, twin to twin transfusion syndrome, and carrying your pregnancy more than 2 weeks past the due date.

What are the Signs and Symptoms of Oligohydramnios?

The symptoms of oligohydramnios include leaking of amniotic fluid and decreased amount of amniotic fluid on an ultrasound.

Diagnosis is primarily made by using an ultrasound.

What is the Treatment for Oligohydramnios?

Treatment for oligohydramnios includes close monitoring of your amniotic fluid levels. Sometimes an amnioinfusion will be performed. This is an experimental procedure which involves injecting fluid into the amniotic sac.

Your baby’s health and well being will be monitored regularly. If your baby is thought to be in danger due to the low amniotic fluid, a premature delivery may be necessary.

Babies with IUGR will have a low birth weight, may develop hypothermia when born, and have a higher rate of stillbirth and fetal distress.

How is Intrauterine Growth Restriction (IUGR) Diagnosed?

Intrauterine growth restriction can be difficult to diagnose, because there are generally little or no signs and symptoms.

It is vital that you keep all of your prenatal visits and check-ups because this is the only way that IUGR can be detected. At each of your prenatal visits, your health care provider will measure your uterus to see how your baby is growing.

IUGR is usually discovered at a prenatal visit, when your health care provider detects that your measurements and your weight are not increasing at a normal rate.

Once IUGR is suspected, an ultrasound can be used to confirm the diagnosis.

What Causes Intrauterine Growth Restriction (IUGR)?

Intrauterine Growth Restriction (IUGR) could be the result of problems with the placenta, which prevent the proper transfer of nutrition and oxygen to the fetus.

The following may contribute to a predisposition to IUGR:

• Cigarette smoking
• Drug abuse
• Alcohol consumption
• Maternal high blood pressure
• Preeclampsia or eclampsia
• Malnutrition or poor weight gain by the mother
• Disease in the mother
• Multiples pregnancies
• Immune disorders
• Cord or placenta abnormalities
• Rubella, cytomegalovirus, or toxoplasmosis infection
• Birth defects or chromosomal abnormalities
• Maternal anemia

What is the Treatment for Intrauterine Growth Restriction (IUGR)?

The first step to improving intrauterine growth restriction is to avoid correct any contributing factors, such as smoking, drug use, alcohol use, or poor nutrition.

Sometimes admission to the hospital or bed rest may be prescribed. Resting on your side takes pressure off of the uterus and can help the baby get optimal blood flow, which is key to improving the baby’s health and growth.

If disease in the mother is the cause of IUGR, then treatment will be geared at improving the mother’s health.

Ultrasound may be used every few weeks to help track the baby’s growth and development. Your healthcare provider may suggest an amniocentesis in order to evaluate whether or not the fetus has any chromosomal abnormalities or if an infection is present.

If test results show that your baby is not growing well and that the fetus is in danger, your health care provider may recommend early delivery of your baby. This may be done by inducing a vaginal labor or by caesarian, depending on the issues involved.

Sometimes it is possible to reverse IUGR with careful monitoring and early intervention. Even if the baby does not catch up to normal size before birth, it is not an indication of future growth and development.

Many growth restricted babies will catch up to normal sizes by the time they are 1 ½ to 2 years of age. In many cases the chances are high that most growth restricted babies will have normal physical and intellectual development over time.

In cases of incompetent cervix, a cervical cerclage is generally performed in order to help prevent miscarriage.

Hydramnios, or polyhydramnios, is a condition where there is an excess of amniotic fluid surrounding the fetus. Hydramnios occurs in approximately 3 to 4 percent of pregnancies.

What Causes Hydramnios?

Hydramnios can arise from an excess production of amniotic fluid or from a problem in the fetus that prevents the fluid from being taken up. Maternal diabetes can predispose a pregnant woman to hydramnios.

Issues with the fetus that can cause hydramnios include congenital infection, gastrointestinal abnormalities that block the passage of fluid, abnormal swallowing, chromosomal abnormalities, central nervous system abnormalities, heart failure, and twin-to-twin transfusion syndrome.

What are the Risks Associated with Hydramnios?

An excess of amniotic fluid can lead to preterm labor or early rupture of the amniotic sac (water breaks). If the amniotic sac ruptures, there is a greater risk of the placenta detaching (placental abruption).

Hydramnios can lead to birth defects in the fetus.

What are the Signs and Symptoms of Hydramnios?

Symptoms of hydramnios include contractions, abdominal discomfort and rapid growth of the uterus.

Hydramnios is generally diagnosed with the use of an ultrasound.

How is Hydramnios Treated?

The treatment of hydramnios includes close monitoring of amniotic fluid levels, medication to decrease urine production in the baby, amniocentesis procedure to remove amniotic fluid and decrease pressure, and early delivery.

What is HELLP Syndrome?

HELLP syndrome is a serious condition which is a complication of pregnancy induced hypertension (PIH). It is related to preeclampsia and toxemia. It usually develops during pregnancy, but can develop after childbirth as well.

Hemolysis is the destruction of red blood cells. Elevated liver enzymes indicate a disorder of the liver and possibly damage to the liver. Low platelets indicate a low number of cells which are required to help blood to clot and work to arrest bleeding.

What are the Signs and Symptoms of HELLP Syndrome?

Not all symptoms need be present:

• headache
• nausea/vomiting
• stomach tenderness and abdominal pain in the upper right side of the abdomen
• increased blood pressure
• swelling
• protein in the urine
• visual disturbances
• bleeding

HELLP syndrome can be life threatening to the mother and baby. Seek treatment immediately.

How is HELLP Syndrome Diagnosed?

HELLP syndrome is diagnosed through physical exams and lab tests, including red blood cell count, liver function tests, platelet counts and urine tests.

What is the Treatment for HELLP Syndrome?

Treatment for HELLP Syndrome depends on the severity of your symptoms. You may be put on bed rest, hospitalized, receive blood pressure regulating medications and other medications.

If you have HELLP Syndrome, your baby may be monitored with a variety of tests to help assess its well-being.

Your blood pressure and lab results will be carefully monitored.

Early diagnosis and treatment of HELLP syndrome is important to preventing some complications of the disease.

If symptoms are worsening, it may endanger the lives of both the mother and the baby. If symptoms are severe, early delivery may be necessary.

Generally, Group B strep causes no symptoms in adults, but can cause serious and life threatening infections in newborns.

Your health care provider will test you for Group B strep. This test is performed between weeks 35 and 37 of gestation.

Giving antibiotics to women testing positive for Group B strep during labor has been found to prevent most Group B strep infections in newborns.

The risk of a molar pregnancy is higher in woman over the age of 40 years.

A molar pregnancy can be the result of chromosome problems in the sperm, egg, or embryo.

There are two types of molar pregnancy: partial molar pregnancy and complete molar pregnancy. In a partial molar pregnancy, the embryo is abnormally formed, and generally will not survive. In a complete molar pregnancy, the uterus has a cluster of fluid filled pouches instead of an embryo.

What are the Signs and Symptoms of a Molar Pregnancy?

Molar pregnancy will generally cause bleeding before the 12th week of pregnancy. Also, in the case of a molar pregnancy, the uterus often expands more than usual. Often hCG hormone levels will be higher than normal when a molar pregnancy is present.

How is a Molar Pregnancy Diagnosed?

Your health care provider may check your hCG levels, listen for a fetal heartbeat, and perform and ultrasound.

How is a Molar Pregnancy Treated?

A molar pregnancy is generally treated by removing it with a D&C (dilation and curettage) procedure.

Following a molar pregnancy, it is advised that you wait at least one year before attempting to become pregnant again.

Are there Complications from a Molar Pregnancy?

After a molar pregnancy, it is important to make sure that all the tissue has been successfully removed from the uterus. After a molar pregnancy, women are at risk of developing a type of malignant tumor in the uterus.

The development of a tumor is very rare, and the success rate of treating the tumors is close to 100 percent with the use of chemotherapy.

For this reason, your doctor will monitor you regularly after the D&C procedure, checking your hCG levels, which helps to detect any abnormal growth.

What is Gestational Diabetes?

Diabetes is a condition in which blood sugar levels in the body are not regulating correctly. The hormone insulin controls blood sugar, or glucose levels, in the body. Gestational diabetes occurs when a pregnant woman who didn’t previously have diabetes develops the condition while pregnant.

What are the Risk Factors for Gestational Diabetes?

The risk factors for gestational diabetes include:

• Family history of diabetes
• Obesity
• Age older than 30
• Previous complications during pregnancy
• High blood pressure

What are the Signs and Symptoms of Gestational Diabetes?

Gestational diabetes generally does not cause any symptoms and is usually discovered through testing.

How is Gestational Diabetes Diagnosed?

Gestational Diabetes is diagnosed through screening tests. The 1 hour glucose challenge test is a routine screening which is done between weeks 26 and 28 of pregnancy.

When this screening is done, you will be asked to drink a glass of a sweet glucose solution containing 50 grams of glucose. One hour later you will have a blood sample drawn so that your blood glucose level can be checked.

If your test result is abnormal, you will be asked to return for a second test called an oral glucose tolerance test.

For the glucose tolerance test you will be asked to fast overnight. When you arrive at your health care provider for testing, you will be given a very strong glucose solution with 100 grams of glucose to drink.

Your blood will be drawn 4 times. The first time is before you drink the glucose solution, and then at 1, 2, and 3 hour intervals after you drink the glucose solution.

How is Gestational Diabetes Treated?

Gestational diabetes is treated by managing your blood sugar levels. This involves dietary changes, exercise and regular testing of your blood glucose level.

If you are unable to manage your condition through diet and exercise, you may be given an oral medication or insulin shots to control your blood sugar levels.

Gestational diabetes generally disappears shortly after the delivery of your baby.

Does Gestational Diabetes Pose any Risks to the Baby?

Gestational diabetes can be harmful to the baby if goes untreated. This is because women who have gestational diabetes tend to have babies with excessive birth weight.

Large babies are more at risk of being injured during childbirth than average sized babies. Large babies are also at risk of having hypoglycemia, respiratory distress, and being still born.

When you receive treatment for gestational diabetes, your baby will be at no greater risk than any other baby.

Generally, a mild infection or cold will not be a risk to the fetus. There are other diseases that are a risk to your baby. Some of these may go virtually unnoticed by the mother, yet be very harmful to the growing baby.

The following are a list of infections that may be transmitted from a mother to her growing baby:

• HIV
• Syphilis
• Herpes simplex virus
• Rubella (German measles)
• Cytomegalovirus (CMV)
• Chickenpox
• Fifth disease (Human Parovirus B19)
• Lyme disease
• Hepatitis B
• Group B Strep
• Toxoplasmosis