Placental causes include preexisting chronic disorders that are poorly controlled eg, systemic lupus erythematosus [SLE], chronic hypertension. Chromosomal abnormalities Overview of Chromosomal Anomalies Chromosomal anomalies cause various disorders. Anomalies that affect autosomes the 22 paired chromosomes that are alike in males and females are more common than those that affect sex chromosomes Evaluation for recurrent pregnancy loss should include the following to help determine the cause:.
Genetic evaluation Genetic Evaluation Genetic evaluation is part of routine prenatal care and is ideally done before conception.
The extent of genetic evaluation a woman chooses is related to how the woman weighs factors such as Screening for hereditary thrombotic disorders is no longer routinely recommended unless supervised by a maternal-fetal medicine specialist. Some causes of recurrent pregnancy loss can be treated. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world.
The Manual was first published in as a service to the community. Learn more about our commitment to Global Medical Knowledge. This site complies with the HONcode standard for trustworthy health information: verify here. Common Health Topics. Videos Figures Images Quizzes Symptoms. Courtesy of. Symptoms and Signs. Key Points.
Recurrent Pregnancy Loss. Etiology Diagnosis Treatment Key Points. Abnormalities of Pregnancy. Test your knowledge. Bacterial vaginosis is vaginitis due to an alteration in vaginal flora in which lactobacilli decrease and anaerobic pathogens overgrow.
Which of the following is least likely to contribute to this condition? More Content. Click here for Patient Education. Early or late. Clinical criteria.
Disappearance of previously detected embryonic cardiac activity. Observation for threatened abortion. Uterine evacuation is eventually necessary for inevitable, incomplete, or missed abortions. Often, uterine evacuation is not needed for threatened and complete abortions. Causes of recurrent pregnancy loss may be maternal, fetal, or placental.
Uterine or cervical abnormalities eg, polyps, myomas, adhesions, cervical insufficiency. Maternal or paternal chromosomal abnormalities eg, balanced translocations. Expectant management proved to be successful, with no need for surgical intervention in 82 to 96 percent of women. In women with missed spontaneous abortions, expectant management has a variable but generally lower success rate than medical therapy, ranging from 16 to 76 percent.
One study 25 found that patients had an 80 percent success rate after using mcg of misoprostol, administered intravaginally and repeated after four hours, if necessary.
Intravaginal administration of misoprostol causes less diarrhea than oral administration. Patient preferences should be considered when choosing a treatment for spontaneous abortion. Physicians should discuss the available options and the evidence to support each option with the patient. There is evidence to suggest that women who are given the opportunity to choose a treatment option have better subsequent mental health than women who are not allowed to choose their therapy. An algorithm for managing women with spontaneous abortion is presented in Figure 2.
Algorithm for the management of spontaneous pregnancy loss. Physicians should recognize the psychologic issues that affect a patient who experiences a spontaneous abortion. Although the literature lacks good evidence to support psychologic counseling for women after a spontaneous abortion, it is thought that patients will have better outcomes if these issues are addressed. The patient and her partner may be dealing with feelings of guilt, and they typically will go through a grieving process and have symptoms of anxiety and depression.
Women who have a spontaneous abortion frequently struggle with guilt over what they may have done to cause or prevent the loss. Physicians should encourage the patient and her partner to allow themselves to grieve. The woman and her partner may grieve differently; specifically, they may go through the stages of grief in different orders or at different rates.
They also should be aware that friends and family members may not recognize the magnitude of their loss. Friends and family members may ignore the subject of miscarriage, or they may make well-meaning comments that try to minimize the event. Connecting the couple with a counselor who has experience in helping couples cope with pregnancy loss may be beneficial.
Many hospitals offer programs that provide follow-up care and literature to the woman and her partner. Most studies 31 — 34 have found that a significant percentage of women experience psychiatric symptoms in the weeks to months after spontaneous abortion.
Women who were found to be especially prone to these symptoms are childless and have lost a wanted pregnancy. Physicians should realize the importance of providing care that is sensitive to the medical and psychologic aspects of a couple who experiences spontaneous abortion.
Many patients report dissatisfaction with the medical care they receive. Information from reference 5. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. He also is associate dean for community health. He received his medical degree from the University of Iowa Roy J. Address correspondence to Craig P. Griebel, M. Reprints are not available from the authors. Prim Care. Early pregnancy failure—current management concepts.
Obstet Gynecol Surv. Everett C. Incidence and outcome of bleeding before the 20th week of pregnancy: prospective study from general practice. Incidence of early loss of pregnancy. N Engl J Med. First trimester pregnancy complications.
Leawood, Kan. Threatened miscarriage in general practice: diagnostic value of history taking and physical examination. Br J Gen Pract. Transvaginal sonography in the detection of retained products of conception after first-trimester spontaneous abortion. J Clin Ultrasound. The reliability of ultrasonography in the management of spontaneous abortion, clinically thought to be complete: a prospective study.
Am J Obstet Gynecol. Goddijn M, Leschot NJ. Genetic aspects of miscarriage. Spontaneous abortion. Williams Obstetrics. New York: McGrawHill, — Risk factors in miscarriage: a review. Rasch V. Cigarette, alcohol, and caffeine consumption: risk factors for spontaneous abortion.
Acta Obstet Gynecol Scand. Relationship of bacterial vaginosis and mycoplasmas to the risk of spontaneous abortion. Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study. Does stress influence early pregnancy loss?. Ann Epidemiol. Spontaneous abortion: short-term complications following either conservative or surgical management. The role of ultrasound in the expectant management of early pregnancy loss.
Ultrasound Obstet Gynecol. Expectant management of first-trimester miscarriage in clinical practice. Spontaneous abortion: expectant management, medical treatment or surgical evacuation.
Expectant management of incomplete, spontaneous first-trimester miscarriage: outcome according to initial ultrasound criteria and value of follow-up visits. Nielsen S, Hahlin M.
Take a step toward emotional healing by understanding what can cause a miscarriage, what increases the risk and what medical care might be needed. If you have passed fetal tissue from your vagina, place it in a clean container and bring it to your health care provider's office or the hospital for analysis. Most women who have vaginal spotting or bleeding in the first trimester go on to have successful pregnancies.
About 50 percent of miscarriages are associated with extra or missing chromosomes. Most often, chromosome problems result from errors that occur by chance as the embryo divides and grows — not problems inherited from the parents.
Molar pregnancy and partial molar pregnancy. With a molar pregnancy, both sets of chromosomes come from the father. A molar pregnancy is associated with abnormal growth of the placenta; there is usually no fetal development.
A partial molar pregnancy occurs when the mother's chromosomes remain, but the father provides two sets of chromosomes. A partial molar pregnancy is usually associated with abnormalities of the placenta, and an abnormal fetus.
Molar and partial molar pregnancies are not viable pregnancies. Molar and partial molar pregnancies can sometimes be associated with cancerous changes of the placenta. Some women who miscarry develop an infection in the uterus. This is also called a septic miscarriage. Signs and symptoms of this infection include:. Often, there's nothing you can do to prevent a miscarriage.
Simply focus on taking good care of yourself and your baby:. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Overview Miscarriage is the spontaneous loss of a pregnancy before the 20th week. Request an Appointment at Mayo Clinic. More Information Blighted ovum: What causes it?
Share on: Facebook Twitter. Show references Tulandi T, et al. Spontaneous abortion: Risk factors, etiology, clinical manifestations, and diagnostic evaluation.
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