There is no guarantee that every pregnancy will go on to full term despite the best efforts of the mother, caregivers and medical professionals. While some factors such as advancing maternal age, generally over 35 years, is known to be associated with a greater risk of miscarriage, there is no sure way of knowing at the outset whether a pregnancy will end with the delivery of a healthy baby or in a miscarriage. Nevertheless, if a miscarriage happens more than once consecutively, it needs to be investigated further.

Reasons for Spontaneous Abortion

The exact reason for a miscarriage cannot always be determined. Intensive investigation is warranted in the event of recurrent spontaneous abortions.  Some of the possible causes of a miscarriage includes :

• Genetic abnormalities, also known as chromosomal abnormalities, are the most common causes of miscarriage with most occurring within the first trimester and less frequently before 24 weeks.
• Various factors, sometimes unknown, may be teratogenic (causes embryo malformation) or mutagenic (causes gene mutation). This can at times be associated with lifestyle factors such as cigarette smoking, alcohol consumption and illicit drug use.
• Structural problems of the uterus, cervix and endocervical canal. This includes uterine fibroids.
• Previous uterine surgery can cause adhesions (scar tissue) which may also complicate the pregnancy and lead to miscarriage. This is known as Asherman’s syndrome. Certain medication may also be a causative factor particularly in an unplanned pregnancy. Surgical and medical factors are known as iatrogenic causes. Read more on drugs that affect pregnancy.
• Infections such as rubella (German measles), toxoplasmosis and Listeria infection.
• Chronic diseases particularly endocrine and gynecological disorders such as polycystic ovary syndrome, thyroid disorders, uncontrolled diabetes mellitus, Cushing syndrome and corpus lutem deficiency which is more often acute. Other conditions such as kidney disease, systemic lupus erythematosus (SLE), severe hypertension, sickle cell anemia and antiphospholipid-antibody syndrome may also be associated with a miscarriage.
• Lifestyle factors including tobacco use, alcohol consumption, illicit substances like cocaine and crack and excessive caffeine intake.
• Psychological and physical stress may also be responsible for a miscarriage.
• Injury to the pregnant uterus may be associated with assault, car accidents, falls or even a high voltage electric shock can also cause a miscarriage depending on the severity of the trauma.

Symptoms of a Miscarriage

The most common and pronounced symptom of miscarriage is vaginal bleeding during pregnancy. Sometimes a miscarriage may occur without a woman even knowing that she is pregnant and is marked by unusually heavy periods. This is often ignored and normal periods resumes afterwards. It is important to note that bleeding in the first trimester does not in every case mean that there is a miscarriage. Most women who do experience this type of pregnancy bleed go on to carry full term and give birth to a healthy baby.

Other symptoms of a miscarriage may include abdominal pains and cramps which may also extend to the back. Apart from blood, there may be a copious discharge of fluid from the vagina along with pieces of tissue. Fever, chills, generalized body pains and a foul smelling vaginal discharge may also be present. Some of these symptoms can occur with other pregnancy-related and gynecological disorders that requires further investigation.

Stages of Abortion

There are several terms that are used to describe different types of abortion. The four types known as threatened, inevitable, incomplete and complete abortion are four stages seen in spontaneous abortion.

• Threatened abortion is where the pregnancy is at risk and it typically presents as vaginal bleeding in early pregnancy. About half of all cases can be treated and managed effectively to ensure a normal and healthy full term pregnancy. Threatened abortion is often seen as the first stage of spontaneous abortion.
• Inevitable abortion is where the pregnancy cannot be saved and the cervix dilates in preparation to expel the products of conception. It is marked by vaginal bleeding in addition to abdominal cramping and pain with lower back pain. Inevitable abortion is considered as the second stage of spontaneous abortion.
• Incomplete abortion is where some of the products of conception pass out of the uterus through the dilated cervix and is expelled through the vagina. Along with the symptoms mentioned above under threatened and inevitable abortion, there is also gushing of fluid from the vagina along with pieces of tissue.  Not all the products of conception are expelled though and intervention may be necessary. This is considered to be the third stage of abortion.
• Complete abortion is where all the products of conception have been expelled from the uterus. The vaginal bleeding and abdominal pain peaks and gradually subsides as all the contents are expelled. The cervical dilatation resolves and the os closes. This is considered to be the fourth and final stage of a miscarriage.

Sometimes the products of conception are fully retained and this is known as a missed abortion.

Vaginal bleeding in pregnancy is not always serious. Within the first few days after conceiving, you will experience a little spotting or light bleed. This is known as the implantation bleed and is perfectly normal. Apart from the implantation bleed, mild spotting and light bleeding in early pregnancy can occur with no danger to the mother or child. Some women even experience a light bleed at the time of their period although they are pregnant. However caution in early pregnancy is always advisable and if you are experiencing any vaginal bleeding, speak to your gynecologist.

Causes of Bleeding in Early Pregnancy

The most common cause of vaginal bleeding in early pregnancy is a spontaneous abortion or miscarriage. This may occur for a number of reasons and it is usually associated with abdominal pain. Every pregnant woman is at risk of a miscarriage, especially in the first 12 weeks as this is a very delicate stage in the pregnancy. If you have any of the risk factors associated with a spontaneous abortion, you should be even more weary of any sign of a vaginal bleed. These risk factors include a history of previous miscarriage(s), repeated fertility procedures, cigarette smoking, drug abuse or excessive alcohol consumption during pregnancy, adhesions and uterine fibroids.

Other causes of vaginal bleeding in early pregnancy include a ruptured ectopic pregnancy, which is very dangerous for the health of the mother. Bleeding in early pregnancy may also arise as a result of :

• Trauma – injury, fall, assault.
• Inflammation of the cervix (cervicitis).
• Inflammation of the vagina (vaginitis).
• Rupture of an ovarian cyst.

Other less common causes of vaginal bleeding in early pregnancy will be discussed with you by your gynecologist after he/she has excluded the most serious and common causes.

Warning Signs

Vaginal bleeding in early pregnancy is not uncommon. It should be investigated by your gynecologist or the attending doctor and in many cases, it is not serious. However if there are other signs and symptoms present, a case of vaginal bleeding in early pregnancy should be taken very seriously. These signs and symptoms include :

• Abdominal or pelvic pain with/without tenderness of the abdomen.
• Vaginal discharge that is yellow, brown or almost black or contains spots of blood, especially if there is a smelly vaginal odor.
• Dizziness, light headed feeling and/or fainting spells.
• Changes in blood pressure and or pulse.
• Fever.

Danger in Early Pregnancy

The main danger in early pregnancy is not taking any action when there are signs and symptoms present that should alert you to a possible problem. If you are feeling unwell in your early pregnancy, even if there is no signs or symptoms of any condition, rather consult with your gynecologist and put you mind at ease. While many of the signs and symptoms of pregnancy make a pregnant woman feel unwell, there are other possibilities that could be an indication of complications that could put both you and your baby at risk.

Every year there are hundreds of thousands of women suffering from the devastating affects of miscarriage; while some get through this time relatively easy for others it can be devastating, leaving the women with many feelings such as grieving, guilt, inferiority and depression. One thing that almost all women will have in common is the question why me?

Unfortunately in many cases the question can’t be answered as miscarriages can and do just happen without what seems to be any clear reason, this is very often the hardest part to deal with. However some causes can be explained and while this doesn’t make it any easier to deal with at least you’re not left wondering why.

What is a miscarriage?

The medical explanation for miscarriage is the spontaneous loss of pregnancy before 24 weeks, studies into miscarriage have shown that around ¼ of all pregnancies do actually miscarry many times with women not realising they have had a miscarriage as most happen within the first 6 weeks.

Are there any symptoms or signs of a miscarriage?

You should always be wary of any bleeding during early pregnancy, while some women do bleed during the first few months and have even been known to bleed lightly throughout the pregnancy, bleeding can be a sign of a miscarriage.

The bleeding can range from lightly spotting to heavier bleeding and a doctor’s advice should be sought. Often with a miscarriage there is stomach pain, very much like the pain you get when your period is due, this is a clear sign something is wrong and you should get help immediately.

If you have any stomach pain and/or bleeding the best thing you can do is to lie down straight away and call your doctor for advice. Some women are advised to spend the first three months in bed this way particularly if they have suffered two or more miscarriages in the past.

Why does miscarriage happen?

Unfortunately in a lot cases the cause for it is unknown, this can be one of the hardest things for the women to deal with, and in around 60% of the cases it is thought to be a problem with the way the sperm and the egg join together initially. Another cause is the egg not attaching to the wall of the womb properly and it comes away, age also seems to be a factor with miscarriages being more common in older women.

Types of miscarriage

The medical profession put miscarriages into different categories depending on the outcome of an internal investigation made by the doctor, they are:

• Threatened miscarriage – this is when bleeding starts early in the pregnancy but on examination the cervix is found to be closed and the pregnancy can continue to full term.
• Inevitable miscarriage – this term describes bleeding in early pregnancy and on examination the cervix is found to be open, a miscarriage will also certainly occur in this case.
• Incomplete miscarriage – a miscarriage occurs but there is still some tissue left in the womb, the cervix will usually be found to be open.
• Complete miscarriage – this term describes the pregnancy being lost and the womb is empty.
• Missed miscarriage – this occurs when no bleeding or other sign of miscarriage has taken place but the pregnancy has stopped growing.

The aftercare of miscarriage

Some women deal with miscarriage better than others so there are no clear guidelines for aftercare, the physical effects will usually heal quicker than the mental effects with any bleeding usually settling down after around 10 days.

The emotional side however can take a long time, grief will be a normal sign after miscarriage and the couple should take adequate time to do so, it is important for the couple to talk about what happened and to be there for each other. During this time the women in particular will be very emotional and will need a lot of support from their partner, family and friends, they may also need to see a miscarriage councillor.