Introduction:

Miscarriage is the spontaneous loss of a pregnancy before 20 weeks. Usually miscarriage happens because the fetus isn' t developing as it should. Miscarriage is common -- about 15% of pregnancies end in miscarriage, usually before the 12th week of pregnancy (first trimester).

Some miscarriages may happen even before a woman knows for certain that she is pregnant. But it can still be a traumatic emotional experience. Most women who have miscarriages go on to have successful later pregnancies -- a second miscarriage generally occurs in only 1% of women. Some women may have several miscarriages, however.

Signs and Symptoms:

Miscarriage is often accompanied by the following signs and symptoms:

• Bleeding -- brown or bright red vaginal bleeding or spotting. Light bleeding early in pregnancy is fairly common, and does not mean you will have a miscarriage. But you should see your doctor.
• Passage of tissue from the vagina or a gush of clear or pink vaginal fluid
• Abdominal pain or cramping
• Signs of pregnancy, such as breast sensitivity and morning sickness, may go away
• Dizziness, lightheadedness, or feeling faint

What Causes It?:

Normal activities -- work, exercise, sex -- won' t cause a miscarriage, nor will nausea and vomiting (even severe morning sickness). Most often a miscarriage happens there is a problem with the baby' s genes. But some health conditions can make the mother more prone to miscarriage, including:

• Physical problems with the uterus or cervix
• Poorly controlled diabetes
• Hyperthyroidism or hypothyroidism
• Hormonal problems
• Infection, including bacterial, viral, parasitic, fungal, or sexually transmitted diseases

Who's Most At Risk?:

Women with the following conditions or characteristics are at risk for having a miscarriage:

• Previous miscarriages (two or more)
• Age 35 or older
• Smoking or drinking alcohol
• Using cocaine or other illegal drugs
• Environmental toxins -- excessive exposure to lead, mercury, organic solvents
• Having chronic health problems
• Low levels of folic acid (see nutrition section)

What to Expect at Your Provider's Office:

If you think you are having a miscarriage, see your doctor immediately. Your doctor will do a pelvic examination to check for any problems with the uterus and see if it has begun to dilate. Your doctor will do an ultrasound to check on the baby' s heartbeat and see how it is developing. If you have miscarried, your doctor may do a blood test to make sure that no tissue is left inside your uterus.

Treatment Options:

Prevention

In most cases, there is no way to prevent a miscarriage. You can avoid known risks, such as being overweight, consuming caffeine or alcohol, and smoking cigarettes, as well as other risks listed above. Keeping your body healthy -- by eating well, exercising regularly and getting enough sleep -- may help lower the risks of a miscarriage.

Treatment Plan

If you are threatening miscarriage, your doctor may tell you to rest and avoid sex and exercise. If your cervix is dilated and your uterus has started to contract, the miscarriage can' t be stopped. In that case, your doctor may give you medication that causes your body to get rid of the placenta and tissue from the pregnancy. If any of the tissue remains inside your uterus, your doctor will perform a dilation and curettage (D & C), which involves dilating your cervix and gently suctioning out the tissue. If you have a history of unexplained miscarriages, in vitro fertilization, embryo transfer, or artificial insemination may be used to achieve a successful pregnancy.

Drug Therapies

If you have an underlying medical condition or have had repeated miscarriages, your doctor may prescribe medications to try to help you achieve a successful pregnancy. The medications will depend on what the specific health problem is.

Surgical and Other Procedures

Dilation and curettage (D&C) can remove pregnancy tissue if it is not expelled naturally from the uterus. Other surgical procedures may help address problems with the uterus.

Complementary and Alternative Therapies

Keeping your body healthy may help lower your risk of a miscarriage. Before getting pregnant, it is a good idea to have counseling about the risks, including the importance of staying healthy and avoiding caffeine, alcohol, and recreational drugs.

Miscarriage is a serious health issue. Ask your doctor about alternative therapies that may help you stay healthy during pregnancy, and never take any herb or supplement while you are pregnant without first checking with your doctor.

Nutrition and Supplements

These nutritional tips can help you stay healthy before and during pregnancy:

• Eat calcium rich foods, including low-fat dairy, beans, almonds, and dark green leafy vegetables (such as spinach and kale).
• Avoid refined foods such as white breads, pastas, and sugar.
• Eat lean meats, cold-water fish, tofu (soy), and beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine
• Drink 6 - 8 glasses of filtered water daily.
• Exercise regularly but talk to your doctor about finding the right exercise program for you. If your pregnancy is high risk, your doctor may prescribe bed rest.
• Caffeine, alcohol, and tobacco raise the risk of miscarriage and should be avoided.

Pregnant women may need these nutrients:

• Women who are pregnant need additional amounts of folic acid (600 mcg per day), often taken with a B-complex vitamin. Folic acid is needed for the normal development of the baby' s neural tube (what becomes the brain and spine). Low levels of folic acid have been linked to miscarriage. Your doctor will prescribe prenatal vitamins that have the nutrients you need.
• Calcium citrate, 500 - 1000 mg daily, for healthy bones.
• Vitamin D, 400 IU daily, for healthy bones.
• Omega-3 fatty acids, such as those found in cold-water fish, seem to reduce the chance of premature delivery. They are also necessary for the baby' s brain health. Pregnant women should avoid fish containing high levels of mercury. The Food and Drug Administration says pregnant women may eat up to 12 ounces a week or two average-sized portions of shrimp, salmon, cod, catfish, canned light tuna (no more than 6 oz. a week of albacore tuna and tuna steak), and pollock. If you don' t eat fish, ask your doctor about taking supplements. Omega-3 supplements may increase the risk of bleeding, especially if you take blood-thinning medications such as warfarin (Coumadin) or aspirin.
• A prenatal vitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium, and iron. You should take at least 800 mcg of folic acid along with a B-complex vitamin during pregnancy. Ask your health care provider.

Herbs

Do not use herbs during pregnancy unless you are under the care of a qualified health care provider. Work with your health care provider in order to determine which dietary supplements are right for you.

You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Herbs that may help to reduce stress and aid in balancing the immune system include green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anti-inflammatory and stress effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.

Homeopathy

No conventional scientific literature supports the use of homeopathy to prevent miscarriage. However, homeopathic literature does contain reports of successful treatment for women with frequent miscarriage with homeopathy. An experienced homeopath would consider your individual case and may recommend treatments to address your underlying condition and support your overall health.

Prognosis and Possible Complications:

Many women who have one or two miscarriages go on to have successful pregnancies. Women have only a 1% chance of recurring miscarriage. However, the risk increases with each miscarriage. Possible complications include infected pregnancy tissue, which could lead to pelvic abscess, septic shock, or even death. Many women feel depression or guilt after a miscarriage. A support group or individual counseling may help to deal with these feeling.

Following Up:

Your health care provider will monitor you until the miscarriage is complete. If you have had a miscarriage and become pregnant, you should see your doctor right away.

Alternative Names:

Spontaneous abortion