Introduction:

Miscarriage is the loss of a fetus before 20 weeks of pregnancy. About 15% of pregnancies end in miscarriage, usually before the 12th week of pregnancy (first trimester). The most common cause of miscarriage is a genetic abnormality in the fetus. Most women who have miscarriages go on to have successful later pregnancies – a second miscarriage generally occurs in only 1% of women. However, some women have habitual miscarriages (three or more consecutive miscarriages). Some miscarriages may occur as a late menstrual period, even before a woman knows for certain that she is pregnant.

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 clots or a gush of clear or pink vaginal fluid (may indicate pregnancy tissue from the uterus)
• Abdominal pain or cramping
• Decrease in signs of pregnancy, such as breast sensitivity and morning sickness
• 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). Although most often a miscarriage is caused because there is a problem with the baby’s genes, some health conditions can make the mother more prone to miscarriage, including:

• Physical problems, such as distortion of the uterine cavity or adhesions from disease or surgery
• Endocrine or hormone disorders, such as diabetes (when poorly controlled) and hyper- or hypothyroidism
• Infection, including bacterial, viral, parasitic, fungal, or acquired through sexually transmitted diseases
• Abnormal antibodies in the blood that cause formation of blood clots (for example, antiphospholipid antibodies, or APLA)

Who's Most At Risk?:

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

• Previous miscarriages (two or more)
• Women age 35 or older
• Cigarette smoking -- smoking half a pack or more per day significantly increases risk
• Alcohol -- risk doubles with more than two drinks per day
• Caffeine -- see section on nutrition for more details
• Using cocaine or other illegal drugs
• Environmental toxins -- excessive exposure to lead, mercury, organic solvents
• Serious maternal illness
• 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 take a comprehensive medical, family, and social history to determine any underlying cause. A pelvic examination will check for any problems with the uterus and see if it has begun to dilate. Ultrasound imaging and other diagnostic and laboratory tests may help confirm diagnosis and to evaluate the condition of the uterus and fetus.

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 -- will help decrease the risks of a miscarriage.

Treatment Plan

If you are threatening miscarriage, your doctor may order you to rest and avoid sex and exercise. If your cervix is dilated and your uterus has begun 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 other tissue from the pregnancy. If any of the tissue remains inside your uterus, your doctor will perform a dilation and curettage (D & C) to remove it. In vitro fertilization, embryo transfer, or artificial insemination may be used to achieve a successful pregnancy if you have a history of unexplained, recurrent miscarriages.

Drug Therapies

Your health care provider may prescribe the following medications to treat underlying conditions or, in the case of repeated miscarriages, to help you achieve a successful pregnancy:

• Anti-D immunoglobulin
• Antibiotics to treat infections
• Estrogen supplementation following uterine surgery for adhesions to stimulate the growth of the uterine lining
• Aspirin or heparin if a clotting abnormality is present
• Vaginal progesterone suppositories
• Immunotherapy

Surgical and Other Procedures

Dilation and curettage (D&C) may be performed to remove pregnancy tissue if it has not been expelled naturally from the uterus. Other surgical procedures may help address uterine problems.

Complementary and Alternative Therapies

Keeping your body healthy may help avoid a miscarriage. Before becoming 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 protect your pregnancy, and never take any herb or supplement while you are pregnant without first checking with your doctor.

Nutrition and Supplements

These nutritional tips are for general health:

• Try to eliminate all potential food allergens, including dairy, wheat (gluten), soy, corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
• Eat calcium rich foods, including 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 moderately, as tolerated, 5 days a week In most cases, normal exercise is fine; however, 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.

• Women who are pregnant need additional amounts of folic acid (600 mcg per day), often taken with a B-complex vitamin. Folic acid is necessary 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. Folic acid is often taken with a B-complex vitamin. Your doctor will prescribe prenatal vitamins that contain the nutrients you need.
• Calcium citrate, 500 - 1000 mg daily, for bone support.
• Vitamin D, 400 IU daily, for bone support.
• Omega-3 fatty acids, such as flaxseed and fish oils, 1 - 2 capsules or 1 tablespoonful oil two to three times daily, seem to reduce the chance of premature delivery. They are also necessary for the baby’s brain health.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
• 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. You should take at least 800 mcg of folic acid along with a B-complex vitamin during pregnancy. Ask your health care provider.

Herbs

Some herbs may help balance female hormones, help the immune system function more readily, and decrease stress. These herbs, however, have not yet been studied in relation to spontaneous abortion, only for underlying symptoms. 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:

Women have only a 1% chance of recurring miscarriage. However, the risk increases significantly with each miscarriage. Possible complications include infected pregnancy tissue, which could lead to pelvic abscess, septic shock, or even death. Depression and guilt are common feelings that may follow a miscarriage. There are times when counseling may be appropriate.

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 provider immediately.

Alternative Names:

Spontaneous abortion