Miscarriages - symptoms, causes, diagnosis and treatment

Miscarriages affect up to one in two pregnancies. A miscarriage is the spontaneous termination of a pregnancy before the 22nd week, involving the separation of the fetal egg from the uterus and its expulsion from the mother's body.

How often do miscarriages occur?

As statistics show, miscarriages end even 50% of all pregnanciesMore than half of these pregnancies are lost shortly after the embryo has implanted in the uterus, with genital bleeding occurring during the perimenopausal period and the woman often not realising that she has just had a miscarriage. Until 80% miscarriages occur in the first trimester of pregnancy (first 12 weeks of pregnancy).

Symptoms of miscarriage

Signs of early miscarriage (up to the 12th week of pregnancy) are:

  • relatively strong, long-lasting cramps or pains in the lower abdomen that may radiate to the sacral region;

  • bleeding from the genital tract (the blood is bright red in colour and tissue and clots may be visible);

  • cessation of symptoms typical of pregnancy (nausea, breast tenderness),

  • absence of a fetal pulse on ultrasound (it is detectable from the fifth week of pregnancy).

In the 14th week of pregnancy, the placenta is fully formed - the termination of pregnancy from this point onwards is known as a late miscarriage . It manifests itself in a similar way to an early miscarriage, but the severity of the symptoms (genital bleeding, cramps) is much greater. 

During a late miscarriage, the amniotic fluid drains away, and if an infection of the fetal egg is present, the woman may experience high fever and chills, muscle pains

Asymptomatic miscarriage

A miscarriage can also occur asymptomatically, as the fetus dies in the uterus. In this case, there is a so-called "retained miscarriage", which can only be detected by ultrasound examination. Sometimes, a poor prognosis for the development of the pregnancy is established during an ultrasound examination carried out at an early stage - worrying signs include delayed embryo development in relation to the age of the pregnancy and a very slow heart rate in the foetus.

Genital tract bleeding in pregnancy - what to do?

Not all genital bleeding ends in miscarriage, but the occurrence of this symptom should prompt the pregnant woman to consult an obstetrician-gynaecologist as soon as possible (in the ED or on-call gynaecology department at the hospital, especially if the bleeding is heavy). 

Miscarriage - medical intervention

In some patients, it is possible to stop a miscarriage by promptly instituting pharmacological treatment, but in most cases the use of pregnancy support measures has no effect, as miscarriage is de facto a natural mechanism available to the mother's body to eliminate an embryo that is not developing properly.

Medical assistance for miscarriage also includes performing a curettage of the uterine cavity if the organ has not completely cleared following the loss of the pregnancy, and in cases of persistent heavy bleeding from the genital tract.

Causes of miscarriage

Miscarriages in the first trimester of pregnancy are most often caused by genetic factors (genetic abnormalities present in the fetus), uterine abnormalities and abnormalities in the formation of the fetal egg and surrounding tissues (trophoblast).

In the later stages of pregnancy, miscarriage is sometimes the result:

  • hormonal disorders (insufficient production of progesterone by the placenta or corpus luteum);

  • systemic diseases in the pregnant woman (hypothyroidism, uncompensated diabetes);

  • autoimmune factors (e.g. antiphospholipid syndrome);

  • severe bacterial or viral infections in the woman that have led to infection of the foetal egg;

  • cervical insufficiency (spontaneous cervical dilation).

Miscarriages and the age of women and men

An important factor influencing the risk of miscarriage is age, both of the woman and her partner. 

Woman

The probability of spontaneous pregnancy loss in a 20-year-old woman is on average 12-15%, while in a 40-year-old woman it increases to over 50%. This fact is related to the deterioration of the quality of the oocytes, in which damage to the genetic material caused by harmful environmental factors (e.g. air pollution, preservatives in food, etc.) accumulates.

Male

Similar processes occur in the sperm-forming cells, which translates into a systematic decrease in sperm parameters in men, and an increased risk of genetic abnormalities of the embryo, accounting for more than 60% causes of miscarriage. Statistics show that the probability of miscarriage increases by as much as approx. 1.6 times when the pregnant woman's partner is over 40 years old.

Research after miscarriage

After a first miscarriage, doctors usually order basic investigations, assuming that the pregnancy loss may have been a random event. Above all, it is necessary to rule out the role of systemic diseases and to assess whether the pregnant woman's lifestyle had an impact on the miscarriage.

If there have been more miscarriages, it is worth implementing a full diagnostic workup, with a view to:

  • to rule out genetic disorders (karyotype testing in both partners);

  • to detect possible anatomical abnormalities in the structure of the uterine cavity (hysteroscopy);

  • exclusion of blood coagulation disorders, especially hypercoagulability (e.g. antiphospholipid syndrome);

  • determine whether the miscarriages may have been related to the existence of infectious agents (e.g. chlamydial infection);

  • assessment of the hormonal profile and exclusion of the role of endocrine disorders in pregnancy loss.

Depending on the history taken, diagnosed disorders and past medical history, the doctor may also order other tests.

Habitual miscarriages

A full diagnosis is essential if a third consecutive pregnancy is miscarried (so-called habitual miscarriages), as each subsequent pregnancy will automatically be treated as a high-risk pregnancy requiring surveillance and treatment (if the cause of the miscarriages can be established in time, there is a chance of causal treatment). 

It is advisable to have diagnostic tests carried out at an infertility clinic, as such centres provide access to full diagnostics and rapidly implemented treatment - and time is at a premium, especially in the first trimester of pregnancy when the risk of miscarriage is greatest.

In cases of recurrent miscarriages or repeated embryo implantation failures, diagnostics for immunological causes may also be considered.

Find out more about consulting an immunologist >>

Miscarriage after in vitro

Before an IVF approach, a woman is examined in detailsystemic diseases, anatomical defects and infections are excluded, and after the embryo is transferred into the uterine cavity, the patient takes pharmacological agents (mainly the hormone progesterone and its derivatives) to prevent hormonal deficiencies and increase the chances of successful embryo implantation. In addition, she is advised to rest, avoid intercourse, stress and prolonged shock.

Despite this, approximately 16% cases result in early pregnancy loss. Miscarriages are more common in older patients, so it can be assumed that they are most often caused by abnormalities in the genetic material of the embryo.

In this situation, if the couple still has frozen embryos, the doctors generally modify the pharmacotherapy before the next IVF approach. Often additional tests are performed, and the choice is individual, depending on the couple's situation. 

Miscarriage after IVF and genetic factors

Doctors may also opt to use the so-called 'medicalisation'. preimplantation screening (PGT-A), a study of the genetic status of embryos before they are implanted in the uterine cavity.

If miscarriages occur because one or both parents carry a genetic defect that significantly reduces the chances of giving birth to a healthy child (or prevents the pregnancy from being carried to term), the parents can use cells from an anonymous donor or donor.

Find out more about oocyte adoption programmes at Invimed >>.

Prevention of miscarriages

Miscarriage prevention includes lifestyle modification (balanced diet, avoidance of stimulants, sleep hygiene, moderate physical activity, skilful stress management), appropriate treatment of systemic diseases and infections, and removal of diagnosed causes of miscarriage (e.g. surgical correction of anatomical abnormalities of the uterus).

It is a good idea to test levels early in pregnancy:

  1. progesterone (Deficiency of this hormone due to failure of the gestational corpus luteum can result in bleeding, cramps and miscarriage);
  2. estrogens ovarian;
  3. pregnancy hormone hCG (the result of the test helps to determine whether the pregnancy is developing normally).

The results obtained should always be analysed based on the treatment given and the clinical condition of the pregnant woman.

Pregnancy after miscarriage

The good news for women who have experienced a pregnancy loss is that it is possible to get pregnant again after a miscarriage, and the chances of carrying the pregnancy to term are higher than with a first pregnancy. If you have experienced a miscarriage, consult an infertility clinic.

If you have experienced a miscarriage, consult an infertility clinic. To arrange a consultation or teleportation at Invimed, call: 500 900 888.

Check out

***
Medical consultation of the article: Dr Robert Gizler, gynaecologist-obstetrician, medical director of the InviMed clinic in Wrocław. Graduate of the Medical University of Wrocław. Member of the Polish Gynaecological Society (PTG), the Polish Society of Reproductive Medicine and Embryology (PTMRiE) and the European Society of Human Reproduction and Embryology (ESHRE).