Robert Wood Johnson University Hospital
 

Miscarriage

High-Risk Pregnancy - Miscarriage

What is a miscarriage?

Miscarriage is usually defined as an early pregnancy loss. Miscarriage is also called spontaneous abortion. Types of miscarriage include the following:

What is an incompetent cervix?

Fetal loss in the second trimester may occur when the cervix is weak and opens too early, called incompetent cervix. In some cases of incompetent cervix, a physician can help prevent pregnancy loss by suturing the cervix closed until delivery, called a cerclage.

How is miscarriage diagnosed?

The most common signs of miscarriage are vaginal spotting or bleeding, passing of tissue, and cramping. Ultrasound is usually used to diagnose miscarriage. If the fetus is no longer in the uterus, or there is no longer a fetal heartbeat, miscarriage is diagnosed. Other tests that may be used include pregnancy blood tests for the hormone human chorionic gonadotrophin (hCG). No increase in this hormone level or a decrease can indicate that the pregnancy is not growing.

Treatment for miscarriage:

Treatment for miscarriage in early pregnancy includes a procedure to remove the fetus and other tissues if they have not all been naturally passed. The procedure is called a surgical evacuation of the uterus, or a dilatation and curettage (D&C). Anesthesia is used as the procedure can be painful to the mother. The cervical opening is dilated (opened) and either suction or an instrument called a curette is used to remove all the pregnancy tissues inside the uterus (called products of conception). These tissues may be sent to the laboratory for culture or testing for genetic or chromosomal abnormalities.

Later pregnancy loss may need a different procedure using hormones such as prostaglandin or Pitocin to cause the uterus to contract and push out the fetus and tissues.

Pregnancy loss does not usually cause other serious medical problems, unless an infection is present, or unless a missed abortion occurred in which the fetus and other tissues are not passed. A serious complication with a late miscarriage is disseminated intravascular coagulation (DIC), a severe blood clotting problem. This is more likely if there is a long time (usually a month or more) until the fetus and other tissues are passed.

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