Miscarriage
A miscarriage is a loss of pregnancy during the first 20 weeks. Though miscarriage occurs in about half of all pregnancies, only 10% of pregnancies are known and most occur during the first 13 weeks.
Often, a miscarriage is nature’s way of ending a pregnancy in which the fetus is not growing as it should or would not have been able to survive. In many cases, there is no known cause for a miscarriage.
The loss of a pregnancy, no matter how early, can result in feelings of loss and grief. Speak with your doctor if these feelings become overwhelming.
Genetic Causes
Most first-trimester miscarriages are caused by chromosomal errors that occur when the fetus is first forming. Chromosomes are tiny structures inside the center of each of the body's cells, each carrying many genes that determine a person’s traits. Most chromosome problems are not inherited and are not likely to occur in another pregnancy. In most cases, there is nothing wrong with the health of the female or male partner.
The Woman's Health
Preexisting health conditions can also cause you to miscarry. In many cases, your doctor can monitor these conditions and manage them so that your pregnancy can be successful. As always, talk with your doctor about any questions or concerns you have about your pregnancy.
Possible conditions that can cause a miscarriage include:
- Infections that affect the uterus or the fetus
- Problems with your hormones
- Chronic diseases such as diabetes, especially if they are not controlled prior to pregnancy
- An abnormally shaped uterus
- An incompetent cervix
- Bleeding disorders
There is no proof that working, exercising, having sex, using of birth control pills, most accidental falls, or morning sickness cause miscarriages.
Risk Factors
There are several risk factors that may increase your chances of a miscarriage. These include:
- Increasing age, especially age 35 and older
- A history of two or more miscarriages
- Nonprescription NSAID (such as ibuprofen or naproxen) use when you become pregnant or early in your pregnancy
- Alcohol or drug use during pregnancy
- Cigarette smoking during pregnancy
- Exposure to dangerous chemicals before or during pregnancy
- Heavy caffeine use during pregnancy
- Certain gynecological problems, such as uterine fibroids or other abnormalities of the uterus
- Disease or infection during pregnancy
- Physical trauma
After the first 12 weeks of pregnancy, when a fetal heartbeat is seen on ultrasound, the risk of miscarriage drops significantly. Ultrasound is a test that uses reflected sound waves to produce an image of the developing fetus. It does not use X-rays or other types of potentially harmful radiation.
Symptoms of Miscarriage
Common signs of a miscarriage include:
- Vaginal bleeding
- Abdominal or pelvic cramping or pain
- Lower back pain
- Tissue that passes from the vagina
While most women who have vaginal spotting or bleeding during the early stages of their pregnancy have healthy babies, bleeding is the most common symptom of a miscarriage.
Diagnosing a Miscarriage
If you have any symptoms of a miscarriage, call your doctor right away. Often, your doctor will be able to diagnose a miscarriage from a pelvic exam. If not, your doctor may order blood tests or perform an ultrasound exam.
Treating a Miscarriage
There is no proven medical treatment to stop a miscarriage that has already started. While many miscarriages complete on their own, some my require a dilation and curettage, also known as a D&C. In this procedure, the remaining tissue is gently removed from your uterus. Most D&Cs are performed in the doctor's office and require no hospital stay. It is recommended that you wait until you have had at least one normal menstrual period before attempting to become pregnant again.
Coping With The Loss
It is normal to go through a grieving process after a miscarriage, regardless of the length of your pregnancy. Guilt, anxiety, and sadness are common and normal reactions. It is also normal to want to know why a miscarriage happened; however, in most cases, a miscarriage is a natural event that could not have been prevented.
Emotional healing is as vital as physical healing after a miscarriage. Grieving is normal and allows you to accept the painful loss and go on with your life. Counseling can help both you and your partner if you have trouble dealing with your feelings after a miscarriage.
Ectopic Pregnancy
In a normal pregnancy, the fertilized egg travels through the fallopian tube into the uterus and implants itself. An ectopic pregnancy occurs when the fertilized egg does not make it to the uterus because of blockage, but becomes implanted somewhere along the route, most often in the fallopian tube.
Because the egg is outside the uterus, an ectopic pregnancy cannot grow as it should and must be treated. It can also cause the fallopian tube to burst, which can cause a dangerous loss of blood. A ruptured fallopian tube must be treated by surgery. Although an ectopic pregnancy can threaten your health and well being, prompt treatment and follow-up care can help prevent complications.
Who Is At Risk
About one in 50 pregnancies is ectopic and any woman can be at risk. If you have abnormal fallopian tubes, you are at a higher risk. This may be present in women who have had:
- Pelvic inflammatory disease
- Previous ectopic pregnancy
- Infertility
- Pelvic or abdominal surgery
- Endometriosis
- Sexually transmitted disease (STD)
- Prior tubal surgery, such as tubal ligation
Other factors that can increase a woman's risk of an ectopic pregnancy include:
- Cigarette smoking
- Exposure to DES during your mother's pregnancy
- Increased age
Symptoms
Early symptoms of an ectopic pregnancy sometimes are similar to the symptoms of pregnancy, such as tender breasts or an upset stomach. However, you may have no symptoms in the early stages of this type of pregnancy.
As an ectopic pregnancy progresses, you may have:
- Abnormal vaginal bleeding
- Abdominal or pelvic pain
- Shoulder pain
- Weakness, dizziness, or fainting
If you have any of these symptoms, call your doctor, even if you do not think you are pregnant.
Diagnosis
An ectopic pregnancy can be difficult to diagnose in its early stages. To determine if you have an ectopic pregnancy, your doctor may:
- Perform a pelvic exam
- Check your blood pressure and pulse
- Perform an ultrasound exam
- Test your blood for increased hormone levels
Treatment
If your ectopic pregnancy is in its early stages and your fallopian tube has not ruptured, medication can be used to stop the growth of the pregnancy. The medication allows your body to absorb the pregnancy over time and, in most cases, no surgery is needed. It takes your body about four to six weeks to completely absorb the pregnancy.
If your doctor suspects that you have an ectopic pregnancy that has ruptured, emergency surgery will be needed. Depending on the stage of your ectopic pregnancy, surgery may be performed either through a small cut made in the fallopian tube during a laparoscopy or through a larger incision in your abdomen. In either case, some or all of your fallopian tube may need to be removed.
After An Ectopic Pregnancy
Once you have had an ectopic pregnancy, you have an increased risk for future ectopic pregnancies. If medication was used to treat your ectopic pregnancy and there was little or no damage to your fallopian tube, there is a good chance for a normal pregnancy in the future. If your ectopic pregnancy was treated with surgery in which your fallopian tube was repaired, there is also a good chance for a future normal pregnancy. Your doctor will discuss the best treatment for you based on your medical condition and your future plans for pregnancy.
Hyperemesis
Nausea and vomiting are common complaints during pregnancy, especially during the early months. These symptoms are often called "morning sickness," though they can occur at any time of day.
In most women, symptoms of nausea and vomiting are mild and go away during the second trimester. But in some cases, the nausea and vomiting are severe and persist throughout most of the pregnancy. This leads to a condition called hyperemesis gravidarum, when the body is unable to compensate for the ongoing vomiting and loses valuable body salts (electrolytes) and body fluids, often requiring medical treatment. Hyperemesis is typically linked to higher-than-usual levels of hormones and is more common in first pregnancies, young women, and women carrying multiple babies.
What You Can Do
There is no guaranteed way to prevent morning sickness; however, studies have shown that if you are taking a multivitamin regularly at the time you become pregnant, you are less likely to have a severe case of morning sickness.
There are also some things you can do to relieve mild morning sickness:
- Get plenty of rest.
- Avoid smells that bother you.
- Eat five or six small meals a day instead of three large ones.
- Avoid spicy and fatty foods.
- Eat crackers before you get out of bed in the morning.
Medical Treatment
If your nausea and vomiting become severe, you may need medical treatment. Your doctor can give you anti-nausea medications to help relieve your symptoms. In cases of hyperemesis gravidarum, you may need to be hospitalized so that you can be monitored and receive fluids through an intravenous (IV) line.
Be sure and call your doctor if:
- You have a small amount of urine and it is dark in color.
- You cannot keep down liquids.
- You are dizzy or faint when you stand up.
- You have a racing or pounding heart.
- You vomit blood.
The doctors at Capital Women's Care can help you cope with even severe cases of nausea and vomiting during your pregnancy.
Preterm Labor
The normal length of a pregnancy is 40 weeks. In most pregnancies, labor starts between 37 and 42 weeks after your last menstrual period. When labor begins before the 37th week of your pregnancy, it is considered preterm labor. There are many reasons for preterm labor; however, in most cases the exact cause of early labor is not known.
Signs of Preterm Labor
Because serious illness or death can occur if a baby is born too early, it is important to be alert to the warning signs of preterm labor. In many cases, these warning signs are fairly easy to detect.
If any of these warning signs occurs, don't wait - call your doctor's office or go directly to the hospital:
- Change in type of vaginal discharge
- Increase in the amount of discharge
- Pelvic or lower abdominal pain
- Constant, low, dull backache
- Mild abdominal cramps, with or without diarrhea
- Regular or frequent contractions or uterine tightening, often painless
- Ruptured membranes (water breaking)
In many cases, if preterm labor is detected early, delivery can be prevented or postponed through the use of medication and by limiting activity. This extra time is important for the healthy development of your baby.
Women At Risk
Some women are at greater risk for preterm labor than others. Risk factors for preterm labor include:
- Preterm labor or a preterm birth in a previous pregnancy
- Smoking cigarettes or using cocaine
- Carrying more than one baby
- Abnormal cervix
- Abnormal uterus
- Abdominal surgery during your pregnancy
- Infection during your pregnancy
- Bleeding during the second or third trimester of your pregnancy
- Being underweight
- Mother or grandmother took DES during pregnancy
- Little or no prenatal care
- Having a child with chromosomal disorders
About one in ten babies born in the United States is preterm. Despite what is know about the risks for preterm labor, about half the women who go into preterm labor have no known risk factors.
What You Can Do
If you are at risk for preterm labor, be sure to get early prenatal care and follow a healthy diet and exercise plan. Talk with your doctor about changes you can make to your lifestyle and daily routine to help prevent preterm labor. You may need to restrict travel, exercise, or sexual activity as your pregnancy progresses.
You may also need to see your doctor more often for exams and may need to monitor yourself for signs of uterine activity after about 20 weeks of pregnancy. Your doctor will explain how to monitor the outside feel of your uterus and to keep track of any contractions you experience. You may also be given progesterone to prevent contractions from occurring or intensifying.
There are things you can do to have a healthy pregnancy:
- Get regular prenatal care.
- Eat healthy foods and do not skip meals.
- Lead a healthy lifestyle.
- Be alert to signs of preterm labor.
- Follow your doctor's advice.
Gestational Diabetes
Diabetes is a condition that causes high levels of glucose in your blood. Glucose is a sugar that is your body's main source of energy. Health problems can occur when your glucose levels are too high. When diabetes starts during pregnancy it is called gestational diabetes and it is of special concern.
Gestational diabetes can occur when no risk factors or symptoms are present; therefore, pregnant women are tested for this condition. Gestational diabetes can potentially harm the health of your baby, so it is important to monitor your glucose levels closely.
Working With Your Doctor
By working together, you and your doctor can control your glucose level to help ensure you have a safe pregnancy and a healthy baby.
If you develop gestational diabetes, you will be monitored closely during your pregnancy. Your doctor will conduct regular tests to detect any problems early so that steps can be taken to correct them. These tests may include:
- Ultrasound uses sound waves to create pictures of your baby, allowing your doctor to check the baby's growth and development.
- Electronic fetal monitoring helps your doctor detect signs of problems your baby may be having late in pregnancy.
- A biophysical profile uses electronic fetal monitoring and ultrasound results to assess the well-being of your baby.
A kick count is a record of how often you feel your baby move. You may be asked to keep track of this movement in the latter part of pregnancy and to contact your doctor if your baby is not active.
Preeclampsia
Normal blood pressure levels are key to good health. When your blood pressure becomes too high, it is known as hypertension. This condition can pose serious health risks at any time. During pregnancy, hypertension can cause added problems. In some cases, preeclampsia, a serious disorder that can affect your pregnancy and your health, may develop. Preeclampsia occurs when your blood pressure reaches levels of 140/90 or higher after your 20th week of pregnancy, there is extremity swelling and protein spillage in the urine.
Signs of Preeclampsia
Preeclampsia can have serious side effects for you and your baby; therefore, it is important to be aware of its warning signs. If you have any of these symptoms, talk with your doctor right away:
- Headaches
- Vision problems
- Rapid weight gain
- Swelling of the hands and face
If you develop preeclampsia during your pregnancy, you will need special medical care.
Risk Factors
Doctors do not know why some women get preeclampsia; however, they do know that certain women are at higher risk. The risk of developing preeclampsia is increased in women who:
- Are pregnant for the first time
- Have had preeclampsia in a previous pregnancy
- Have a history of chronic hypertension
- Are 35 years or older
- Are carrying more than one fetus
- Have certain medical conditions, such as diabetes or kidney disease
- Are obese
- Are African American
- Have certain blood diseases or immune disorders, such as lupus
What You Can Do
If you know you have high blood pressure, there are steps you can take before and during your pregnancy to reduce the chance that preeclampsia will harm you or your baby. Before your pregnancy, you can:
- Work with your doctor to lower your blood pressure.
- Lose weight through diet and exercise, if needed.
- Take blood pressure medication as prescribed.
- Ask your doctor if your blood pressure medication is safe to use during pregnancy.
Working with your doctor to control your blood pressure level will help improve your chances of having a healthy baby.
During your pregnancy, you can:
- See your doctor regularly.
- Tell your doctor if you have kidney disease or other risk factors.
- Let your doctor know right away if you develop any of the warning signs.
- Check your blood pressure and weight at home, if your doctor recommends it.
Treatment
If your blood pressure increases slightly during your pregnancy, bed rest at home or in the hospital may help keep preeclampsia from developing. If preeclampsia does develop, the only real treatment is to have the baby because continuing the pregnancy can result in damage to your organs, including your kidneys, liver, brain, heart, and eyes. Although preeclampsia typically lasts for up to two weeks after delivery, it always goes away after a pregnancy.
The decision to deliver the baby depends on the risks to you and whether the risk to your baby is greater staying inside your uterus or in a special nursery. Your doctor will explain the best and safest way for the delivery to occur.
