Contents 1 Signs and symptoms 2 Risk factors 2.1 First trimester 2.2 Second and third trimesters 2.3 Multiple pregnancy and age 2.4 Obesity, eating disorders and caffeine 2.5 Endocrine disorders 2.6 Food poisoning 2.7 Amniocentesis and chorionic villus sampling 2.8 Surgery 2.9 Medications 2.10 Chemotherapy and radiation treatments for cancer 2.11 Intercurrent diseases 2.12 Immune status 2.13 Anatomical defects and trauma 2.14 Smoking 2.15 Morning sickness 2.16 Chemicals and occupational exposure 2.17 Other 3 Diagnosis 3.1 Ultrasound criteria 3.2 Classification 4 Prevention 4.1 Non-modifiable risk factors 4.2 Modifiable risk factors 5 Management 5.1 Methods 5.2 Delayed and incomplete miscarriage 5.3 Induced miscarriage 5.4 Support 6 Outcomes 6.1 Psychological and emotional effects 6.2 Subsequent pregnancies 6.3 Later cardiovascular disease 7 Epidemiology 8 Terminology 9 History 10 Society and culture 11 Other animals 12 See also 13 References 14 Bibliography 15 External links


Signs and symptoms[edit] Signs of a miscarriage include vaginal spotting, abdominal pain or cramping, and fluid or tissue passing from the vagina.[19][20][21]  Bleeding can be a symptom of miscarriage, but many women also have bleeding in early pregnancy and don't miscarry.[22] Bleeding during pregnancy may be referred to as a threatened miscarriage. Of those who seek clinical treatment for bleeding during pregnancy, about half will miscarry.[23] Miscarriage may be detected during an ultrasound exam, or through serial human chorionic gonadotropin (HCG) testing.


Risk factors[edit] Further information: List of miscarriage risks Miscarriage may occur for many reasons, not all of which can be identified. Risk factors are those things that increase the likelihood of having a miscarriage but don't necessarily cause a miscarriage. Up to 70 conditions,[4][1][24][25][26][27] infections,[28][29][30] medical procedures,[31][32][33][33] lifestyle factors,[5][6][5][34][35][36] occupational exposures,[9][37][9][37][38] chemical exposure,[38] and shift work are associated with increased risk for miscarriage.[39] Some of these risks include endocrine, genetic, uterine, or hormonal abnormalities, reproductive tract infections, and tissue rejection caused by an autoimmune disorder. First trimester[edit] Chromosomal abnormalities found in first trimester miscarriages Description Percent of total first trimester miscarriage Normal 45-55% Autosomal trisomy 22-32% Monosomy X (45, X) 5-20% Triploidy 6-8% Structural abnormality of the chromosome 2% Double or triple trisomy 0.7-2%[40] Translocation unknown[41] Most clinically apparent miscarriages (two-thirds to three-quarters in various studies) occur during the first trimester.[1][28][42][43] About 30% to 40% of all fertilized eggs miscarry, often before the pregnancy is known.[1] The embryo typically dies before the pregnancy is expelled; bleeding into the decidua basalis and tissue necrosis causes uterine contractions to expel the pregnancy.[43] Early miscarriages can be due to a developmental abnormality of the placenta or other embryonic tissues. In some instances an embryo does not form but other tissues do. This has been called a "blighted ovum".[40][44][45] Successful implantation of the zygote into the uterus is most likely 8 to 10 days after conception. If the zygote has not implanted by day 10, implantation becomes increasingly unlikely in subsequent days.[46] A chemical pregnancy refers to a pregnancy that was detected by testing but ends in miscarriage before or around the time of the next expected period.[47] Chromosomal abnormalities are found in more than half of embryos miscarried in the first 13 weeks. Half of embryonic miscarriages (25% of all miscarriages) have an aneuploidy (abnormal number of chromosomes).[48] Common chromosome abnormalities found in miscarriages include autosomal trisomy (22-32%), monosomy X (5-20%), triploidy (6-8%), tetraploidy (2-4%), or other structural chromosomal abnormalities (2%).[43] Genetic problems are more likely to occur with older parents; this may account for the higher rates observed in older women.[49] There is no evidence that progesterone given in the first trimester reduces the risk of miscarriage, and luteal phase progesterone deficiency may or may not be a contributing factor to miscarriage.[50][51] Second and third trimesters[edit] Second trimester losses may be due to maternal factors such as uterine malformation, growths in the uterus (fibroids), or cervical problems.[28] These conditions also may contribute to premature birth.[42] Unlike first-trimester miscarriages, second-trimester miscarriages are less likely to be caused by a genetic abnormality; chromosomal aberrations are found in a third of cases.[43] Infection during the third trimester can cause a miscarriage.[28] These include an older parent, previous miscarriage, exposure to tobacco smoke, obesity, diabetes, and drug or alcohol use, among others.[5] Multiple pregnancy and age[edit] Further information: Advanced maternal age The age of the pregnant woman is a significant risk factor. Miscarriage rates increase steadily with age, with more substantial increases after age 35.[52] In those under the age of 35 the risk is about 10% while it is about 45% in those over the age of 40.[1] Risk begins to increase around the age of 30.[5] Paternal age is associated with increased risk.[53] Obesity, eating disorders and caffeine[edit] Not only is obesity associated with miscarriage, it can result in sub-fertility and other adverse pregnancy outcomes. Recurrent miscarriage is also related to obesity. Women with bulimia nervosa and anorexia nervosa may have a greater risk for miscarriage. Nutrient deficiencies have not been found to impact miscarriage rates but hyperemesis gravidarum sometimes precedes a miscarriage. [37] Caffeine consumption also has been correlated to miscarriage rates, at least at higher levels of intake.[28] However, such higher rates have been found to be statistically significant only in certain circumstances. Vitamin supplementation has generally not shown to be effective in preventing miscarriage.[54] Chinese traditional medicine has not been found to prevent miscarriage.[21] Endocrine disorders[edit] Disorders of the thyroid may affect pregnancy outcomes. Related to this, iodine deficiency is strongly associated with an increased risk of miscarriage.[37] The risk of miscarriage is increased in those with poorly controlled insulin-dependent diabetes mellitus.[37] Well-controlled diabetes may lower this risk.[55][needs update] Food poisoning[edit] Ingesting food that has been contaminated with listeriosis, toxoplasmosis, and salmonella is associated with an increased risk of miscarriage.[28][14] Amniocentesis and chorionic villus sampling[edit] Amniocentesis and chorionic villus sampling are procedures conducted to assess the fetus. A sample of amniotic fluid is obtained by the insertion of a needle through the abdomen and into the uterus. Chorionic villus sampling is a similar procedure with a sample of tissue removed rather than fluid. These procedures are not associated with pregnancy loss during the second trimester but they are associated with miscarriages and birth defects in the first trimester.[33] Miscarriage caused by invasive prenatal diagnosis (chorionic villus sampling (CVS) and amniocentesis) is rare (about 1%).[32] Surgery[edit] The effects of surgery on pregnancy are not well-known including the effects of bariatric surgery. Abdominal and pelvic surgery are not risk factors in miscarriage. Ovarian tumors and cysts that are removed have not been found to increase the risk of miscarriage. The exception to this is the removal of the corpus luteum from the ovary. This can cause fluctuations in the hormones necessary to maintain the pregnancy.[56] Medications[edit] Immunizations have not been found to cause miscarriage.[57] There is no significant association between antidepressant medication exposure and spontaneous abortion.[58] The risk of miscarriage is not likely decrease by discontinuing SSRI prior to pregnancy.[59] Some available data suggest that there is a small increased risk of miscarriage for women taking any antidepressant,[60][61] though this risk becomes less statistically significant when excluding studies of poor quality.[58][62] Medicines that increase the risk of miscarriage include: retinoids  nonsteroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen misoprostol  methotrexate[28] Chemotherapy and radiation treatments for cancer[edit] Ionizing radiation levels given to a woman during cancer treatment cause miscarriage. Exposure can also impact fertility. The use of chemotherapeutic drugs used to treat childhood cancer increases the risk of miscarriage.[37] Intercurrent diseases[edit] Several intercurrent diseases in pregnancy can potentially increase the risk of miscarriage, including diabetes, polycystic ovary syndrome (PCOS), hypothyroidism, certain infectious diseases, and autoimmune diseases. PCOS may increases the risk of miscarriage.[28] Two studies suggested treatment with the drug metformin significantly lowers the rate of miscarriage in women with PCOS,[63][64] but the quality of these studies has been questioned.[65] The use metformin treatment in pregnancy has not been shown to be safe.[66] In 2007 the Royal College of Obstetricians and Gynaecologists also recommended against use of the drug to prevent miscarriage.[65] Thrombophilias or defects in coagulation and bleeding were once thought to be a risk in miscarriage but have been subsequently questioned.[67] Severe cases of hypothyroidism increase the risk of miscarriage. The effect of milder cases of hypothyroidism on miscarriage rates has not been established. A condition called luteal phase defect (LPD) is a failure of the uterine lining to be fully prepared for pregnancy. This can keep a fertilized egg from implanting or result in miscarriage.[68] Mycoplasma genitalium infection is associated with increased risk of preterm birth and miscarriage.[30] Infections can increase the risk of a miscarriage: rubella (German measles), cytomegalovirus, bacterial vaginosis, HIV, chlamydia, gonorrhoea, syphilis, and malaria.[28] Immune status[edit] Autoimmunity is possible cause of recurrent or late-term miscarriages. In the case of an autoimmune-induced miscarriages the woman's body attacks the growing fetus or prevents normal pregnancy progression.[7][69] Autoimmune disease may cause genetic abnormalities in embryos which in turn may lead to miscarriage.[70] As an example, Celiac disease increases the risk of miscarriage by an odds ratio of approximately 1.4.[26][27] A disruption in normal immune function can lead to the formation of antiphospholipid antibody syndrome. This will effect the ability to continue the pregnancy and if a woman has repeated miscarriages, she can be tested for it.[38] Approximately 15% of recurrent miscarriages are related to immunologic factors.[71] The presence of anti-thyroid autoantibodies is associated with an increased risk with an odds ratio of 3.73 and 95% confidence interval 1.8–7.6.[72] Having Lupus also increases the risk for miscarriage.[73] Anatomical defects and trauma[edit] Fifteen percent of women who have experienced three or more recurring miscarriages have some anatomical reason for the inability to complete the pregnancy.[74] The structure of the uterus has an effect on the ability to carry a child to term. Anatomical differences are common and can be congenital. Type of Uterine structure Miscarriage rate associated with defect References Bicornate uterus 40-79% [24][25] Septate or unicornate 34-88% [24][28] Arcuate unknown [24][28] Didelphhys 40% [24][28] Fibroids unknown [28] In some women, cervical incompetence or cervical insufficiency occurs with the inability of the cervix to stay closed during the entire pregnancy.[29][35] It does not cause first trimester miscarriages. In the second trimester it is associated with an increased risk of miscarriage. It is identified after a premature birth has occurred at about 16–18 weeks into the pregnancy.[74] During the second trimester, major trauma can result in a miscarriage.[27] Smoking[edit] See also: Smoking and pregnancy Tobacco (cigarette) smokers have an increased risk of miscarriage.[34][35] There is an increased risk regardless of which parent smokes, though the risk is higher when the gestational mother smokes.[36] Morning sickness[edit] Nausea and vomiting of pregnancy (NVP, or morning sickness) are associated with a decreased risk. Several causes are thought to cause morning sickness but there is still no agreement.[75] NVP is generally interpreted as a defense mechanism which discourages the mother's ingestion of foods that are harmful to the fetus; according to this model, a lower frequency of miscarriage would be an expected consequence of the different food choices made by women experiencing NVP. Chemicals and occupational exposure[edit] Chemical and occupational exposures may have some effect in pregnancy outcomes. A cause and effect relationship almost can never be established. Those chemicals that are implicated in increasing the risk for miscarriage are DDT, lead, formaldehyde, arsenic, benzene and ethylene oxide. Video display terminals and ultrasound have not been found to have an effect on the rates of miscarriage. In dental offices where nitrous oxide is used with the absence of anesthetic gas scavenging equipment, there is a greater risk of miscarriage. For women who work with cytotoxic antineoplastic chemotherapeutic agents there is a small increased risk of miscarriage. No increased risk for cosmetologists has been found.[38] Other[edit] Alcohol increases the risk of miscarriage.[28] Progesterone has not been found to be effective in preventing miscarriage.[76] Cocaine use increases the rate of miscarriage.[34] Some infections have been associated with miscarriage. These include Ureaplasma urealyticum, Mycoplasma hominis, group B streptococci, HIV-1, and syphilis. Infections of Chamydia trachomatis, Camphylobacter fetus, and Toxoplasma gondii have not been found to be linked to miscarriage.[43]


Diagnosis[edit] In the case of blood loss, pain, or both, transvaginal ultrasound is performed. If a viable intrauterine pregnancy is not found with ultrasound, blood tests (serial βHCG tests) can be performed to rule out ectopic pregnancy, which is a life-threatening situation.[77][78] If hypotension, tachycardia, and anemia are discovered, exclusion of an ectopic pregnancy is important.[78] A miscarriage may be confirmed by an obstetric ultrasound and by the examination of the passed tissue. When looking for microscopic pathologic symptoms, one looks for the products of conception. Microscopically, these include villi, trophoblast, fetal parts, and background gestational changes in the endometrium. When chromosomal abnormalities are found in more than one miscarriage, genetic testing of both parents may be done.[79] Ultrasound criteria[edit] A review article in The New England Journal of Medicine based on a consensus meeting of the Society of Radiologists in Ultrasound in America (SRU) has suggested that miscarriage should be diagnosed only if any of the following criteria are met upon ultrasonography visualization:[80] Miscarriaged Diagnosed Miscarriage suspected References Crown-rump length of at least 7 mm and no heartbeat. Crown–rump length of less than 7 mm and no heartbeat. [80][81] Mean gestational sac diameter of at least 25 mm and no embryo. Mean gestational sac diameter of 16–24 mm and no embryo. [80][81] Absence of embryo with heartbeat at least 2 weeks after an ultrasound scan that showed a gestational sac without a yolk sac. Absence of embryo with heartbeat 7–13 days after an ultrasound scan that showed a gestational sac without a yolk sac. [80][81] Absence of embryo with heartbeat at least 11 days after an ultrasound scan that showed a gestational sac with a yolk sac. Absence of embryo with heartbeat 7–10 days after a scan that showed a gestational sac with a yolk sac. [80][81] Absence of embryo at least 6 weeks after last menstrual period. [80][81] Amniotic sac seen adjacent to yolk sac, and with no visible embryo. [80][81] Yolk sac of more than 7 mm. [80][81] Small gestational sac compared to embryo size (less than 5 mm difference between mean sac diameter and crown–rump length). [80][81] Classification[edit] A threatened miscarriage describes any bleeding during pregnancy, prior to viability, that has yet to be assessed.. At investigation it may be found that the fetus remains viable and the pregnancy continues without further problems.[medical citation needed] An anembryonic pregnancy (also called an "empty sac" or "blighted ovum") is a condition where the gestational sac develops normally, while the embryonic part of the pregnancy is either absent or stops growing very early. This accounts for approximately half of miscarriages. All other miscarriages are classified as embryonic miscarriages, meaning that there is an embryo present in the gestational sac. Half of embryonic miscarriages have aneuploidy (an abnormal number of chromosomes).[43] An inevitable miscarriage occurs when the cervix has already dilated,[82] but the fetus has yet to be expelled. This usually will progress to a complete miscarriage. The fetus may or may not have cardiac activity. Transvaginal ultrasonography after an episode of heavy bleeding in an intrauterine pregnancy that had been confirmed by a previous ultrasononography. There is some widening between the uterine walls, but no sign of any gestational sac, thus in this case being diagnostic of a complete miscarriage. A complete miscarriage is when all products of conception have been expelled; these may include the trophoblast, chorionic villi, gestational sac, yolk sac, and fetal pole (embryo); or later in pregnancy the fetus, umbilical cord, placenta, amniotic fluid, and amniotic membrane. The presence of a pregnancy test that is still positive as well as an empty uterus upon transvaginal ultrasonography does, however, fulfill the definition of pregnancy of unknown location. Therefore, there may be a need for follow-up pregnancy tests to ensure that there is no remaining pregnancy, including an ectopic pregnancy. Transvaginal ultrasonography, with some products of conception in the cervix (to the left in the image) and remnants of a gestational sac by the fundus (to the right in the image), indicating an incomplete miscarriage. An incomplete miscarriage occurs when some products of conception have been passed, but some remains inside the uterus.[83] However, an increased distance between the uterine walls on transvaginal ultrasonography may also simply be an increased endometrial thickness and/or a polyp. The use of a Doppler ultrasound may be better in confirming the presence of significant retained products of conception in the uterine cavity.[84] In cases of uncertainty, ectopic pregnancy must be excluded using techniques like serial beta-hCG measurements.[84] A 13-week fetus without cardiac activity located in the uterus (delayed or missed miscarriage) A missed miscarriage is when the embryo or fetus has died, but a miscarriage has not yet occurred. It is also referred to as delayed miscarriage, silent miscarriage, or missed abortion.[85][86] A septic miscarriage occurs when the tissue from a missed or incomplete miscarriage becomes infected, which carries the risk of spreading infection (septicaemia) and can be fatal.[43] Recurrent miscarriage ("recurrent pregnancy loss" (RPL) or "habitual abortion") is the occurrence of multiple consecutive miscarriages; the exact number used to diagnose recurrent miscarriage varies.[43] If the proportion of pregnancies ending in miscarriage is 15% and assuming that miscarriages are independent events,[87] then the probability of two consecutive miscarriages is 2.25% and the probability of three consecutive miscarriages is 0.34%. The occurrence of recurrent pregnancy loss is 1%.[87] A large majority (85%) of those who have had two miscarriages will conceive and carry normally afterward. The physical symptoms of a miscarriage vary according to the length of pregnancy, though most miscarriages cause pain or cramping. The size of blood clots and pregnancy tissue that are passed become larger with longer gestations. After 13 weeks' gestation, there is a higher risk of placenta retention.[88]


Prevention[edit] Prevention of a miscarriage can sometimes be accomplished by decreasing risk factors.[9] This may include good prenatal care, avoiding drugs and alcohol, preventing infectious diseases, and avoiding x-rays.[9] Identifying the cause of the miscarriage may help prevent future pregnancy loss, especially in cases of recurrent miscarriage. Often there is little a person can do to prevent a miscarriage.[9] Vitamin supplementation before or during pregnancy has not been found to affect the risk of miscarriage.[89] Non-modifiable risk factors[edit] Preventing a miscarriage in subsequent pregnancies may be enhanced with assessments of: Immune status[7][69] Chemical and occupational exposures[38] Anatomical defects[74][25] Intercurrent diseases[67][30] Polycystic ovary disease[90][91][92][93][65] Previous exposure to Chemotherapy and Radiation Medications[27][58][59][60][61][62] Surgical history[56] Endocrine disorders[37][55][needs update] Genetic abnormalities[24][25] Modifiable risk factors[edit] Maintaining a healthy weight and good pre-natal care can reduce the risk of miscarriage.[28] Some risk factors can be minimized by avoiding the following: Smoking[34][36][28] Cocaine use[34] Alcohol[28] Poor nutrition Occupational exposure to agents that can cause miscarriage[38] Medications associated with miscarriage[57][59][28] Drug abuse[28]


Management[edit] Women who miscarry early in their pregnancy usually do not require any subsequent medical treatment but they can benefit from support and counseling.[22][94] Most early miscarriages will complete on their own; in other cases, medication treatment or aspiration of the products of conception can be used to remove remaining tissue.[95] While bed rest has been advocated to prevent miscarriage, this has not been found to be of benefit.[96][20] Those who are or who have experienced an abortion benefit from the use of careful medical language. Significant distress can often be managed by the ability of the clinician to clearly explain terms without suggesting that the woman or couple are somehow to blame.[97] Evidence to support Rho(D) immune globulin after a spontaneous miscarriage is unclear.[98] In the UK, Rho(D) immune globulin is recommended in Rh-negative women after 12 weeks gestational age and before 12 weeks gestational age in those who need surgery or medication to complete the miscarriage.[99] Methods[edit] No treatment is necessary for a diagnosis of complete miscarriage (so long as ectopic pregnancy is ruled out). In cases of an incomplete miscarriage, empty sac, or missed abortion there are three treatment options: watchful waiting, medical management, and surgical treatment. With no treatment (watchful waiting), most miscarriages (65–80%) will pass naturally within two to six weeks.[100] This treatment avoids the possible side effects and complications of medications and surgery,[101] but increases the risk of mild bleeding, need for unplanned surgical treatment, and incomplete miscarriage. Medical treatment usually consists of using misoprostol (a prostaglandin) to contract the uterus, expelling remaining tissue out of the cervix. This works within a few days in 95% of cases.[100] Vacuum aspiration or sharp curettage can be used, though vacuum aspiration is lower-risk and more common.[100] Delayed and incomplete miscarriage[edit] In delayed or incomplete miscarriage, treatment depends on the amount of tissue remaining in the uterus. Treatment can include surgical removal of the tissue with vacuum aspiration or misoprostol.[102] Some organizations recommend delaying sexual relations immediately after a miscarriage to prevent infection.[103] Induced miscarriage[edit] Further information: Self-induced abortion An induced abortion may be performed by a physician for women who do not want to continue the pregnancy.[104] Self-induced abortion performed by a woman or non-medical personnel is extremely dangerous and is still a cause of maternal mortality in some countries. In some locales it is illegal or carries heavy social stigma.[105] Support[edit] Organizations exist that provide information and counseling to help those who have had a miscarriage.[106] Family and friends often conduct a memorial or burial service. Hospitals also can provide support and help memorialize the event. Depending on locale others desire to have a private ceremony.[106] Providing appropriate support with frequent discussions and sympathetic counseling are part of evaluation and treatment. Those who experience unexplained miscarriage can be treated with emotional support.[94][97]


Outcomes[edit] Psychological and emotional effects[edit] A cemetery for miscarried fetuses, stillborn babies, and babies who have died soon after birth See also: Miscarriage and grief and Miscarriage and mental illness Experiencing a miscarriage "is a major loss for all pregnant women."[94] A miscarriage can result in anxiety, depression or stress for those involved.[78][107][108] The impact on a woman life can be underestimated.[109] It can have an effect on the whole family.[110] Almost all those experiencing a miscarriage go through a grieving process.[2][111][112] "Prenatal attachment" often exists that can be seen as parental sensitivity, love and preoccupation directed toward the unborn child.[113] Serious emotional impact is usually experienced immediately after the miscarriage.[2] Some may go through the same loss when an ectopic pregnancy is terminated.[28] In some, the realization of the loss can take weeks. Providing family support to those experiencing the loss can be challenging because some find comfort in talking about the miscarriage while others may find the event painful to discuss. The father can have the same sense of loss. Expressing feelings of grief and loss can sometimes be harder for men. Some women are able to begin planning their next pregnancy after a few weeks of having the miscarriage. For others, planning another pregnancy can be difficult.[106][103] Some facilities acknowledge the loss. Parents can name and hold their infant. They may be given momentos such as photos and footprints. Some conduct a funeral or memorial service. They may express the loss by planting a tree.[114] Some health organizations recommend that sexual activity be delayed after the miscarriage. The menstrual cycle should resume after about three to four months.[106] Women report that the medical management of their miscarriage can be performed in a manner that can make the experience even worse than the event.[109] Women report that they were dissatisfied with the care they received from physicians and nurses.[115] Subsequent pregnancies[edit] Some parents want to try to have a baby very soon after the miscarriage. The decision of trying to become pregnant again can be difficult. Reasons exist that may prompt parents to consider another pregnancy. For older mothers, there may be some sense of urgency. Other parents are optimistic that future pregnancies are likely to be successful. Many are hesitant and want to know about the risk of having another or more miscarriages. Some clinicians recommend that the women have one menstrual cycle before attempting another pregnancy. This is because the date of conception may be hard to determine. Also, the first menstrual cycle after a miscarriage can be much longer or shorter than expected. Parents may be advised to wait even longer if they have experienced late miscarriage or molar pregnancy, or are undergoing tests. Some parents wait for six months based upon recommendations from their health care provider.[103] The risks of having another miscarriage vary according to the cause. The risk of having another miscarriage after a molar pregnancy is very low. The risk of another miscarriage is highest after the third miscarriage. Pre-conception care is available in some locales.[103] Later cardiovascular disease[edit] There is a significant association between miscarriage and later development of coronary artery disease, but not of cerebrovascular disease.[116][27]


Epidemiology[edit] Among women who know they are pregnant, the miscarriage rate is roughly 10% to 20%, while rates among all fertilized zygotes are around 30% to 50%.[1][5][43][94] A 2012 review found the risk of miscarriage between 5 and 20 weeks from 11% to 22%.[117] Up to the 13th week of pregnancy, the risk of miscarriage each week was around 2%, dropping to 1% in week 14 and reducing slowly between 14 and 20 weeks.[117] The precise rate is not known because a large number of miscarriages occur before pregnancies become established and before the woman is aware they are pregnant.[117] Additionally, those with bleeding in early pregnancy may seek medical care more often than those not experiencing bleeding.[117] Although some studies attempt to account for this by recruiting women who are planning pregnancies and testing for very early pregnancy, they still are not representative of the wider population.[117] The prevalence of miscarriage increases with the age of both parents.[117][118][119][120] In a Danish register-based study where the prevalence of miscarriage was 11%, the prevalence rose from 9% at 22 years of age to 84% by 48 years of age.[118][needs update] Another, later study in 2013 found that when either parent was over the age of 40, the rate of known miscarriages doubled.[43] In 2010, 50,000 inpatient admissions for miscarriage occurred in the UK.[12]


Terminology[edit] Many women, fathers and partners refer to miscarriage as the loss of a 'baby' rather than an embryo or fetus. Clinical terms can suggest blame and even cause anger. Terms that are known to cause distress in those experiencing miscarriage include: 'habitual aborter', 'products of conception', 'blighted ovum', and 'evacuation of retained products of conception' (ERPC). 'Pregnancy loss' is a term that describes miscarriage, ectopic and molar pregnancies.[97] The term "fetal death" applies variably in different countries and contexts, sometimes incorporating weight, and gestational age from 16 weeks in Norway, 20 weeks in the US and Australia, 24 weeks in the UK to 26 weeks in Italy and Spain.[121][122][123] A fetus that died before birth after this gestational age may be referred to as a stillbirth.[121] Under UK law, all stillbirths should be registered,[124] although this does not apply to miscarriages.


History[edit] The medical terminology applied to experiences during early pregnancy has changed over time.[125] Before the 1980s, health professionals used the phrase "spontaneous abortion" for a miscarriage and "induced abortion" for a termination of the pregnancy.[125][126] In the late 1980s and 1990s, doctors became more conscious of their language in relation to early pregnancy loss. Some medical authors advocated change to use of "miscarriage" instead of "spontaneous abortion" because they argued this would be more respectful and help ease a distressing experience.[127][128][needs update] The change was being recommended by some in the profession in Britain in the late 1990s.[129] In 2005 the European Society for Human Reproduction and Embryology (ESHRE) published a paper aiming to facilitate a revision of nomenclature used to describe early pregnancy events.[85]


Society and culture[edit] In places where induced abortion is illegal or carries social stigma, suspicion may surround miscarriage, complicating an already sensitive language issue. Research suggests that some dislike the term spontaneous abortion for miscarriage, some are indifferent and some prefer it. These preferences may reflect cultural differences.[97] In the 1960s, the use of "miscarriage" in Britain (instead of "spontaneous abortion") occurred after changes in legislation. Developments in ultrasound technology (in the early 1980s) allowed them to identify miscarriages.[125] According to French statutes, an infant born before the age of viability, determined to be 28 weeks, is not registered as a 'child'. If birth occurs after this, the infant is granted a certificate that allows women who have given birth to a stillborn child, to have a symbolic record of that child. This certificate can include a registered and given name with the purpose of allowing a funeral and acknowledgement of the event.[130][131][132]


Other animals[edit] Miscarriage occurs in all animals that experience pregnancy, though in such contexts it is more commonly referred to as a "spontaneous abortion" (the two terms are synonymous). There are a variety of known risk factors in non-human animals. For example, in sheep, miscarriage may be caused by crowding through doors, or being chased by dogs.[133] In cows, spontaneous abortion may be caused by contagious disease, such as brucellosis or Campylobacter, but often can be controlled by vaccination.[134] In many species of sharks and rays, stress induced miscarriage occurs frequently on capture.[135] Other diseases are also known to make animals susceptible to miscarriage. Spontaneous abortion occurs in pregnant prairie voles when their mate is removed and they are exposed to a new male,[136] an example of the Bruce effect, although this effect is seen less in wild populations than in the laboratory.[137] Female mice who had spontaneous abortions showed a sharp rise in the amount of time spent with unfamiliar males preceding the abortion than those who did not.[138]


See also[edit] Childbirth Pregnancy and Infant Loss Remembrance Day


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Sheep Husbandry in Canada Archived September 24, 2015, at the Wayback Machine., page 124 (1911). ^ "Beef cattle and Beef production: Management and Husbandry of Beef Cattle" Archived January 1, 2009, at the Wayback Machine., Encyclopaedia of New Zealand (1966). ^ Adams, Kye R.; Fetterplace, Lachlan C.; Davis, Andrew R.; Taylor, Matthew D.; Knott, Nathan A. (January 2018). "Sharks, rays and abortion: The prevalence of capture-induced parturition in elasmobranchs". Biological Conservation. 217: 11–27. doi:10.1016/j.biocon.2017.10.010.  ^ Fraser-Smith AC (1975). "Male-induced pregnancy termination in the prairie vole, Microtus ochrogaster". Science. 187 (4182): 1211–3. doi:10.1126/science.1114340. PMID 1114340.  ^ Mahady, Scott; Wolff, Jerry (2002). "A field test of the Bruce effect in the monogamous prairie vole (Microtus ochrogaster)". Behavioral Ecology and Sociobiology. 52 (1): 31–7. doi:10.1007/s00265-002-0484-0. JSTOR 4602102.  ^ Becker SD, Hurst JL (2009). 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Bibliography[edit] Hoffman, Barbara (2012). Williams gynecology. New York: McGraw-Hill Medical. ISBN 9780071716727. 


External links[edit] Classification V · T · D ICD-10: O03 ICD-9-CM: 634 OMIM: 614389 MeSH: D000022 DiseasesDB: 29 External resources MedlinePlus: 001488 eMedicine: search/miscarriage Patient UK: Miscarriage v t e Pathology of pregnancy, childbirth and the puerperium (O, 630–679) Pregnancy Pregnancy with abortive outcome Ectopic pregnancy Abdominal pregnancy Cervical pregnancy Interstitial pregnancy Ovarian pregnancy Molar pregnancy Miscarriage Stillbirth Oedema, proteinuria and hypertensive disorders Gestational hypertension Pre-eclampsia HELLP syndrome Eclampsia Other, predominantly related to pregnancy Digestive system Acute fatty liver of pregnancy Gestational diabetes Hepatitis E Hyperemesis gravidarum Intrahepatic cholestasis of pregnancy Integumentary system / dermatoses of pregnancy Gestational pemphigoid Impetigo herpetiformis Intrahepatic cholestasis of pregnancy Linea nigra Prurigo gestationis Pruritic folliculitis of pregnancy Pruritic urticarial papules and plaques of pregnancy (PUPPP) Striae gravidarum Nervous system Chorea gravidarum Blood Gestational thrombocytopenia Pregnancy-induced hypercoagulability Maternal care related to the fetus and amniotic cavity amniotic fluid Oligohydramnios Polyhydramnios Braxton Hicks contractions chorion / amnion Amniotic band syndrome Chorioamnionitis Chorionic hematoma Monoamniotic twins Premature rupture of membranes Obstetrical bleeding Antepartum placenta Circumvallate placenta Monochorionic twins Placenta praevia Placental abruption Twin-to-twin transfusion syndrome Labor Amniotic fluid embolism Cephalopelvic disproportion Dystocia Shoulder dystocia Fetal distress Locked twins Obstetrical bleeding Postpartum Pain management during childbirth placenta Placenta accreta Preterm birth Postmature birth Umbilical cord prolapse Uterine rupture Vasa praevia Puerperal Breastfeeding difficulties Low milk supply Cracked nipples Breast engorgement Diastasis symphysis pubis Peripartum cardiomyopathy Postpartum depression Postpartum thyroiditis Puerperal fever Puerperal mastitis Other Concomitant conditions Diabetes mellitus Systemic lupus erythematosus Thyroid disorders Maternal death Sexual activity during pregnancy v t e Chromosome abnormalities (Q90–Q99, 758) Autosomal Trisomies Down syndrome 21 Edwards syndrome 18 Patau syndrome 13 Trisomy 9 Warkany syndrome 2 8 Cat eye syndrome/Trisomy 22 22 Trisomy 16 Monosomies/deletions 1q21.1 deletion syndrome/1q21.1 duplication syndrome/TAR syndrome 1 Wolf–Hirschhorn syndrome 4 Cri du chat/Chromosome 5q deletion syndrome 5 Williams syndrome 7 Jacobsen syndrome 11 Miller–Dieker syndrome/Smith–Magenis syndrome 17 DiGeorge syndrome 22 22q11.2 distal deletion syndrome 22 22q13 deletion syndrome 22 genomic imprinting Angelman syndrome/Prader–Willi syndrome (15) Distal 18q-/Proximal 18q- X/Y linked Monosomy Turner syndrome (45,X) Trisomy/tetrasomy, other karyotypes/mosaics Klinefelter syndrome (47,XXY) XXYY syndrome (48,XXYY) XXXY syndrome (48,XXXY) 49,XXXYY 49,XXXXY Triple X syndrome (47,XXX) Tetrasomy X (48,XXXX) 49,XXXXX Jacobs syndrome (47,XYY) 48,XYYY 49,XYYYY 45,X/46,XY Translocations Leukemia/lymphoma Lymphoid Burkitt's lymphoma t(8 MYC;14 IGH) Follicular lymphoma t(14 IGH;18 BCL2) Mantle cell lymphoma/Multiple myeloma t(11 CCND1:14 IGH) Anaplastic large-cell lymphoma t(2 ALK;5 NPM1) Acute lymphoblastic leukemia Myeloid Philadelphia chromosome t(9 ABL; 22 BCR) Acute myeloblastic leukemia with maturation t(8 RUNX1T1;21 RUNX1) Acute promyelocytic leukemia t(15 PML,17 RARA) Acute megakaryoblastic leukemia t(1 RBM15;22 MKL1) Other Ewing's sarcoma t(11 FLI1; 22 EWS) Synovial sarcoma t(x SYT;18 SSX) Dermatofibrosarcoma protuberans t(17 COL1A1;22 PDGFB) Myxoid liposarcoma t(12 DDIT3; 16 FUS) Desmoplastic small-round-cell tumor t(11 WT1; 22 EWS) Alveolar rhabdomyosarcoma t(2 PAX3; 13 FOXO1) t (1 PAX7; 13 FOXO1) Other Fragile X syndrome Uniparental disomy XX male syndrome/46,XX testicular disorders of sex development Marker chromosome Ring chromosome 6; 9; 14; 15; 18; 20; 21, 22 Authority control GND: 4128069-6 NDL: 00569917 Retrieved from "https://en.wikipedia.org/w/index.php?title=Miscarriage&oldid=819573296" Categories: AbortionPathology of pregnancy, childbirth and the puerperiumPregnancy with abortive outcomeTheriogenologyCounselingPsychotherapyGriefDeathSex chromosome aneuploidiesPainDeath of childrenCongenital disordersChromosomal abnormalitiesHidden categories: CS1 maint: Extra text: authors listCS1 maint: Multiple names: authors listAll articles with dead external linksArticles with dead external links from June 2017Articles with permanently dead external linksCS1 French-language sources (fr)Webarchive template wayback linksUse mdy dates from May 2012Infobox medical condition (new)Wikipedia articles in need of updating from September 2017All Wikipedia articles in need of updatingAll articles with unsourced statementsArticles with unsourced statements from November 2017Wikipedia articles in need of updating from October 2017Wikipedia articles with GND identifiersRTT


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Miscarriage - Photos and All Basic Informations

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RejectionAutoimmune DisorderXY Sex-determination SystemTrisomyMonosomyTriploid SyndromeChromosome AbnormalityZygoteUterusAneuploidyTrisomyTurner SyndromePolyploidTetraploidyUterine MalformationUterine FibroidCervical IncompetencePremature BirthObesityDiabetes MellitusAdvanced Maternal AgeBulimia NervosaAnorexia NervosaHyperemesis GravidarumCaffeineWikipedia:Manual Of Style/Dates And NumbersListeriosisToxoplasmosisSalmonellaChorionic Villus SamplingAmniocentesisBariatricAntidepressantSelective Serotonin Reuptake InhibitorAntidepressantStatistical SignificanceIntercurrent Diseases In PregnancyPolycystic Ovary SyndromeMetforminHypothyroidismMycoplasma GenitaliumPreterm BirthCeliac DiseaseOdds RatioAnti-thyroid AutoantibodiesOdds RatioConfidence IntervalUterusBicornate UterusCervical IncompetenceSmoking And PregnancyMorning SicknessOccupational ExposureDDTLeadFormaldehydeArsenicBenzeneEthylene OxideVideo Display TerminalNitrous OxideCosmetologistCocaine IntoxicationUreaplasma Urealyticum InfectionMycoplasma Hominis InfectionGroup B Streptococcal InfectionHIV/AIDSSyphilisChlamydia InfectionCampylobacter FetusToxoplasma GondiiObstetric UltrasonographyHuman Chorionic GonadotropinHypotensionTachycardiaAnemiaObstetric UltrasoundPathologyProducts Of ConceptionChorionic VilliTrophoblastEndometriumThe New England Journal Of MedicineCrown-rump LengthEmbryonic HeartbeatGestational SacYolk SacLast Menstrual PeriodAmniotic SacWikipedia:Identifying Reliable Sources (medicine)Anembryonic GestationGestational SacAneuploidyEnlargeTransvaginal UltrasonographyUterine WallGestational SacTrophoblastChorionic VilliGestational SacYolk SacFetal PoleEmbryoFetusUmbilical CordPlacentaAmniotic SacPregnancy TestTransvaginal UltrasonographyPregnancy Of Unknown LocationEnlargeTransvaginal UltrasonographyCervixGestational SacFundus Of The UterusProducts Of ConceptionUterine WallPolypEctopic PregnancyBeta-hCGEnlargeSeptic AbortionSepticaemiaRecurrent MiscarriagePrenatal CareOccupational 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PregnancyMolar PregnancyStillbirthEdemaProteinuriaHypertensive Disorders Of PregnancyGestational HypertensionPre-eclampsiaHELLP SyndromeEclampsiaHuman Digestive SystemAcute Fatty Liver Of PregnancyGestational DiabetesHepatitis EHyperemesis GravidarumIntrahepatic Cholestasis Of PregnancyIntegumentary SystemDermatoses Of PregnancyGestational PemphigoidImpetigo HerpetiformisIntrahepatic Cholestasis Of PregnancyLinea NigraPrurigo GestationisPruritic Folliculitis Of PregnancyPruritic Urticarial Papules And Plaques Of PregnancyStriae GravidarumNervous SystemChorea GravidarumBloodGestational ThrombocytopeniaHypercoagulability In PregnancyFetusAmniotic CavityAmniotic FluidOligohydramniosPolyhydramniosBraxton Hicks ContractionsChorionAmnionAmniotic Band SyndromeChorioamnionitisChorionic HematomaMonoamniotic TwinsPremature Rupture Of MembranesObstetrical BleedingAntepartum HaemorrhagePlacental DiseaseCircumvallate PlacentaMonochorionic TwinsPlacenta PraeviaPlacental AbruptionTwin-to-twin Transfusion SyndromeObstetric Labor ComplicationAmniotic Fluid EmbolismCephalopelvic DisproportionDystociaShoulder DystociaFetal DistressLocked TwinsObstetrical BleedingPostpartum BleedingPain Management During ChildbirthPlacental DiseasePlacenta AccretaPreterm BirthPostterm PregnancyUmbilical Cord ProlapseUterine RuptureVasa PraeviaPuerperal DisorderBreastfeeding DifficultiesLow Milk SupplyCracked NippleBreast EngorgementDiastasis Symphysis PubisPeripartum CardiomyopathyPostpartum DepressionPostpartum ThyroiditisPuerperal FeverPuerperal MastitisConcomitant Conditions In PregnancyDiabetes Mellitus And PregnancySystemic Lupus Erythematosus And PregnancyThyroid Disease In PregnancyMaternal DeathSexual Activity During PregnancyTemplate:Chromosomal AbnormalitiesTemplate Talk:Chromosomal AbnormalitiesChromosome AbnormalityICD-10 Chapter XVII: Congenital Malformations, Deformations And Chromosomal AbnormalitiesList Of ICD-9 Codes 740–759: Congenital AnomaliesAutosomeTrisomyDown SyndromeChromosome 21 (human)Edwards SyndromeChromosome 18 (human)Patau SyndromeChromosome 13 (human)Trisomy 9Trisomy 8Chromosome 8 (human)Cat Eye SyndromeTrisomy 22Chromosome 22 (human)Trisomy 16MonosomyDeletion (genetics)1q21.1 Deletion Syndrome1q21.1 Duplication SyndromeTAR SyndromeChromosome 1 (human)Wolf–Hirschhorn SyndromeChromosome 4 (human)Cri Du ChatChromosome 5q Deletion SyndromeChromosome 5 (human)Williams SyndromeChromosome 7 (human)Jacobsen SyndromeChromosome 11 (human)Miller–Dieker SyndromeSmith–Magenis SyndromeChromosome 17 (human)DiGeorge SyndromeChromosome 22 (human)22q11.2 Distal Deletion SyndromeChromosome 22 (human)22q13 Deletion SyndromeChromosome 22 (human)Genomic ImprintingAngelman SyndromePrader–Willi SyndromeChromosome 15 (human)Distal 18q-Proximal 18q-X ChromosomeY ChromosomeMonosomyTurner SyndromeTrisomyTetrasomyAneuploidyMosaic (genetics)Klinefelter SyndromeXXYY SyndromeXXXY Syndrome49, XXXXY SyndromeTriple X SyndromeTetrasomy X49, XXXXXXYY Syndrome45,X/46,XY MosaicismChromosomal TranslocationLeukemiaLymphomaBurkitt's LymphomaMycIGH@Follicular LymphomaIGH@Bcl-2Mantle Cell LymphomaMultiple MyelomaCyclin D1IGH@Anaplastic Large-cell LymphomaAnaplastic Lymphoma KinaseNPM1Acute Lymphoblastic LeukemiaPhiladelphia ChromosomeABL (gene)BCR (gene)Acute Myeloblastic Leukemia With MaturationRUNX1T1RUNX1Acute Promyelocytic LeukemiaPromyelocytic Leukemia ProteinRetinoic Acid Receptor AlphaAcute Megakaryoblastic LeukemiaRBM15MKL1Ewing's SarcomaFLI1Ewing Sarcoma Breakpoint Region 1Synovial SarcomaSynaptotagmin 1Synovial Sarcoma, X BreakpointDermatofibrosarcoma ProtuberansCollagen, Type I, Alpha 1PDGFBMyxoid LiposarcomaDNA Damage-inducible Transcript 3FUS (gene)Desmoplastic Small-round-cell TumorWT1Ewing Sarcoma Breakpoint Region 1Alveolar RhabdomyosarcomaPAX3FOXO1PAX7FOXO1Fragile X SyndromeUniparental DisomyXX Male Syndrome46,XX Testicular Disorders Of Sex DevelopmentMarker ChromosomeRing ChromosomeRing Chromosome 14 SyndromeRing 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