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Miscarriage

Also listed as: Spontaneous abortion


Spontaneous abortion, or miscarriage, is the loss of a fetus before 20 weeks of pregnancy. The most common cause of miscarriage is a genetic abnormality. A second miscarriage generally occurs in only 1% of women. However, there are women who experience habitual miscarriages (three or more consecutive spontaneous abortions). Almost one-third of 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
  • Passage of clots or a gush of clear or pink vaginal fluid (may indicate pregnancy tissue from the uterus)
  • Abdominal pain or cramping
  • Fever
  • Decrease in signs of pregnancy, such as breast sensitivity and morning sickness
  • Dizziness, lightheadedness, or feeling faint

What Causes It?

A wide range of health conditions that affect at least one parent can cause a miscarriage, including the following:

  • Chromosomal abnormalities account for up to 60% of losses
  • 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)
  • Other factors of conception (such as defective sperm cells, time of egg implantation), or stress

Who's Most At Risk?

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

  • Previous spontaneous abortion
  • 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
  • Cocaine use
  • X-ray exposure
  • Environmental toxins -- excessive exposure to lead, mercury, organic solvents
  • Serious maternal illness
  • Flight attendants working more than 74 hours per month
  • Maternal or paternal handling of anti-cancer agents
  • Increased levels of homocysteine (see Nutrition section)

What to Expect at Your Provider's Office

If you think you are having a miscarriage, see your health care provider immediately. Your health care provider will take a comprehensive medical, family, and social history to try to determine if there is a suggestion of an underlying cause. A pelvic examination detects uterine abnormalities. 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

Avoid known risks, such as obesity, caffeine, alcohol, and cigarette smoking, as well as other risks listed above. A healthy body, with the immune and hormonal systems functioning properly, will help decrease the risks of a miscarriage.

Treatment Plan

Immediate treatment sometimes involves surgery to remove pregnancy tissue. Your health care provider may recommend counseling to help you through the grieving process. 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 followed by 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

There may be a strong connection among diet, lifestyle and risk of spontaneous abortion. 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. Also, some case reports suggest certain herbal medicines may help prevent recurring miscarriages caused by immune system problems. However, there is no clear scientific evidence of this.

Miscarriage is a serious health issue. Ask your health care provider about alternative therapies that may help protect your pregnancy. Always tell your health care provider about the herbs and supplements you are using.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

  • 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 fewer red meats and more 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
  • Avoid coffee and other stimulants, alcohol, and tobacco.
  • Drink 6 - 8 glasses of filtered water daily.
  • Drink soy milk, for bone and hormonal health.
  • Exercise moderately, as tolerated, 5 days a week.

You may be able to address nutritional deficiencies with the following supplements:

  • 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.
  • 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, to help decrease inflammation. Cold-water fish, such as salmon or halibut, are good sources.
  • SAMe (s-adenosyl-L-methionine), 100 - 200 mg before breakfast daily, for mood improvement.
  • 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.
  • Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune support.
  • Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
  • L-theanine, 200 mg one to three times daily, for stress and nervous system support.

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.
  • Evening primrose oil ( Oenothera biennis ) standardized extract, 500 - 1000 mg daily, as a source of gamma linolenic acid (GLA), for symptoms of hormonal imbalance and stress.
  • Milk thistle ( Silybum marianum ) seed standardized extract, 80 - 160 mg two to three times daily, for detoxification support.

Homeopathy

No conventional scientific literature supports the use of homeopathy to prevent spontaneous abortion. However, homeopathic literature does contain reports of successful treatment for women with frequent, spontaneous abortion with homeopathy. An experienced homeopath would consider your individual case and may recommend treatments to address your underlying condition and support your overall health.

Acupuncture

No scientific literature supports the use of acupuncture to prevent spontaneous abortion. However, many acupuncturists report success in treating women with a history of spontaneous abortion, leading to the ability to carry the pregnancy to full term. This may result from clearing up underlying endocrine problems and reducing stress.


Prognosis and Possible Complications

There is only a 1% chance of recurring miscarriage. However, the risk increases significantly with each subsequent loss. Possible complications from spontaneous abortion 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 suffered a miscarriage, you should see your provider very soon after any future pregnancies.


Supporting Research

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  • Review Date: 9/5/2006
  • Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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