Editing Miscarriage (section)

{{Short description|Natural premature termination of pregnancy}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{For|usage in law|Miscarriage of justice}}
{{use mdy dates|date=May 2012}}
{{Infobox medical condition (new)
| name          = Spontaneous abortion
| synonyms      = miscarriage, [[early pregnancy loss]]
| image         = Anembryonic gestation.jpg
| caption       = An [[ultrasound]] showing a [[gestational sac]] containing a [[yolk sac]] but no [[embryo]]
| field         = [[Obstetrics and Gynaecology]], [[Neonatology]], [[Pediatrics]]
| symptoms      = [[Vaginal bleeding]] with or without pain<ref name="John20122" />
| complications = [[Infection]], [[bleeding]],<ref name=Mer2018>{{cite web|title=Spontaneous Abortion – Gynecology and Obstetrics|url=https://www.merckmanuals.com/en-ca/professional/gynecology-and-obstetrics/abnormalities-of-pregnancy/spontaneous-abortion|website=Merck Manuals Professional Edition|access-date=5 May 2018|archive-date=December 4, 2020|archive-url=https://web.archive.org/web/20201204041458/https://www.merckmanuals.com/en-ca/professional/gynecology-and-obstetrics/abnormalities-of-pregnancy/spontaneous-abortion|url-status=dead}}</ref> [[sadness]], [[anxiety]], [[guilt (emotion)|guilt]]<ref name="Pregnancy loss"/>
| onset         = Before 20 weeks of pregnancy<ref name=NIH2013Def/>
| duration      =
| types         =
| causes        = [[Chromosomal abnormalities]],<ref name="John20122" /><ref name=Vai2015/> uterine abnormalities<ref>{{cite journal |vauthors=Chan YY, Jayaprakasan K, Tan A, Thornton JG, Coomarasamy A, Raine-Fenning NJ |title=Reproductive outcomes in women with congenital uterine anomalies: a systematic review |journal=Ultrasound in Obstetrics & Gynecology |volume=38 |issue=4 |pages=371–382 |date=October 2011 |pmid=21830244 |s2cid=40113681 |doi=10.1002/uog.10056 |doi-access=free}}</ref>
| risks         = Being an older parent, previous miscarriage, exposure to [[tobacco smoke]], [[obesity]], [[diabetes mellitus|diabetes]], [[autoimmune disease]]s, [[Recreational drug use|drug or alcohol use]]<ref name="NIH2013Epi2" /><ref name="Ol2014" /><ref name=CarpSelmi2012 />
| diagnosis     = [[Physical examination]], [[human chorionic gonadotropin]], [[ultrasound]]<ref name=NIH2015Diag/>
| differential  = [[Ectopic pregnancy]], [[implantation bleeding]].<ref name="John20122" />
| prevention    = [[Prenatal care]]<ref name=NIH2013Pre/>
| treatment     = [[Expectant management]], [[vacuum aspiration]], emotional support<ref name="Ol2014" /><ref name=NIH2013Tx/>
| medication    = [[misoprostol]]
| prognosis     =
| frequency     = 10–50% of pregnancies<ref name="John20122" /><ref name="NIH2013Epi2" />
| deaths        =
| alt           =
}}
'''Miscarriage''', also known in medical terms as a '''spontaneous abortion''', is an end to [[pregnancy]] resulting in the loss and expulsion of an [[embryo]] or [[fetus]] from the [[womb]] before it can [[fetal viability|survive independently]].<ref name="John20122" /><ref name="NIH2013Def">{{cite web |title=What is pregnancy loss/miscarriage? |url=http://www.nichd.nih.gov/health/topics/pregnancyloss/conditioninfo/Pages/default.aspx |url-status=live |website=www.nichd.nih.gov/ |date=15 July 2013 |access-date=14 March 2015 |archive-url=https://web.archive.org/web/20150402121055/http://www.nichd.nih.gov/health/topics/pregnancyloss/conditioninfo/Pages/default.aspx |archive-date=2 April 2015 |df=mdy-all}}</ref> Miscarriage before 6 weeks of [[gestation]] is defined as '''biochemical loss''' by [[European Society of Human Reproduction and Embryology|ESHRE]].<ref name="clarej">{{cite journal |last1=Larsen |first1=Elisabeth Clare |last2=Christiansen |first2=Ole Bjarne |last3=Kolte |first3=Astrid Marie |last4=Macklon |first4=Nick |title=New insights into mechanisms behind miscarriage |journal=BMC Medicine |date=26 June 2013 |volume=11 |issue=1 |pages=154 |pmid=23803387 |pmc=3699442 |issn=1741-7015 |doi=10.1186/1741-7015-11-154 |doi-access=free}}</ref><ref>{{cite journal |last1=Messerlian |first1=Carmen |last2=Williams |first2=Paige L. |last3=Mínguez-Alarcón |first3=Lidia |last4=Carignan |first4=Courtney C. |last5=Ford |first5=Jennifer B. |last6=Butt |first6=Craig M. |last7=Meeker |first7=John D. |last8=Stapleton |first8=Heather M. |last9=Souter |first9=Irene |last10=Hauser |first10=Russ |title=Organophosphate flame-retardant metabolite concentrations and pregnancy loss among women conceiving with assisted reproductive technology |journal=Fertility and Sterility |volume=110 |issue=6 |pages=1137–1144.e1 |date=1 November 2018 |issn=0015-0282 |pmid=30396558 |pmc=7261497 |doi=10.1016/j.fertnstert.2018.06.045 |doi-access=free}}</ref> Once [[ultrasound]] or [[histological]] evidence shows that a pregnancy has existed, the term used is '''clinical miscarriage''', which can be "early" (before 12 weeks) or "late" (between 12 and 21 weeks).<ref name="clarej" /> Spontaneous fetal termination after 20 weeks of gestation is known as a [[stillbirth]].<ref name="NIH2014Def">{{cite web |title=Stillbirth: Overview |url=https://www.nichd.nih.gov/health/topics/stillbirth/Pages/default.aspx |url-status=live |website=NICHD |date=23 September 2014 |access-date=4 October 2016 |archive-url=https://web.archive.org/web/20161005085055/https://www.nichd.nih.gov/health/topics/stillbirth/Pages/default.aspx |archive-date=October 5, 2016 |df=mdy-all}}</ref> The term ''miscarriage'' is sometimes used to refer to all forms of [[pregnancy loss]] and [[pregnancy with abortive outcome]]s before 20 weeks of gestation.

The most common symptom of a miscarriage is [[vaginal bleeding]], with or without pain.<ref name="John20122" /> [[Tissue (biology)|Tissue]] and [[clot]]-like material may leave the [[uterus]] and pass through and out of the [[vagina]].<ref>{{cite web |date=2013-07-15 |title=What are the symptoms of pregnancy loss/miscarriage? |url=http://www.nichd.nih.gov/health/topics/pregnancyloss/conditioninfo/Pages/symptoms.aspx |url-status=live |archive-url=https://web.archive.org/web/20150402113638/http://www.nichd.nih.gov/health/topics/pregnancyloss/conditioninfo/Pages/symptoms.aspx |archive-date=April 2, 2015 |access-date=14 March 2015 |website=www.nichd.nih.gov/ |df=mdy-all}}</ref> Risk factors for miscarriage include being an older parent, previous miscarriage, exposure to [[tobacco smoke]], [[obesity]], [[diabetes mellitus|diabetes]], [[thyroid problems]], and [[Recreational drug use|drug or alcohol use]].<ref name="NIH2013Epi2" /><ref name="Ol2014" /> About 80% of miscarriages occur in the first 12 weeks of [[pregnancy]] (the [[first trimester]]).<ref name="John20122" /> The underlying cause in about half of cases involves [[chromosomal abnormalities]].<ref name="Vai2015">{{cite journal | vauthors = Vaiman D | title = Genetic regulation of recurrent spontaneous abortion in humans | journal = Biomedical Journal | volume = 38 | issue = 1 | pages = 11–24 | year = 2015 | pmid = 25179715 | doi = 10.4103/2319-4170.133777 | doi-access = free}}</ref><ref name="John20122" /> Diagnosis of a miscarriage may involve checking to see if the [[cervix]] is open or [[Cervical mucus plug|sealed]], testing blood levels of [[human chorionic gonadotropin]] (hCG), and an [[ultrasound]].<ref name="NIH2015Diag">{{cite web|title=How do health care providers diagnose pregnancy loss or miscarriage?|url=http://www.nichd.nih.gov/health/topics/pregnancyloss/conditioninfo/Pages/diagnosed.aspx|website=www.nichd.nih.gov/|access-date=14 March 2015|date=2013-07-15}}</ref> Other conditions that can produce similar symptoms include an [[ectopic pregnancy]] and [[implantation bleeding]].<ref name="John20122" />

Prevention is occasionally possible with good [[prenatal care]].<ref name="NIH2013Pre" /> Avoiding drugs (including  [[Alcohol dependence|alcohol]]), [[infectious diseases]], and [[radiation]] may decrease the risk of miscarriage.<ref name="NIH2013Pre">{{cite web|title=Is there a cure for pregnancy loss/miscarriage?|url=http://www.nichd.nih.gov/health/topics/pregnancyloss/conditioninfo/Pages/cure.aspx|website=www.nichd.nih.gov/|access-date=14 March 2015|date=2013-10-21|url-status=live|archive-url=https://web.archive.org/web/20150402181042/http://www.nichd.nih.gov/health/topics/pregnancyloss/conditioninfo/Pages/cure.aspx|archive-date=April 2, 2015|df=mdy-all}}</ref> No specific treatment is usually needed during the first 7 to 14 days.<ref name="Ol2014" /><ref name="NIH2013Tx" /> Most miscarriages will be completed without additional interventions.<ref name="Ol2014" /> Occasionally the medication [[misoprostol]] or a procedure such as [[vacuum aspiration]] is used to remove the remaining tissue.<ref name="NIH2013Tx" /><ref>{{cite journal | vauthors = Tunçalp O, Gülmezoglu AM, Souza JP | title = Surgical procedures for evacuating incomplete miscarriage | journal = The Cochrane Database of Systematic Reviews | issue = 9 | pages = CD001993 | date = September 2010 | volume = 2010 | pmid = 20824830 | doi = 10.1002/14651858.CD001993.pub2 | pmc = 7064046 }}</ref> Women who have a blood type of [[rhesus negative]] (Rh negative) may require [[Rho(D) immune globulin]].<ref name="Ol2014" /> [[Pain medication]] may be beneficial.<ref name="NIH2013Tx" /> Feelings of [[sadness]], [[anxiety]] or [[Guilt (emotion)|guilt]] may occur following a miscarriage.<ref name="Pregnancy loss">{{cite journal |vauthors=Robinson GE |date=January 2014 |title=Pregnancy loss |journal=Best Practice & Research. Clinical Obstetrics & Gynaecology |volume=28 |issue=1 |pages=169–178 |doi=10.1016/j.bpobgyn.2013.08.012 |pmid=24047642 |s2cid=32998899}}</ref><ref name="radford">{{cite journal |vauthors=Radford EJ, Hughes M |date=June 2015 |title=Women's experiences of early miscarriage: implications for nursing care |journal=Journal of Clinical Nursing |volume=24 |issue=11–12 |pages=1457–1465 |doi=10.1111/jocn.12781 |pmid=25662397}}</ref> Emotional support may help with processing the loss.<ref name="NIH2013Tx">{{cite web|title=What are the treatments for pregnancy loss/miscarriage?|url=http://www.nichd.nih.gov/health/topics/pregnancyloss/conditioninfo/Pages/treatments.aspx|website=www.nichd.nih.gov|access-date=14 March 2015|date=2013-07-15|url-status=live|archive-url=https://web.archive.org/web/20150402121052/http://www.nichd.nih.gov/health/topics/pregnancyloss/conditioninfo/Pages/treatments.aspx|archive-date=April 2, 2015|df=mdy-all}}</ref>

Miscarriage is the most common [[Complications of pregnancy|complication of early pregnancy]].<ref name="NICE-20122">{{cite journal |last=National Coordinating Centre for Women's and Children's Health (UK) |date=December 2012 |title=Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0055257/ |url-status=live |archive-url=https://web.archive.org/web/20131020003707/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0055257/ |archive-date=October 20, 2013 |access-date=4 July 2013 |website=NICE Clinical Guidelines, No. 154 |publisher=Royal College of Obstetricians and Gynaecologists |pmid=23638497 |df=mdy-all}}</ref> Among women who know they are pregnant, the miscarriage rate is roughly 10% to 20%, while rates among all [[Human fertilization|fertilisation]] is around 30% to 50%.<ref name="John20122" /><ref name="NIH2013Epi2" /> In those under the age of 35, the risk is about 10% while in those over the age of 40, the risk is about 45%.<ref name="John20122" /> Risk begins to increase around the age of 30.<ref name="NIH2013Epi2" /> About 5% of women have two miscarriages in a row.<ref>{{cite journal |vauthors=Garrido-Gimenez C, Alijotas-Reig J |date=March 2015 |title=Recurrent miscarriage: causes, evaluation and management |journal=Postgraduate Medical Journal |volume=91 |issue=1073 |pages=151–62 |doi=10.1136/postgradmedj-2014-132672 |pmid=25681385 |s2cid=207022511}}</ref> Recurrent miscarriage (also referred to medically as Recurrent Spontaneous Abortion or RSA)<ref name="jidc.org">{{cite journal |last1=Yu |first1=Jie |last2=Yu |first2=Shanshan |last3=Zhu |first3=Liye |last4=Sun |first4=Xuan |last5=Lu |first5=Boqi |last6=Li |first6=Jian |last7=Hu |first7=Yuecheng |last8=Li |first8=Peijun |date=2022-08-30 |title=Is there an association between recurrent spontaneous abortion and mycoplasma infection? |url=https://www.jidc.org/index.php/journal/article/view/15134 |journal=The Journal of Infection in Developing Countries |volume=16 |issue=8 |pages=1302–1307 |doi=10.3855/jidc.15134 |issn=1972-2680 |pmid=36099373 |s2cid=252219683 |doi-access=free}}</ref> may also be considered a form of [[infertility]].<ref name="gloss">{{cite web |date=10 January 2017 |title=Glossary {{!}} womenshealth.gov |url=https://www.womenshealth.gov/glossary/ |access-date=11 September 2017 |website=womenshealth.gov}}{{PD-notice}}</ref>