With all things considered, the birth of a normal, healthy baby is quite the miracle. Most people aren't aware that estimates of miscarriage range between 20% and 50% of all pregnancies. Some are inevitably so early that the mother never knew she was pregnant or had lost it. Most miscarriages result from chromosome abnormalities in the embryo. Some inherited disorders from the parents, but most are just errors which occur in the chromosomal replication process of the embryo.
The first sign of threatened miscarriage is usually vaginal bleeding. The second common symptom is cramping pain in the pelvic area. Doctors use the term "threatened abortion" to describe this occurrence, however, most patients associate this term with and induced abortion, so miscarriage is probably the better term. Let's say a typical patient missed her last period six weeks ago, after which she had a positive home pregnancy test. If she or her partner is over 35, she is at increased risk of a miscarriage. She probably wouldn't have seen an obstetrician at this point, but rather goes to her family doctor or to the emergency room. The doctor will probably ask a lot of questions like, "When was your last period?", "When did the bleeding start?", "When did the pain start, and where is it located?" "Is this pain referred to the right shoulder area?" This can happen with tubal or ectopic pregnancy. He will want to know what your blood type is: If it is Rh-negative, he will probably want to give you a Rho-gam shot to prevent your blood from making antibodies to the baby's blood.
The next step in the evaluative process will be the vaginal speculum exam. The doctor will want to see if clots or products of conception are in the vagina. He will want to look at the cervix to see if it is open or closed. If it is open, he will want to see if he can see clots or tissues within. He will want to feel whether there are masses where the tubes are located which could be an ectopic or tubal pregnancy.
Now the doctor has to decide whether to institute watchful waiting or order further somewhat expensive testing. He knows that one-fourth of all pregnancies have at least some spotting or bleeding at some time, and half of these will go in to normal deliveries. One test which is very valuable is the quantative blood pregnancy test. If gives specific value amounts of HCG pregnancy hormone, and these can be compared with normal values for each week of the pregnancy. If they are low values, then probably the miscarriage has occurred or is inevitable. The other test the doctor may wish to order is the vaginal ultrasound or OB ultrasound. As early as five weeks it can show embryonic heart activity, and this is a good sign that everything is all right. Ultra sound can show if the pregnancy is in the tube, which requires immediate surgery or specialized medical treatment. If the ultrasound shows no evidence of a viable embryo, then a decision will be made as to how to evacuate the uterine contents for the best health and safety of the mother.
In the course of all this, the doctor may wish to advise the patients of possible causes of miscarriage in the event of future pregnancies. Certainly, diabetes, high blood pressure, thyroid problems, and medical conditions like lupus can lead to miscarriage, so a good medical check-up will be recommended. Uses of caffeine, tobacco, alcohol, and cocaine have been shown to lead to increased miscarriage occurrence. In fact certain studies have shown that substance use by the father can increase the occurrence of miscarriages. Having one or even two miscarriages leads to a one in six chance of future miscarriage. Of course one would want to eliminate all the known causes of miscarriage from lifestyle choices. If a hopeful mother has had three or more miscarriages for no discernible reason, a specialist may recommend genetic testing of both potential parents.
It can be very traumatic for a couple to have a miscarriage. It is important to reassure them that this happens probably more frequently than they think, and that the future hopes and chances of successful pregnancy are under most circumstances good.
John Drew Laurusonis
Doctors Medical Center