Threatened or habitual miscarriage

When a woman bleeds during her pregnancy it is very terrifying, but at times can be inconsequential. However, if the bleeding is excessive, i.e. more than just spotting, it may indicate a miscarriage. At times a miscarriage is referred to as a spontaneous abortion:

  • 1st trimester spontaneous abortion

    • chromosomal abnormalities

  • 3rd trimester spontaneous abortion

    • anti-cardiolipin antibody

      • Systemic Lupus Erythematous

    • placental problem

      • placenta previa – post-coital bleeding

      • vasa previa – placenta hangs out of the cervix

      • placenta accreta – placenta attached to superficial lining

      • placenta increta – placenta invades into myometrium

      • placenta percreta – placenta perforates through myometrium

      • placenta abruption – severe pain, premature separation of placenta

    • infection

      • 1st trimester

        • Toxoplasmosis

        • Other infections

          • Syphilis, hepatitis B, coxsackie B virus, EBV, VZV, human papilloma virus (HPV)

        • Rubella

        • Cytomegalovirus (CMV)

        • Herpes simplex virus (HSV)

      • incompetent cervix.

Usually the bleeding associated with a threatened miscarriage is mild as is the pain.  A threatened abortion occurs when the cervix is closed and the baby is still intact, so bed rest is suggested. If the cervix is open, then the abortion will be inevitable, complete or incomplete. The best thing to do in these situations is perform an ultrasound and a D&C if needed.

Most common causes of threatened miscarriages are:

  • An abnormal fetus most common cause in first trimester

  • Causes during the 4th to 6th month of pregnancy for miscarriages are usually associated with the mother:

    • Chronic illness

      • Diabetes

      • Severe high blood pressure

      • Kidney disease

      • Lupus (SLE)

      • Thyroid

        • Underactive or hyperactive

      • Hormonal imbalance

      • Infections

        • German measles

        • CMV

        • Atypical pneumonia

      • Disease with abnormal of internal female organs

      • Drugs

      • Excessive caffeine

      • Alcohol

      • Tobacco

      • Cocaine.

Symptoms that may alarm a pregnant woman that she is having a miscarriage are:

  • Heavy vaginal bleeding

  • Blood clots

  • Tissue present in blood

  • Pain as well as cramping in lower abdomen

    • One side of the abdomen

    • Both sides of abdomen

    • Middle abdomen

    • Pain can go into lower back, buttocks, and/or genitals.

After seeking medical care, the woman will be sent home if the cervical os is closed, bleeding is no longer heavy, lab results (HCG, AFP, estradiol) levels are normal, and the ultrasound reveals the pregnancy is not tubal (ectopic).

Ways to prevent threatened miscarriages are:

  • Adequate prenatal care

  • Listen to healthcare professionals

  • Avoid alcohol, street drugs, trauma to the vagina

  • Avoid and reduce caffeine intake

  • Control high blood pressure

  • Control diabetes – keep glucose under control

  • Get treatment for infections right away!

Those women who reside in Denver should visit the Denver Holistic Center to obtain more information about their pregnancy and their risks. Over half the population of pregnant women experience some form of vaginal bleeding in their first trimester, nonetheless, no situation should be taken lightly in such circumstances. There are many surgical interventions to help in these situations and some nonsurgical interventions as well. Bed rest is most preferred form of management. Moreover, the use of uterine relaxing agents, human chorionic gonadotrophin, immunotherapy and vitamins is being researched and used in some cases.