Threatened Miscarriages

What is a threatened miscarriage?

It is a condition where the process of miscarriage has started but has not progressed to a state from which recovery is impossible. It might take place before the 20th week of pregnancy.

What causes threatened miscarriage?

The actual cause is often unclear, common causes include:

• Chromosomal abnormality in the fetus is the most common cause during the first 3 months.
• Chronic diseases in mother like diabetes, lupus, high blood pressure, thyroid disorders.
• Inadequate hormone production
• Acute infections
• Diseases and abnormalities of the uterus, fibroids, weakness in the mouth of the womb (cervix), abnormal growth of the placenta, and being pregnant with multiples. (e.g. twins or triplets).
• Excessive caffeine, alcohol, tobacco, and cocaine, may be the cause.

What are the signs of threatened miscarriage?

the signs are usually not so severe but any pregnant female should visit the Dr Mayuri Gynecology Clinic in Jaipur, if the following is present:

• Vaginal bleeding is usually slight and may be brownish or bright red in color. but the bleeding may be heavy, especially in the late second trimester.
• Bleeding is usually painless but there may be backache or pain in lower abdomen.
• Pain as soon as bleeding starts.

How is threatened miscarriage diagnosed in Jaipur at Dr Mayuri Gynecology Clinic?

A thorough medical, surgical and obstetric history with meticulous clinical examination is carried out to find out the possible causes. Careful history taking includes the nature of previous abortion process, history of any chronic illness etc.

Routine investigations include:

1. Blood—for hemoglobin, hematocrit, ABO and Rh grouping. Blood transfusion may be required if abortion becomes inevitable and anti-D gamma globulin has to be given in Rh-negative nonimmunized women.
2. Serum progesterone value of 25 ng/mL or more generally indicates a viable pregnancy in about 95% of cases.

• Serial serum hCG level is helpful to assess the fetal well-being

1. Ultrasonography

Management of threatened miscarriage

• Rest: The patient should be in bed for few days until bleeding stops. Prolonged restriction of activity is not adviced.
• Relief of pain may be ensured by diazepam 5 mg tablet twice daily.
• There is some evidence that treatment with progesterone improves the outcome.

What is the prognosis of a threatened miscarriage?

In about two-third cases, the pregnancy continues beyond 28 weeks. In the rest, it terminates and if the pregnancy continues, there is increased frequency of preterm labor, placenta previa, intrauterine growth restriction of the fetus and fetal anomalies.