Signs and Risks of a Threatened Miscarriage

Understanding the Causes and the Diagnostic Process

Pregnant Woman Having An Ultrasound
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During the early stages of pregnancy, there may be symptoms or sensations that don’t seem right to you. It may be something you can’t put your finger on or a feeling that things are not proceeding as they should. At other times, there may be bleeding or abdominal pain that in no way seems normal.

Your first instinct may be to assume the worst: that you are experiencing the early signs of a miscarriage.

If this is the case, there are things your doctor can do to either confirm or rule out your suspicions. One of the more common complications in early pregnancy is a condition known as threatened miscarriage.

Understanding Threatened Miscarriage

Threatened miscarriage is a term used to describe abnormal bleeding and abdominal pain that occur while the pregnancy still continues. While vaginal bleeding is common during early pregnancy, anything other than spotting during the first trimester may be considered a threatened miscarriage.

The bleeding and pain will typically be mild, while the opening of the cervix (cervical os) will ideally be closed. A dilated cervix, by contrast, is an indication of an inevitable miscarriage.

Threatened miscarriage occurs in 20 percent of all pregnancies before 20 weeks of gestation. While most women will go on the deliver their babies without incident, as many as one in seven will experience further complications following a threatened miscarriage.

Causes of Threatened Miscarriage

While it is not always possible to know what causes a threatened miscarriage, there are some factors that can place a woman at increased risk during the first trimester:

  • Chromosomal problems with the fetus
  • Problems with the placenta
  • Older age (most common in women over 40)
  • Obesity
  • Smoking
  • Alcohol use during pregnancy
  • Drug use
  • Excessive caffeine intake (over 200mg per day)

Threatened miscarriage during the later trimesters is more commonly associated unmanaged diabetes, kidney problems, thyroid disorder, high blood pressure, infection, or structural problems with the uterus, cervix, or ovaries.

What Happens in a Threatened Miscarriage

When a threatened miscarriage is diagnosed, the doctor will order a battery of test to assess the viability of the pregnancy. These can include an ultrasound and hCG blood tests.

  • The hCG blood test is especially useful as it can tell us how much human chorionic gonadotropin (hGG) is in the blood. This is the hormone that helps stimulate the production of progesterone during the first trimester and is key to a healthy pregnancy. In early pregnancy, however, one hGC test is not enough. It requires at least two tests spaced two days apart to judge whether the levels are rising or falling.
  • Similarly, an ultrasound often needs to be repeated a few days or a week later in order to conclusively diagnose an early miscarriage or a missed miscarriage (where the fetus has died but the body has not yet recognized this).

In both cases, the wait for answers can be painful.

Still, you need to go through the process to get a definitive answer and, more likely than not, your pregnancy will continue unhindered.

Dealing With a Threatened Miscarriage Diagnosis

If you have been diagnosed with threatened miscarriage and need to wait for repeat tests, here are some things you can do:

  • Some doctors will suggest bed rest while you wait for a definitive response. While rest itself will not prevent miscarriage, overexertion may needlessly add to your stress. This also applies to overexerting yourself at the gym.
  • Try not to douche or insert anything (including tampons) into your vagina, and avoid sexual intercourse until symptoms have completely gone for one week.
  • Other doctors may prescribe as progesterone supplements which some studies suggest might have some nominal benefit in preventing miscarriage.
  • Turn to your support network if only to distract yourself from the persistent worrying. Alternately, find a good book, rent some videos, or visit with friends to fill in the gap between tests.

In most cases, your pregnancy will continue to term. In some cases, supportive treatments and lifestyle adjustments may be recommended to prevent further complications.

However, if the outcome is not good, it is important to remember that the miscarriage is not your fault. Call on supportive friends if you need to talk, or join a support group. Carve out the time you need to fully recover and try not to rationalize your feelings away.

Miscarriage is a painful experience regardless of when it happened. Allow yourself the time to grieve and the space to recover.

Source:

National Collaborating Centre for Women's and Children's Health (UK). "Chapter 7: Management of threatened miscarriage and miscarriage." Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage. London: RCOG; 2012.

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