Overview of Pregnancy Loss
What is pregnancy loss?
Pregnancy loss is the death of an unborn baby at any time during pregnancy. It is estimated that pregnancy loss occurs in over half of all primeval pregnancies. Most of these occur so primeval that the mom does not even know she is pregnant. Even though 15 to 20 percent of diagnosed pregnancies are lost in the first or second trimesters of pregnancy, almost all occur during the first trimester. Only about 1 percent of diagnosed pregnancies are lost after 16 weeks. Pregnancy loss includes:
blighted ovum – pregnancy loss before 8 weeks in which the egg is fertilized but never develops into an embryo.
miscarriage – primeval pregnancy loss, also called spontaneous abortion.
ectopic pregnancy – the development of the fetus outside the uterus, in a fallopian tube, cervical canal, or the pelvic or abdominal cavity.
molar pregnancy – an abnormal development of placental and fetal tissues, occurring in about one out of 1,000 to one out of 1,500 pregnancies.
stillbirth – when the fetus dies before birth.
What causes pregnancy loss?
The vast majority of pregnancy losses are due to genetic or chromosomal abnormalities. However, other factors can also play a role in pregnancy loss. These include, but are not limited to, the following:
abnormal embryo development
hormone problems in the mom including low levels of progesterone or abnormal thyroid function
diabetes in the mom (especially in women who have poorly controlled blood glucose levels)
abnormalities of the uterus including scar tissue inside the uterus, abnormal formation or shape of the uterus, or myomas (fibroid tumors)
incompetent cervix – the opening to the uterus can't stay shut during pregnancy.
infection (including organisms such as cytomegalovirus (CMV), mycoplasma, chlamydia, and ureaplasma, as well as listeriosis and toxoplasmosis)
antifetal antibodies – the mother’s immune system recognizes the fetus as a foreign body and rejects it.
autoimmune diseases (conditions such as lupus erythematosus in which the body makes antibodies against one’s own normal body chemicals; other autoimmune problems include antiphospholipid antibody syndrome)
cigarette smoking (there is an association with pregnancy loss and cigarette smoking)
exposure to toxic substances and chemicals such as anticancer drugs (studies are conflicting about the relationship of substances such as anesthetic gases, alcohol, and alkaloid to pregnancy loss; exposure to video display terminals, or personal screens, has not been shown to be related to pregnancy loss)
Some women have recurrent problems in which pregnancy loss occurs over and over, usually three or more times. It is often difficult to find a cause for recurrent losses and couples might need additional testing for genetic or chromosomal problems.
Fortunately, most pregnancy losses are usually isolated events. A woman with a spontaneous primeval pregnancy loss has an 80 to 90 percent chance of a normal pregnancy the next time she conceives.
Why is pregnancy loss a concern?
Some pregnancy losses do not cause any problems, while others might be very serious and life threatening for the mother, if untreated. However, the most difficult part for most families is the emotional stress of the loss itself.
The loss of a baby at any time in pregnancy can be emotionally and physically difficult for the mom and other members of the family. For some families, the timing of the loss in the pregnancy might make the experience more or less difficult. For example, an primeval loss, before the mom even knew she was pregnant might not be as stressful as a loss later in pregnancy, after feeling fetal movement or seeing the fetus on ultrasound examination. However, parents might have strong feelings and unhappiness whenever a loss occurs.
Parents often experience a grief reaction to a loss, including feelings of the following:
shock, numbness, denial, and confusion
anger, guilt, searching and yearning
disorientation, depression, withdrawal, demand of energy
reorganization, resolution
These are normal responses to loss and might take months and sometimes years to work through. Experience with grieving families has found the following to be helpful:
seeing or holding (this is especially important in later pregnancy losses and with babies who die with a birth defect)
remembrances (including a lock of hair, hand or footprint, photographs, denotive of the baby)
counseling (with a professional who is experienced in bereavement counseling)
memorial or funeral service
What are the symptoms of pregnancy loss?
Vaginal bleeding is the most common symptom of pregnancy loss. In later pregnancy, a woman with a stillborn might no longer feel fetal movements. However, apiece type of loss has specific symptoms. Also, apiece woman might exhibit different symptoms or the symptoms might resemble other conditions or medical problems. Always consult your doctor for a diagnosis.
How is pregnancy loss diagnosed?
In addition to a complete medical history and physical examination, diagnosis of pregnancy loss is usually based on work tests, with reported symptoms aiding in the diagnosis. Tests used to diagnose pregnancy loss might include:
pregnancy blood tests for the hormone human chorionic gonadotrophin (hCG)
ultrasound – a diagnostic imaging technique which uses high-frequency sound waves and a personal to create images of blood vessels, tissues, and organs.
Treatment for pregnancy loss:
Specific treatment for pregnancy loss will be determined by your doctor based on:
your pregnancy, overall health, and medical history
gestational age of the fetus
your tolerance for specific medications, procedures, or therapies
the type of pregnancy loss
your view or preference
Once pregnancy loss occurs, the uterus must be emptied of all the fetal tissues to prevent further complications. Counseling and support of the family is important. Your doctor can help you find resources and support organizations that can help after pregnancy loss.
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