Spontaneous miscarriage

By Dr Joe Kabyemela, MD

Causes of spontaneous miscarriage

This is a common problem but there is no common explanation to all of them. Spontaneous miscarriage is easily the commonest form of early pregnancy loss.

Extensive studies have shown that chromosomal and genetic abnormalities account for a big proportion of spontaneous miscarriages. Some of these abnormalities are so severe that they are incompatible with life even in the womb, let alone outside.

Other causes of spontaneous miscarriage include:

·Abnormalities in the immune system of the mother could cause miscarriage, which could be a recurrent problem.
Abnormalities of the womb may be such that it is unable to carry a pregnancy beyond a certain stage leading to miscarriage.
·Some infections, especially viral, may lead to miscarriage
·Diseases such as diabetes, if poorly controlled, may lead to early pregnancy failure.

Signs and symptoms of spontaneous miscarriage

Most spontaneous miscarriages occur in the first trimester (the first 13 weeks). Miscarriage can still occur beyond the first trimester but this is much less common. A notable exception to this is in cases of cervical weakness, also called cervical incompetence. This tends to cause pregnancy loss in the middle of the second trimester, roughly around 20 weeks gestation, give or take a few weeks.

A typical presentation is vaginal bleeding which will be light initially and getting progressively heavier. This will normally be accompanied by lower abdominal crampy pains of varying intensity.

Examination will reveal an open or opening cervix, depending on how advanced the miscarriage process is. There may be blood clots mixed with pregnancy tissue within the cervical canal. This confirms the diagnosis. If these clinical features are not clear-cut, it may be necessary to confirm the diagnosis by using an ultrasound scan.

A urine pregnancy test has no role to play in the diagnosis as it may take several days for it to revert to negative after a miscarriage.

Managing a spontaneous miscarriage:

Once a miscarriage has been diagnosed, it is necessary to establish whether it is complete or incomplete.

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