Miscarriages During Pregnancy

A miscarriage is a pregnancy loss that occurs during the early stages of pregnancy. The voluntary termination of pregnancy within legal limits is referred to as elective abortion, while termination due to maternal health risks, fatal fetal anomalies, or fetal death is known as medical termination. This article focuses on spontaneous miscarriages.

One of the most common causes of miscarriage is the failure of the embryo to develop genetically normally. More than 50% of early pregnancy losses are caused by random chromosomal abnormalities. These abnormalities result from errors in the genetic material of the fertilized egg (oocyte). Through natural selection, the body attempts to prevent genetically abnormal embryos from surviving.

After fertilization, the embryo must implant into the uterus and continue developing. Problems during implantation may increase the risk of miscarriage. In addition, hormonal imbalances, chronic maternal diseases, uterine abnormalities, and other medical conditions can also raise the risk.

3. Factors That Increase the Risk of Miscarriage

Common risk factors include:

Advanced Maternal Age:
The risk of miscarriage increases with maternal age. While the risk is approximately 10% in women under 20, it rises to nearly 30% in women over 40. This increase is associated with age-related genetic abnormalities.

Paternal Age:
Advanced paternal age also affects miscarriage risk. In fathers over the age of 40, the risk of miscarriage may double.

Hormonal and Chronic Diseases:
Hormonal disorders such as polycystic ovary syndrome (PCOS) and hypothyroidism, as well as chronic diseases including heart, liver, and kidney disorders, may increase miscarriage risk. Autoimmune diseases, severe anemia, and cancer are also contributing factors.

Gynecological Conditions:
Uterine abnormalities, fibroids, and intrauterine adhesions can prevent proper implantation of the embryo and increase miscarriage risk.

Lifestyle Factors:
Smoking, alcohol consumption, occupational chemical exposure, excessive stress, and poor nutrition are important lifestyle-related risk factors.

History of Previous Miscarriages:
Women who have experienced a previous miscarriage have a slightly increased risk in subsequent pregnancies. In women with two or more miscarriages, the risk is higher. Nevertheless, the probability of having a healthy baby remains high, ranging between 55% and 75%.

4. Diagnosis and Treatment of Miscarriage

Miscarriage is diagnosed using ultrasonography and blood tests. Ultrasound is used to assess embryonic development and cardiac activity, while blood tests measure beta-hCG and hormone levels.

Treatment depends on the underlying cause. Progesterone support or thyroid hormone therapy may be used in cases related to hormonal imbalance. Uterine anomalies may require surgical correction. Anticoagulant therapy can be applied in cases caused by clotting disorders.

5. What Should Be Done After a Miscarriage?

After a miscarriage, medical evaluation is important to identify potential risk factors for future pregnancies. Psychological support is also beneficial during the recovery process.

Most miscarriages are not recurrent, and the likelihood of a successful future pregnancy is high. However, recurrent pregnancy loss requires comprehensive medical evaluation.

Tests Performed After a Miscarriage

For women who experience recurrent miscarriages, several tests may be required to identify underlying causes:

3. Hormone Tests

Hormonal imbalances such as progesterone deficiency or thyroid dysfunction can increase miscarriage risk. Hormone levels including progesterone, TSH, T3, T4, and prolactin should be evaluated.

4. Evaluation of the Uterine Cavity

Hysteroscopy and hysterosalpingography (HSG) are used to detect uterine structural abnormalities such as septum, adhesions, or fibroids.

5. Coagulation Tests (Thrombophilia Panel)

Inherited clotting disorders such as Factor V Leiden mutation, Prothrombin G20210A mutation, Protein C/S deficiency, and Antithrombin deficiency can increase miscarriage risk.

6. Autoimmune Disease Testing

Tests such as antinuclear antibody (ANA) help identify autoimmune conditions that may contribute to pregnancy loss.

7. Infection Screening

Screening for infections including rubella, cytomegalovirus (CMV), toxoplasmosis, and listeria is recommended.

8. Genetic Counseling

Genetic counseling is recommended for couples with recurrent pregnancy loss to assess genetic risks and guide future pregnancy planning.

Threatened Miscarriage: Symptoms, Causes, and Treatment

1. What Is a Threatened Miscarriage?

Threatened miscarriage is characterized by vaginal bleeding during the first half of pregnancy. It occurs in approximately 20–25% of pregnancies, and 40–50% may result in miscarriage.

2. Symptoms of Threatened Miscarriage

The most common symptom is vaginal bleeding, which may be accompanied by abdominal or pelvic pain similar to menstrual cramps.

3. Causes of Threatened Miscarriage

Hormonal Imbalances: Progesterone deficiency
Genetic Abnormalities
Uterine Structural Abnormalities
Infections
Trauma
Chronic Medical Conditions

4. Diagnosis of Threatened Miscarriage

Diagnosis is based on gynecological examination and ultrasonography to assess cervical status and fetal cardiac activity.

5. Management of Threatened Miscarriage

Rest
Avoiding Sexual Intercourse
Progesterone Therapy
Anti-D Immunoglobulin (Rhogam) Administration

6. Follow-Up After Threatened Miscarriage

Pregnancies complicated by threatened miscarriage require close follow-up due to increased risk of preterm birth or fetal growth restriction.

Early recognition and appropriate medical management play a critical role in improving pregnancy outcomes.