WHAT IT MEANS: the death of a fetus before the 24th week of pregnancy, or the expulsion of a fetus weighing less than 500gram. The use of 24 week is a more global definition, as the age of viability of the fetus ranges from 20weeks(most developed countries) to 28 weeks(least developed countries)
FREQUENCY OF OCCURRENCE: difficult to estimate correctly. About half of all fertilized eggs die before implantation. Miscarriage is seen in 10 to 20% of clinically apparent pregnancies. 25 out of 1000 women between the ages of 15 and 44years have miscarriages.
TYPES: In Threatened Miscarriage, there is bleeding through the vagina before 20weeks of pregnancy. This may or may not be associated with abdominal pains, and a vaginal exam shows a closed cervix. Ultrasonography confirms the viability of the fetus. 25 to 50% of threatened Miscarriage end in pregnancy loss. In Inevitable Miscarriage, pregnancy is doomed to end shortly. Vaginal bleeding is profuse and accompanied by severe lower abdominal cramps. Vaginal exam shows an open cervix(at least 3cm). Attempts to keep pregnancy is useless. In Incomplete Miscarriage, there’s retention of parts or products of conception. Patients may report passage of fleshy materials through the vagina. There’s continuous vaginal bleeding with associated lower abdominal cramps and the cervix is open. Ultrasonography confirms the diagnosis. In Completed Miscarriage, all products are expelled, bleeding diminishes and pain ceases. Missed Miscarriage is characterized by retention of dead fetus inside the uterus. Signs and symptoms of pregnancy regress. Ultrasound shows a dead fetus and collapsed Gestational sac. Recurrent Miscarriage is defined by 3 or more consecutive miscarriages and occurs in 1% of all cases.A Septic Miscarriage is any miscarriage with clinical evidence of infection of uterus and it’s contents. Any type of miscarriage can be complicated this way, but majorly with incomplete miscarriage. Mostly follows illegal/criminal/induced abortion.
CAUSES: On the fetal side, two-thirds of all miscarriages are caused by chromosome abnormality. Other fetal causes are structural( eg. Neural tube)defect, which may result from folic acid deficiency hence the folic acid supplementation in pregnancy. From the Maternal side, causes include: Endocrine(or Hormonal) eg Luteal phase insufficiency(inadequate progesterone). Polycystic Ovary syndrome(High luteinizing hormone), Uncontrolled Diabetes Mellitus, Thyroid Diseases. Others are Uterine Anomalies eg ; fusion defects, incompetent cervix, submucous fibroids ,Asherman’s syndrome. Infections such as malaria, urinary tract infection, TORCHES, etc. Toxins eg cytotoxic drugs(methotrexate, etc), Heavy Metals( Lead, Mercury, etc.), Alcohol and Tobacco. Trauma – pelvic surgeries, D&C, repair of cervical laceration. Immunological factors include Rhesus incompatibility, SLE, antiphospholipid antibodies, etc. Psychological Factors – Depression, anxiety, Post Traumatic Stress Disorder.
RISK FACTORS: some factors that predispose women to having miscarriages include Maternal Age above 35years. Previous Miscarriage presents a 25% chance of having a repeat miscarriage. Maternal Weight.(BMI) of less than 18.5kg/m2 or greater than 25kg/m2. Others include Exposure to Radiation, Drug use ( OTC pain killers ,caffeine, alcohol).
PREVENTION: Some preventive measures would include; going for preconception counseling and testing, Early Antenatal registration, Folic acid supplementation, prevention and prompt treatment of malaria and infections, lifestyle modifications(weight loss, caesation of alcohol and smoking, emotional support in pregnancy, Emergency cerclage for cervical incompetence, use of progesterone for luteal phase insufficiency.
TREATMENT: all cases of miscarriage should be managed in the hospital by a doctor. Threatened miscarriage may resolve on just complete bed rest. Completed miscarriage will require no further treatment if not complicated. Incomplete and Inevitable miscarriages would both require Evacuation of products of conception to arrest bleeding. Septic Abortion will definitely need Hospital admission and Antibiotic treatment . Putting a special tape on the cervix( Cerclage) would be necessary to treat cervical incompetence.

SOURCE: http://www.potentialcastlelifeguide.com/2017/05/12/miscarriages/