The death of a fetus or embryo prior to birth is referred to as a miscarriage or spontaneous abortion. There are several terms used to describe the different types of pregnancy loss that can occur before birth:
Miscarriage
A miscarriage is the spontaneous loss of a fetus before the 20th week of pregnancy. Most miscarriages occur during the first trimester, with the risk declining after the 13th week of gestation. Some key facts about miscarriage:
- Up to 20% of known pregnancies end in miscarriage
- In most cases the cause is chromosomal abnormalities that make the fetus nonviable
- Bleeding and cramping are common symptoms
- Risk factors include advanced maternal age, smoking, obesity, diabetes, thyroid problems
- Treatment is managed expectantly, medically, or surgically depending on the case
Missed Miscarriage
This refers to a miscarriage where the fetus has died or stopped developing but has not yet been expelled from the uterus. It is also known as a missed abortion or a silent miscarriage. Signs include:
- Loss of pregnancy symptoms
- No fetal heartbeat detected on ultrasound
- Uterus may still be growing in size
- Eventually bleeding or cramping occurs as the tissue is expelled
Chemical Pregnancy
A chemical pregnancy is a very early miscarriage that occurs shortly after implantation, before a pregnancy can be confirmed on ultrasound. Key points:
- Happens within the first few weeks after fertilization
- The woman may not realize she is pregnant when it occurs
- Positive pregnancy test followed by menstrual period at expected time
- Cramping and bleeding may be mistaken for a heavy period
- Cause is usually chromosomal issues or implantation failure
Ectopic Pregnancy
An ectopic pregnancy is when the fertilized egg implants somewhere outside the uterus, usually in one of the fallopian tubes. Key facts:
- Occurs in 1-2% of pregnancies
- Cramping pain may be the first sign, along with light vaginal bleeding
- Hormone levels rise slower than normal pregnancy
- Detected on ultrasound if pregnancy located in tube
- Tube may rupture causing heavy bleeding if not treated
- Removed medically or surgically to prevent rupture
Blighted Ovum
Also called anembryonic pregnancy, this is when a fertilized egg implants in the uterus but the embryo does not develop. Key characteristics:
- Gestational sac forms but embryo does not grow
- Levels of hCG may rise slower or decline
- Diagnosed on ultrasound showing empty gestational sac
- Usually results in miscarriage by 20 weeks
- Cause is chromosomal abnormalities
Stillbirth
A stillbirth refers to the loss of a fetus after 20 weeks of pregnancy. Some key points:
- Occurs in about 1 in 160 pregnancies in the U.S.
- Leading causes are birth defects, placental problems, infections
- Risk rises with smoking, diabetes, obesity, advanced age
- No contractions or labor pains in most cases
- Diagnosis made when no heartbeat heard on monitoring
- Labor may be induced or C-section performed to deliver fetus
Causes and Risk Factors
Some of the main causes and risk factors for pregnancy loss before birth include:
| Cause | Description |
|---|---|
| Chromosomal abnormalities | Errors during cell division, leading to genetic issues in embryo |
| Uterine abnormalities | Problems with the structure or function of the uterus |
| Hormonal problems | Issues with hormones like progesterone needed to sustain pregnancy |
| Blood clotting disorders | Clotting issues affect development of placenta |
| Advanced maternal age | Risk rises as a woman gets older |
| Uterine infection | Infection impairs implantation or harms developing embryo |
| Uncontrolled diabetes | Impacts embryo development and placental function |
| Lifestyle factors | Like smoking, drug use, alcohol use, obesity |
Diagnosis
Pregnancy loss may be diagnosed through:
- Pelvic exam to check for changes in cervix and bleeding
- Ultrasound to see fetus and detect heartbeat
- Blood tests for hCG levels, which rise then fall in miscarriage
- Tissue analysis if miscarriage occurs to identify cause
Treatment
Treatment options for pregnancy loss before birth may include:
- Expectant management – allowing miscarriage to occur naturally
- Medication – drugs like misoprostol to induce uterine contractions to expel tissue
- D&C procedure – dilation and curettage to remove tissue surgically
- Methotrexate – drug to stop ectopic pregnancy from growing
- Surgery – laparoscopic or open surgery to remove ectopic pregnancy
- Blood transfusion – needed for heavy bleeding associated with some losses
Emotional Support
Experiencing the loss of a pregnancy can be very emotionally difficult. Support and counseling are important, as well as understanding from loved ones. Grief counseling, therapy, or support groups can provide helpful outlets for the complex emotions involved.
Prevention
While not all pregnancy losses can be prevented, some things that may help reduce risk include:
- Prenatal vitamins with folic acid before and during pregnancy
- Avoiding smoking, alcohol, and street drugs
- Controlling pre-existing medical conditions like diabetes and thyroid disorders
- Maintaining a healthy weight before and during pregnancy
- Avoiding known environmental hazards and toxins
- Limiting stress and avoiding excessive physical exertion
Conclusion
The loss of a pregnancy at any stage is a difficult and emotional experience. Terms like miscarriage, ectopic pregnancy, stillbirth, and others denote various types of loss that can occur before birth. Chromosomal abnormalities are the most common underlying cause. Treatment depends on the type and timing of the loss. Being well informed, maintaining health, and seeking emotional support and counseling can all be helpful when grieving a pregnancy loss.