To an outsider a miscarriage may appear as a bit
of bad luck soon to be got over, but to the couple
involved the loss of the pregnancy, even at a very
early stage, may be utterly devastating and the
miscarriage may have profound and prolonged
emotional effects on them as the following
comments illustrate: In the days that followed
(the miscarriage) I grew to feel such failure,
having let down my husband and my family who could
have enjoyed a child or grandchild if I had been
able to carry him/her properlyif my body had
functioned the way it was supposed to.
(www.miscarriageassociation.org.uk) Many people
are unaware how frequently miscarriages occur.
Approximately one in four women who become
pregnant will have one or more miscarriages.
(Lachelin, V) The terms miscarriage and abortion
are used interchangeably by doctors to mean the
loss of a pregnancy from the uterus before 20
weeks gestation. Pregnancy loss after 20 weeks
gestation is referred to as a stillbirth.
Spontaneous abortion indicates that the abortion
occurred naturally and that it was not induced.
Legally and medically, spontaneous abortion is
distinguished from stillbirth by the size and/or
age of the abortus. Although the exact definition
of abortus varies from state to state, the term is
generally applied to a fetus of less than 20 weeks
gestation and/or weighing less than 500 grams (1
lb., 1 oz.). (McBride, 1-2) It is estimated that
between 25-50% of conceptions spontaneously abort.
The true incidence of spontaneous miscarriage is
very difficult to determine for a variety of
reasons. It is clear that many miscarriages will
occur before a menstrual period has been missed
and thus without the woman ever knowing that she
had conceived. Many other women have a suspicion
that they were pregnant and aborted, but are not
A late, heavy, painful period is often
what is experienced in a mid-first trimester
spontaneous abortion. (Lachelin, 33) The major
symptoms of a spontaneous abortion are abdominal
cramps and bleeding from the vagina, sometimes
with clots and/or bits of tissue. Early warning
signs can also include pain in the lower back. It
is important to realize that approximately 20% of
pregnant women experience some vaginal bleeding
during the first trimester. Less than half of
these women experience a spontaneous abortion.
(www.webmd.com) To be certain that a miscarriage
occurred, the woman must have a blood pregnancy
test immediately after the symptoms and a pelvic
ultrasound. The blood test confirms the pregnancy
in its earliest stages, and the ultrasound
confirms that there is no longer an embryo.
Alternatively, if there is a large clot or piece
of tissue, it can be analyzed in the lab to see
whether or not it is an embryo.
(www.estronaut.com) There are six categories of
recognized spontaneous abortion: threatened,
inevitable, incomplete, complete, missed, and
septic (Lachelin, 2-3).
The diagnosis of
threatened abortion should be considered when
vaginal bleeding occurs within the first 20 weeks
of pregnancy. In threatened abortion, the cervical
os remains closed and there is no passage of
tissue. The physician can do little to prevent
fetal loss. However, strict bed rest and the
avoidance of sexual intercourse can sometimes
prevent the loss. (McBride, 5) An inevitable
abortion diagnosis is given when the patient has
the symptoms of threatened abortion, but the
internal os is open. Progression to complete
abortion is inevitable within hours or days.
survival of the fetus is impossible. (McBride, 5)
Complete abortion means that all the products of
conceptionthe fetus, placenta, and amniotic
sachave been expelled from the uterus, and that
the uterus is empty and curettage is not
necessary. Very early miscarriages, before 7 weeks
gestation, are usually complete. (Lachelin, 2)
Incomplete abortion implies that only some of the
products of conception have been expelled and that
some remain in the uterus. This means that there
is a risk of further bleeding and of infection,
and that curettage is required. (Lachelin, 2)
Retention of the products of conception for more
than three weeks after fetal demise is considered
a missed abortion.
(McBride, 6) When a temperature
of at least 100.4 degrees Fahrenheit complicates
any of the previously mentioned types of
spontaneous abortion, the diagnosis may be septic
abortion in the absence of any other source of
fever. Septic abortion is most commonly associated
with intrauterine fetal demise and prolonged
rupture of membrane. (McBride, 7) The cause of
most spontaneous abortions is fetal death due to
fetal growth abnormalities, not caused by the
mother. In a study of 1,000 women admitted with
the diagnosis of abortion, almost 62 percent of
the fetal specimens were found to have
developmental abnormalities incompatible with
life, including both embryonic and placental
abnormalities. (McBride, 2) Another major cause of
spontaneous abortion is chromosomal abnormalities.
Chromosomal abnormalities were found in at least
50 percent of the fetal specimens from spontaneous
abortions, compared with approximately seven
percent of the specimens from all conceptions.
Many of these chromosomal abnormalities are
believed to be spontaneous mutations. (McBride, 2)
There are also maternal factors that may
contribute to the occurrence of spontaneous
The risk for spontaneous abortion is
increased as women age. The risk is about 10% for
women in their 20s, and skyrockets to 50% for
women in their mid-40s. This means that a
significant portion of thirty something
pregnancies will end this way. Certain health
conditions, such as diabetes, thyroid dysfunction,
and hormone deficiencies, may also contribute to
the occurrence of spontaneous abortion. Untreated
thyroid deficiency may account for six of every
100 second-trimester miscarriages. In a study of
9,400 pregnant women, researchers found that those
with elevated levels of thyroid-stimulating
hormone have a four times greater risk of
Spontaneous abortion has been associated with
numerous external factors, including drugs,
anesthetics, radiation, and obstetric or surgical
interventions. Smoking, caffeine intake, and
alcohol use have also been reported to increase
the incidence of spontaneous abortion. (McBride,
3-4) In the last couple of years, the use of
caffeine in pregnancy has been widely studied.
There is some evidence from controlled studies
that a high intake of caffeine during early
pregnancy increases the risk of miscarriage, but
this has not been universally accepted (Scialli,
1). In a recent study, the Karolinska Institute
found that daily intake of at least 500 mg of
caffeineequivalent to about three 8-ounce cups of
coffeecan double a nonsmokers risk of miscarriage
in the first trimester (Caffeine, 1). The
conservative approach is to advise women to limit
their intake to less than three cups of coffee or
the equivalent in the first trimester. It is also
reasonable to counsel women who are trying to
conceive to restrict their caffeine intake.
(Scialli, 1) It’s helpful for women who experience
miscarriage to seek out other women who have gone
through pregnancy loss as well.
There are several
support groups for women who have miscarried once
or twice. Some women may have more severe
reactions to pregnancy loss than others. These
reactions may include sleep disturbances,
psychosomatic illness, worsening of a previous
illness, irritability, and avoiding social
contactparticularly friends with children or
friends who are pregnant. A good therapist can
help women work through some of these feelings,
which are valid and common under these
circumstances. (www.webmd.com) Although it is
possible to become pregnant immediately after a
spontaneous abortion, it is usually recommended to
wait for one or two normal menstrual cycles before
attempting another pregnancy. Some studies have
found that not waiting to conceive again may
increase the risk of another spontaneous abortion.
(www.webmd.com) A report published in the British
Medical Journal states that women who experience a
stillbirth or late-term miscarriage should wait a
year before conceiving again.
It was found that a
one-year period allows women to recover
emotionally from the loss, making them less likely
to experience anxiety and depression in a
subsequent pregnancy. (Timing, 1) Most women who
miscarry either once or twice do go on to have
normal pregnancies and deliveries. The odds of
having a miscarriage tend to increase
exponentially with each recurrent miscarriage. In
general, with no past history of miscarriage, a
womans odds of having one are about 12%. After one
miscarriage, the odds remain at about 12%. After
two miscarriages in a row, the odds of having
another are 27%; after three in a row, the odds
jump up to 36%; and after four miscarriages in a
row, the odds skyrocket to 60%.
Because of this,
it’s important for the woman to stop trying after
two consecutive miscarriages to be evaluated for
factors causing pregnancy loss. (www.webmd.com)
Works Cited Caffeine Linked to Miscarriage. Family
Practice News. 1 March 2001. Estronaut: A Forum
for Womens Health. Online.
World Wide Web. 12
November 2001. Available:
http://www.estronaut.com. Kaas, Jennifer. Thyroid
Miscarriage Clue. Prevention.
June 2001. Lachelin,
Gillian C.L. Miscarriage: The Facts. New York:
Oxford, 1985. McBride, Wayne Z. Spontaneous
American Family Physician. January 1991.
Scialli, Anthony. Caffeine. Family Practice News.
1 April 2000. The Miscarriage Association. Online.
World Wide Web.
12 November 2001. Available:
Pregnancy After Miscarriage. Clinician Reviews.
October 1999. WebMD Health. Online.
Web. 14 November 2001. Available:
Research essay sample on Prolonged Emotional Effects Of Pregnancy Miscarriages