Miscarriage

El aborto espontáneo generalmente se define como la pérdida temprana de un embarazo. El aborto espontáneo también se conoce como aborto no provocado. Los siguientes son algunos de los tipos de aborto espontáneo:

  • Amenaza de aborto. Tener un manchado o sangrado en el primer trimestre puede o no significar que se presentará un aborto espontáneo. Alrededor del 10% al 20% de las mujeres tendrá un aborto espontáneo en el primer trimestre. Se vigila a la mujer para detectar cualquier sangrado adicional. Es común que se hagan ecografías (ultrasonidos) para vigilar el crecimiento del feto y sus latidos.
  • Aborto consumado. El feto, la placenta y otros tejidos se pierden con el sangrado.
  • Aborto no consumado. Solo una parte de los tejidos se pierden; algunos quedan en el útero. Es posible que se presente un sangrado vaginal abundante.
  • Aborto retenido. El embrión o feto muere, pero no sale del útero. A veces, se presenta un manchado marrón oscuro, pero no se detectan latidos ni crecimiento fetales.
  • Aborto séptico. El aborto espontáneo se infecta, la madre presenta fiebre y puede tener sangrado y secreción con mal olor. Es común que se presente dolor abdominal. Esta es una afección seria y puede derivar en un shock e insuficiencia de órganos si no se trata. Es posible que sea necesario administrar medicamentos y hacer un procedimiento llamado dilatación y legrado (D y L). Este procedimiento usa instrumentos especiales para retirar el embarazo anormal.
  • Aborto recurrente. Dos o más abortos espontáneos.

About half of early pregnancy losses are from chromosome defects in the fetus. Other causes may include:

  • Abnormal embryo development
  • Hormone problems in the mother. These include low levels of progesterone or a thyroid problem.
  • Diabetes in the mother, especially poorly controlled blood sugar
  • Problems in the uterus. These include scar tissue inside the uterus, abnormal shape of the uterus, or fibroids.
  • Opening of the uterus cannot stay closed during pregnancy (incompetent cervix)
  • Infection from germs. These include cytomegalovirus (CMV), mycoplasma, chlamydia, listeria, and toxoplasma.
  • Autoimmune diseases such as lupus, in which the body attacks its own tissue 
  • Injury or trauma 
  • Exposure to toxic substances and chemicals, such as anticancer drugs

Often, the cause of a miscarriage can’t be found. 

Some things can make miscarriage more likely. They include:

  • Being an older mother
  • Having an early pregnancy loss in the past
  • Smoking cigarettes
  • Using alcohol
  • Drinking more caffeine
  • Using cocaine
  • Having a low folate level. Folate is a B vitamin.
  • Having a low or high weight

The most common symptom of a miscarriage is vaginal bleeding. The bleeding may be painless. Or you may have mild to severe back pain or cramping in the belly (abdomen). Some women may pass pregnancy tissue. 

Spotting or small amounts of bleeding during the first trimester is common. This may or may not mean you are having a miscarriage. Your healthcare provider will likely use ultrasound to diagnose miscarriage. If the fetus is no longer in the uterus, or there is no longer a heartbeat, your provider will diagnose a miscarriage. Other tests include blood tests for the hormone human chorionic gonadotropin (hCG). Lower than normal levels of this hormone or levels that do not go up may mean the pregnancy is not growing properly.

If you have vaginal bleeding, but the lab tests and ultrasound show that the pregnancy is OK, your healthcare provider may tell you to rest for a few days. You will be watched for more bleeding. You may have more hCG blood tests and ultrasound exams to check the growth of the fetus and the fetal heartbeat. 

If tests show that you have had a miscarriage in the first trimester, you may have several choices. Talk with your healthcare provider about the treatment that is best for you. Treatment choices include:

  • Expectant management. This means waiting to let the miscarriage happen on its own. You will be checked often during this time.  
  • Medical management. This is treatment with medicines to help the pregnancy tissues pass. You may get a medicine called misoprostol. It makes the uterus contract and push out the pregnancy tissues. 
  • Surgical management. You may need surgery to remove the fetus and other tissues if they have not all been naturally passed. The procedure is called a surgical evacuation of the uterus, or a dilation and curettage (D&C). Anesthesia is used because the procedure can be painful to the mother. The cervical opening is stretched open (dilated). The doctor uses either suction or an instrument called a curette to remove all the pregnancy tissues inside the uterus.  

Pregnancy tissues may be sent to the lab to test for gene or chromosome defects. 

 If you have an infection, your healthcare provider will give you antibiotics.

Pregnancy loss after 20 weeks may need different procedures. You may get medicines such as misoprostol or prostaglandin. These medicines help open the cervix and make the uterus contract and push out the fetus and tissues. 

A miscarriage is a significant loss to the woman and her family. It is appropriate and normal to grieve because of the loss.

Pregnancy loss does not usually cause other serious health problems, unless you have an infection or the tissues are not passed. A serious complication with a miscarriage after 20 weeks is a severe blood clotting problem. This is more likely if it take a long time (usually a month or more) to pass the fetus and other tissues.

Women with Rh negative blood may need treatment after a miscarriage to prevent problems with blood incompatibility in a future pregnancy. A medicine called Rh immunoglobulin may be given.     

Tell your healthcare provider if you have any bleeding during your pregnancy. If you also have other symptoms, such as severe cramping, see your healthcare provider as soon as possible. 

  • Miscarriage is a pregnancy loss in the first 20 weeks of pregnancy.
  • Bleeding in pregnancy may or may not be a sign of a miscarriage.
  • If you have bleeding and other symptoms such as severe cramping, see your healthcare provider as soon as possible. 
  • If you have a miscarriage, you may need a procedure to remove the fetus and other tissues, if they have not all been naturally passed.
  • If a miscarriage has not occurred, you will probably be told to rest. You and your baby will both be monitored.

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.