Signs and Risks of a Threatened Miscarriage

Pregnant Woman Having An Ultrasound
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During the early stages of pregnancy, there may be symptoms or sensations that don’t seem right to you. It may be something you can’t put your finger on or a feeling that things are not proceeding as they should. At other times, there may be bleeding or abdominal pain that in no way seems normal. Your first instinct may be to assume the worst: that you are experiencing the early signs of a miscarriage.

If this is the case, there are things your doctor can do to either confirm or rule out your suspicions. One of the more common complications in early pregnancy is a condition known as threatened miscarriage, or threatened abortion.

Understanding Threatened Miscarriage

Threatened miscarriage is a term used to describe abnormal bleeding and abdominal pain that occurs while the pregnancy still continues. While vaginal bleeding is common during early pregnancy, anything other than spotting during the first trimester may be considered a threatened miscarriage.

The bleeding and pain will typically be mild, while the opening of the cervix (cervical os) will ideally be closed. A dilated cervix, by contrast, is an indication of an inevitable miscarriage.

Threatened miscarriage occurs in 20% of all pregnancies before 20 weeks of gestation.

While most women will go on to deliver their babies without incident, as many as one in seven will experience further complications, and sometimes a miscarriage is the result.

Causes

While it is not always possible to know what causes a threatened miscarriage, there are some factors that can place a woman at increased risk during the first trimester. These include:

  • Alcohol and/or drug use
  • Chromosomal problems with the fetus
  • Excessive caffeine intake (over 200 milligrams per day)
  • Exposure to certain medications or chemicals
  • Obesity
  • Older age (threatened miscarriage is most common in women over 40)
  • Problems with the placenta
  • Smoking
  • Trauma to the abdomen

Threatened miscarriage during later trimesters is more commonly associated with the following:

  • High blood pressure
  • Infection
  • Kidney problems
  • Structural problems with the uterus, cervix, or ovaries
  • Thyroid disorder
  • Unmanaged diabetes

What Happens in a Threatened Miscarriage?

When a threatened miscarriage is diagnosed, the doctor will order tests to assess the viability of the pregnancy. These can include an ultrasound and hCG blood tests.

The hCG blood test measures how much human chorionic gonadotropin (hCG) is in the blood. This is a hormone produced by the fetal tissue that helps stimulate the production of progesterone during the first trimester. It is key to a healthy pregnancy.

In early pregnancy, however, one hCG test is not enough. The standard of care requires at least two tests spaced two days apart to judge whether hCG levels are rising or falling.

Similarly, an ultrasound often needs to be repeated a few days or a week later in order to conclusively diagnose an early miscarriage or a missed miscarriage (where the fetus has died but the body has not yet recognized this).

Dealing With the Diagnosis

If you have been diagnosed with threatened miscarriage and need to have repeat tests, you can care for yourself in a few ways during this painful period of waiting.

  • Healthy distraction: Find a good book, stream some movies, or visit with friends to fill in the gap between tests.
  • Hormone treatment: Some doctors prescribe progesterone supplements, which studies suggest might help prevent miscarriage in some cases.
  • Pelvic rest: Do not douche or insert anything (including tampons) into your vagina. Avoid sexual intercourse until symptoms are completely gone for one week.
  • Rest: Some doctors suggest bed rest while you wait for a definitive response. While rest itself will not prevent miscarriage, overexertion may needlessly add to your stress. This also applies to overexerting yourself at the gym.

In most cases, symptoms will subside, and your pregnancy will continue to term. Sometimes, supportive treatments and lifestyle adjustments may be recommended to prevent further complications.

However, if the outcome is not good, it is important to remember that the miscarriage is not your fault—and it's a painful experience regardless of when it happened.

  • Allow yourself the time to grieve and the space to recover.
  • Carve out the time you need to fully recover and try not to rationalize your feelings away.
  • Call on supportive friends or join a support group.
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