Miscarriage: Risks, Symptoms, Treatment, and Care
An overview of a common tragedy
Molar pregnancy: These types of conceptions span the gamut of looking nothing like a pregnancy to looking a lot like a normal pregnancy (“incomplete mole”). It is actually a tumor of pregnancy tissue, but usually only pre-cancerous.
Most couples expect to get pregnant at some point, and when they do for the first time it suddenly dawns on them what a gamble pregnancy actually is. One of the most frightening things is to experience bleeding in the first part of the pregnancy. Termed first trimester bleeding, it is any bleeding noted during the first 12 weeks, and it is one of the most common symptoms to send a woman to her obstetrician. And rightly so, because until a non-threatening cause is identified, all first trimester bleeding is labeled “threatened miscarriage,” or “threatened AB.”
First Trimester Bleeding
No bleeding in early pregnancy is to be considered normal. That’s the bad news. But the good news is that most of the time it’s caused by something fairly harmless. Typical causes are:
Cervicitis is a condition in which the delicate cells at the mouth of the uterus (cervix) can bleed due to the mechanical action of intercourse, the alteration of acidity (pH) in the vagina, or the effects of infections on these cells.
- Ectopy. With the hormonal changes of pregnancy, the fragile internal cells peek out a bit onto the external portion of the cervix, which is a harsher environment for them. When these internal cervical cells are brought to a more external position, this is called ectopy. Normally nestled more deeply away from sexual activity and the acidity of the vagina, now they can be battered both chemically and mechanically. They’re easily damaged, causing bleeding. Of course, we’re not talking about a whole lot of bleeding here—merely what is perceived as spotting. It must also be noted that these cells usually don’t bleed with sex. Usually there is a predisposing condition, like cervicitis.
- Infection. Cervicitis is inflammation due to infection. Yeast is the most common culprit, and a simple prescription or even over-the-counter cream can end this concern quickly. Other infections are more worrisome.
- STDs.Sexually transmitted diseases, like gonorrhea, chlamydia, trichomonas, and Gardnerella can cause inflammation too, so a microscopic evaluation is the best approach rather than just assuming it’s yeast. Some infections may be silent for years, meaning that even though there is no question about fidelity in a couple, still there may have been an infection long before they even met each other. Therefore doing cultures for STDs has become standard in all pregnancies.
2. Cervical polyps.
Harmless small polyps can cause bleeding also. They are overgrowths of benign tissue, probably owing their existence to estrogen which made them grow. Usually they can be gently and painlessly twisted off during a physical exam. If not, then they’re usually destroyed by the very act of delivering the baby. But it’s worth getting them off in the office, otherwise your doctor will be obligated to be on alarm every time there’s spotting, forcing you into a lot of extra tests you don’t need.
3. Subchorionic hemorrhage.
This sounds disastrous, but it usually represents a small clot that causes bleeding then dissolves away harmlessly. Rarely the clot can come between the placenta and the attachment to mother, causing miscarriage.
4. Decidual tissue.
Sometimes a small piece of tissue becomes loose and disintegrates through some unknown cause, causing spotting. It’s usually a hormonally stimulated collection of menstrual-like tissue that can be confused with a miscarriage. If it’s just tissue debris, it can mean nothing. No one knows why such a phenomenon occurs, but it is harmless. It’s the passage of tissue for sure, though, so it’s very disturbing until the pathology report can ease everyone’s mind. In my practice, such shedding of only decidual tissue has had no impact on whether a pregnancy would miscarry. If it’s actual tissue of the pregnancy (fetal or placental), then there should be serious concern, because now this “threatened miscarriage” is re-labeled “incomplete miscarriage.”
5. Implantation bleeding.
People have long thought that an egg eroding into the uterine lining would cause bleeding at the time because of a burrowing effect. It’s doubtful whether there’s any bleeding when this happens, and if so, it’s too small an amount to notice. The myth persists because there are bleeding episodes in which no cause is ever identified and in which the pregnancy goes on successfully to term. Such a mystery that starts off so menacingly but ends so well begs for an explanation that must include a natural process. Implantation makes sense under these criteria, but can’t be proven. This may be a myth.
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