Threatened Miscarriage – Causes, Symptoms and Treatment

Pregnancy is a beautiful and unique gift for every woman. But in some cases, expecting mothers may encounter some challenges that threaten or has the potential in leading to a miscarriage or pregnancy loss. This is a condition called threatened miscarriage, which can occur due to many reasons.

While it doesn’t always mean that having been diagnosed with a threatened miscarriage always ends up in pregnancy loss. However, it is extremely vital to be aware of the symptoms. Here we discuss the causes, symptoms, diagnosis, and preventive measures which can empower pregnant women and their healthcare providers to take proactive steps toward ensuring a healthy and successful pregnancy.

What is a Threatened Miscarriage?

Threatened miscarriage defines the potential of a particular reason that can contribute to the loss of pregnancy. It can start with mild bleeding and cramps. An early diagnosis can help take appropriate steps to prevent miscarriage (1).

Research suggests that around 30% to 40% of pregnant women experience threatened miscarriage. Most women can continue their pregnancy with rest and treatment, but some may not find relief from their symptoms and end up having a miscarriage. If not addressed quickly, it can cause miscarriages and infections, and risk the lives of pregnant women (2).

Causes of a Threatened Abortion

Although the exact reason is unknown, the following are the most typical causes of threatened abortion (3)

• Chromosomal abnormalities
• Overweight or obesity
• Alcohol and smoking
• Infections
• Previous miscarriages
• Placenta problems
• Abdominal injury
• Caffeine
• Weak cervix

Threatened miscarriage in the third trimester is contributed by factors like (4)

• Diabetes
• Kidney disease
• Autoimmune disorders
• An underactive or overactive thyroid gland
• High blood pressure

Symptoms of a Threatened Abortion

Threatened miscarriages occur with mild symptoms, especially during early pregnancy. It is very important to be alert and let your healthcare provider know even if you see the slightest bleeding or spotting when you are not expecting it (5).

Here are a few symptoms that indicate threatened abortion:

1. Vaginal Bleeding

The primary symptom in which light spotting to heavy bleeding occurs. The patient may pass blood clots or tissue along with the bleeding (6).

2. Abdominal Cramps

This symptom is like menstrual cramps and may vary in intensity.

3. Back Pain

Lower back pain is another symptom in which the pain may be dull or sharp and can be constant or intermittent.

How is a Threatened Miscarriage Diagnosed?

Your symptoms and medical history may help your doctor diagnose a threatened abortion and the tests listed below for a thorough examination (7).

1. Blood Tests

Blood tests reveal the hCG levels during pregnancy. They can also diagnose the percentage of progesterone which is an important hormone to maintain a healthy pregnancy.

2. Urine Tests

Urine tests help in identifying urinary tract infections (UTIs) or asymptomatic bacteriuria (bacteria in the urine).

3. An Ultrasound

An ultrasound scan uses sound waves to create images of the uterus and the developing fetus. It can help assess the baby’s heartbeat, check the cervix for any abnormalities, and identify any potential problems that can lead to a threatened miscarriage.

[Read : First Ultrasound During Pregnancy]

4. Genetic Testing

Genetic testing could detect chromosomal abnormalities in the fetus. Based on the reports your doctor may or may not prescribe further tests to confirm your baby’s well-being.

Depending on your health and the potential reason causing the miscarriage, your doctor may order additional tests. They conduct these tests to gain a better understanding of your situation and provide treatment.

How to Prevent Threatened Miscarriage?

While you can not do anything much to prevent a threatened miscarriage. You can somehow reduce the risk of it by following a few things like (8)

• Enough sleep of 8 to 9 hrs
• Regular exercise throughout these 9 months, especially YOGA, is beneficial for both mothers and babies.
• Eat healthy and nutritious diets with vegetables, fruits, and protein rich foods like eggs and dairy products.
• Also, add pregnancy-safe seafood to your diet, which is rich in proteins like fish containing omega 3 which helps in healthy embryo development.
• Gain weight smartly by maintaining healthy proportions (9)

Treatment For Threatened Miscarriage

After a thorough evaluation, doctors may start monitoring you continuously. They will monitor the fetal heart rate and your wellness appointments frequency may increase to make sure everything is running smoothly. Apart from that, doctors suggest (10)

• Bed rest
• Progesterone injections
• RhoGAM shots if you have Rh incompatibility
• Avoiding sex
• Peaceful environment

[Read : Rh Incompatibility in Pregnancy]

What Should You Do After Getting Diagnosed With a Threatened Miscarriage?

Although, there is no treatment to stop the this miscarriage from happening. You can always take a few precautions to maintain a healthy pregnancy. (11)

• Insert nothing (including cotton) into the vagina
• Stop doing sex until symptoms completely clear or wait for one week
• Get complete bed rest, and follow your doctor’s instructions
• Distract and surround yourself with a peaceful environment
• Stay in touch with your doctor often

If your diagnosis confirms the loss of pregnancy

• Get plenty of rest
• Allow yourself some time and space to cope
• Inform your doctor if you have extreme vaginal bleeding and cramping

Having symptoms of threatened miscarriage or getting diagnosed with it doesn’t always mean that you will end up losing your pregnancy. Oftentimes, women get through this phase and continue to full-term pregnancies with healthy babies.

When to Call a Doctor For a Threatened Miscarriage?

Since a threatened miscarriage is also a condition that can sometimes go unnoticed until you have symptoms and a diagnosis, even the mildest of the mild symptoms that feel concerning should not be ignored (12).

Call your doctor if you have –

• Mild or severe abdominal cramping
• Mild bleeding or spotting
• Passing off something heavy, like a tissue part,
• Abdominal pain like in menstruation
• Cramps followed by fever

Threatened miscarriage is a condition that can be diagnosed and has a prognosis. Having said that, a pregnant woman should be alert and proactive about her symptoms. However, some cases may not end up well eventually resulting in loss of pregnancy. While several therapies have been investigated, including bed rest, antibiotics, and progesterone therapy, more research is required to determine the most efficient and secure form of therapy. For managing threatened miscarriages and reducing complications, early detection, rest, and heeding medical advice are imperative.

FAQ’s

1. Is Surgery Required For Threatened Miscarriage?

TM does not require surgery however, it is important to differentiate threatened miscarriage from inevitable or incomplete miscarriage, which may require medical intervention or surgical procedures like dilation and curettage (D&C) to remove the remaining tissue from the uterus. Surgery depends on different factors like severity, time of pregnancy, or other complications. It is better to consult your healthcare for proper treatment.

2. How Long Does A Threatened Miscarriage Last?

Duration varies from person to person. Some symptoms resolve in a few weeks or days while some go longer. A healthcare professional can guide the duration and measures for managing a threatened miscarriage.

3. What To Eat If You Have A Threatened Miscarriage?

There is nothing specific food that is there which can prevent any abortion. So during pregnancy, woman can eat anything they prefer.

 4. Can Progesterone Stop A Threatened Miscarriage?

There are multiple studies done which shows progesterone supplements till 12 weeks of pregnancy has a role in preventing threatened abortion. In IVF pregnancy prophylactically oral progesterone supplements given compulsorily.

5. What Is A Threatened Miscarriage At 16 Weeks?

Threatened miscarriage which happens at 16 weeks can be because of cervical weakness which can cause opening of cervix or can be due to placental abnormalities. This can be prevented by taking bed rest.

[Read Also: Recurrent Miscarriage – Causes, Diagnosis and Treatment]

References

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   Threatened abortion: a risk factor for poor pregnancy outcome, a population-based screening study,
   American Journal of Obstetrics and Gynecology – https://www.sciencedirect.com/science/article/abs/pii/S0002937803011335#:
2. Farideh Dadkhah, Maryam Kashanian, Giuti Eliasi, A comparison between the pregnancy outcome in women both with or without threatened abortion, Early Human Development – https://www.sciencedirect.com/science/article/abs/pii/S0378378210000496#:
3. Asim Kurjak, Damir Zudenigo, Mladen Predanic, Sanja Kupesic, Biserka Funduk; Assessment of the Fetomaternal Circulation in Threatened Abortion by Transvaginal Color Doppler – https://karger.com/fdt/article-abstract/9/5/341/137209/
4. Michels TC, Tiu AY. Second trimester pregnancy loss. Am Fam Physician. 2007 Nov – https://www.aafp.org/pubs/afp/issues/2007/1101/p1341.html#:
5. Journal of Women’s Health & Gender-Based Medicine –https://www.liebertpub.com/doi/abs/10.1089/152460900318696#:
6. British Journal of General Practice 2003 – https://bjgp.org/content/53/494/704.short#:~:
7. R. Ambriz-López, G. Guerrero-González, C.G. Rodríguez-Valero, O.R. Treviño-Montemayor, A. Guzmán López, D. Saldívar-Rodríguez, Evaluation of symptoms of anxiety and depression in patients with a miscarriage, Medicina Universitaria – https://www.sciencedirect.com/science/article/pii/S1665579617300406#:
8. From the journal Hormone Molecular Biology and Clinical Investigation – https://www.degruyter.com/
9. S Feodor Nilsson, PK Andersen, K Strandberg-Larsen, A-M Nybo Andersen First published: 19 February 2014 – https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.12694#:
10. Elina Hemminki, Treatment of Miscarriage: Current Practice and Rationale, Obstetrics & Gynecology – https://www.sciencedirect.com/science/article/abs/pii/S0029784497006066#:
11. Bettina Toth, Udo Jeschke, Nina Rogenhofer, Christoph Scholz, Wolfgang Würfel, Christian J. Thaler, Antonis Makrigiannakis, Recurrent miscarriage: current concepts in diagnosis and treatment, Journal of Reproductive Immunology – https://www.sciencedirect.com/science/article/abs/pii/S0165037810000148#:
12. Jurkovic D, Overton C, Bender-Atik R. Diagnosis and management of first trimester miscarriage BMJ 2013 – https://www.bmj.com/content/346/bmj.f3676.abstract#: