Miscarriage, also called spontaneous abortion , spontaneous expulsion of

theembryo or fetus from the uterus before the 20th week of pregnancy, prior
to the conceptus having developed sufficiently to live without maternal
support. An estimated 10 to 25 percent of recognized pregnancies are lost as
a result of miscarriage, with the risk of loss being highest in the first six weeks
of pregnancy. Because many miscarriages occur prior to a woman knowing
she is pregnant, the actual prevalence of miscarriage is suspected to be
higher than that reflected in the data for clinically recognized cases.
The loss of pregnancy in the first weeks following implantation typically results
in bleeding at about the time of the next expected menstruation. This form of
early miscarriage, which accounts for the majority of miscarriages, is
described as chemical pregnancy. The consecutive loss of pregnancies, which
occurs in about 1 to 2 percent of women, is known as recurrent miscarriage.
The most common cause, accounting for more than 60 percent of
miscarriages, is an inherited defect in the fetus, which might result in a
deformed or otherwise abnormal child. An acute infectious disease may play a
role in causing some miscarriages, particularly if it reduces the oxygen supply
to the fetus. Certain uterine tumours or other uterine abnormalities also may
induce a miscarriage. Death of the fetus stemming from external trauma or
from knotting of the umbilical cord is another cause of miscarriage. Physical
traumas (such as blows to or falls of the mother) and psychological traumas
are rarely implicated in miscarriage.
Endocrine disorders such as deficient secretion of the hormone progesterone
may cause poor development of the decidua (the mucal lining of the uterus) or
an abnormally irritable uterus and may thus sometimes result in miscarriage.
Women over age 35 tend to be at increased risk of miscarriage relative to
younger women. Risk factors include the presence of a preexisting medical
condition such as thyroid disease, a history of miscarriage, and prenatal
testing such asamniocentesis. Smoking, drinking alcohol, or taking certain
drugs during pregnancy are also recognized risk factors.
The principal sign of an impending or threatened miscarriage is vaginal
bleeding. Other symptoms may include pain in the abdomen and lower back.

The pathophysiology is unclear. Vaginal bleeding originates from the

decidual implantation site or from the placenta. The onset of
bleeding may follow or precede fetal demise. Immunogenic, hypoxic,
and vascular causes lead to a final common pathway of severe
villous or placental dysfunction resulting in embryonic or fetal
demise. A possible hypothesis is that local bleeding of variable
severity accompanies all miscarriages, but its persistence is
revealed, concealed, or followed by fetal demise. This hypothesis is
consistent with findings of abnormal vascular development at the
maternal-embryonic interface. [27] [28] Local dysfunction of
implantation-modulating factors as well as systemic abnormalities
have also been demonstrated. [29] The 2 major directions of
current research appear to be the assessment of natural killer cell
activity [30] and impaired decidualisation.