Miscarriage
Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy in Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
The incidence of miscarriage decreases with increasing gestational age. Septic abortion is considered a complication of miscarriage. When considering clinical and subclinical pregnancies, approximately 50% of all pregnancies will end in miscarriage. Miscarriage is a nonspecific term used to describe the spontaneous failure of an intrauterine pregnancy prior to the 20th week of gestation. On occasion, it is useful to further classify miscarriages as early or late, according to whether they occur before or after the 12th week of gestation. The majority of these miscarriages are caused by chromosome abnormalities that make it impossible for the fetus to develop normally. History of a prior miscarriage should always be explored as part of the evaluation of the patient's obstetrical history. Surgical management can be offered for miscarriages of all gestational ages. Surgical management of miscarriage carries some of the same risks as medical management but also additional surgical risk to the patient.
Investigations, treatment and management
Janetta Bensouilah in Pregnancy Loss, 2021
Some women recover from one miscarriage within a relatively short time period, and they remain optimistic about a future pregnancy. Far fewer women remain as optimistic following a second or third loss, as worries mount over whether a successful pregnancy will ever happen. A preoccupation with trying to become pregnant and staying pregnant can eventually dominate the lives of women and their partners. The need to find out the reason why their pregnancies fail can be overwhelming, and many will fear that there is something fundamentally wrong with them which, until it is fixed, will forever blight their hopes of achieving their desired family. In the case of stillbirth, many parents want to know as much as possible about why their baby died, not least in order to protect themselves from such a distressing event occurring again.
‘Troubling the Normal’: ‘Angel Babies’ and the Canny/Uncanny Nexus
Carol Komaromy in Understanding Reproductive Loss, 2012
This chapter discusses the findings from the research on three different forms of reproductive loss termination of pregnancy for foetal anomaly (TOPFA), are sampled heuristically to provide a cross-study insight into the way that diversity is interwoven into accounts of reproductive loss. The chapter maps out some of the ways in which diversity of experience can be influenced by the organisation of formal health care experiences of conducting research in these three distinct areas of reproductive loss. There are four research projects that we reflect on here. Three of these projects were qualitative, in-depth interview studies: parent and staff reactions to feticide prior to termination of pregnancy for foetal anomaly; parent and health professional experiences of treatment withdrawal from sick neonates; and managing the expectation gap in healthcare following a miscarriage. The fourth project was a survey-based study: providing feticide prior to termination of pregnancy for foetal anomaly: a survey of United Kingdom foetal medicine sub-specialists.
How can we better predict the risk of spontaneous miscarriage among women experiencing threatened miscarriage?
Published in Gynecological Endocrinology, 2015
Chee Wai Ku, John C. Allen, Rahul Malhotra, Han Chung Chong, Nguan Soon Tan, Truls Østbye, Sze Min Lek, Desiree Lie, Thiam Chye Tan
This study seeks to establish progesterone and progesterone-induced blocking factor (PIBF) levels as predictors of subsequent completed miscarriage among women presenting with threatened miscarriage between 6 and 10 weeks of gestation. Our secondary objective was to assess the known maternal risk factors, toward development of a parsimonious and clinician-friendly risk assessment model for predicting completed miscarriage. In this article, we present a prospective cohort study of 119 patients presenting with threatened miscarriage from gestation weeks 6 to 10 at a tertiary women’s hospital emergency unit in Singapore. Thirty (25.2%) women had a spontaneous miscarriage. Low progesterone and PIBF levels are similarly predictive of subsequent completed miscarriage. Study results (OR, 95% CI) showed that higher levels of progesterone (0.91, 95% CI 0.88–0.94) and PIBF (0.99, 95% CI 0.98–0.99) were associated with lower risk of miscarriage. Low progesterone level was a very strong predictor of miscarriage risk in our study despite previous concerns about its pulsatile secretion. Low serum progesterone and PIBF levels predicted spontaneous miscarriage among women presenting with threatened miscarriage between gestation weeks 6 to 10. Predictive models to calculate probability of spontaneous miscarriage based on serum progesterone, together with maternal BMI and fetal heart are proposed.
Support following miscarriage: what women want
Published in Journal of Reproductive and Infant Psychology, 2010
Natalène Séjourné, Stacey Callahan, Henri Chabrol
Objective: Miscarriage is a frequent pregnancy complication often accompanied by psychological distress. The current study seeks to query women about their desire for support following miscarriage and specific aspects of content, type and timing of support. Method: An experimenter‐designed questionnaire was presented to Internet forums dealing with miscarriage or gynecological medical information. Three hundred and five women participated in the study. Results: The majority of women indicated that they would appreciate support following miscarriage. All proposed interventions appeared useful to women, particularly those dealing with the medical aspects of miscarriage. Women indicated that they felt poorly informed following miscarriage and had particular difficulty dealing with the emotional impact of their miscarriage. Conclusion: The results emphasise the need for providing more comprehensive care for women who have experienced miscarriage and provide information about how support could be best provided
The Meaning of Miscarriage to Others: Is it an Unrecognized Loss?
Published in Journal of Personal and Interpersonal Loss, 2000
Catherine Renner, Sophia Verdekal, Sigal Brier, Gina Fallucca
Miscarriage is a relatively prevalent occurrence in our society. The reported incidence of this event indicates that 20% of all women experience a miscarriage. Women who have miscarried report friends and family responding in ways that seem to try to reduce the impact and importance of the event. This leaves the grieving woman with a sense of little support or understanding of what she had just experienced. Furthermore, the experiences reported by women who have had a miscarriage are quite different from those reported by other individuals who have experienced other types of loss such as a spouse, partner, parent, or friend. Women who have miscarried report a lack of recognition that they have experienced a loss. Little is known about how society views miscarriage or why individuals respond in such an apparently unsupportive manner to a woman who has had a miscarriage. The present work sought to determine whether miscarriage is an unrecognized loss and to assess the meaning of miscarriage to others. Although the results indicate miscarriage is viewed as a loss, it is a loss with minimal grounded or valuative meaning for others, which suggests that the cultural norm of silence surrounding early pregnancy and miscarriage should be lifted
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