Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
If you are having a spontaneous miscarriage, you will probably have vaginal
bleeding, abdominal pain, and cramping.
Bleeding may be only slight spotting, or it can be quite severe. Your
health care practitioner will ask about how much you have bled-usually the number of
pads you've soaked through. You will also be asked about blood clots or whether
you saw any tissue.
Pain and cramping occur in the lower abdomen. They may occur on only one
side, both sides, or in the middle. The pain can also go into your lower back,
buttocks, and genitals.
You may no longer have signs of pregnancy such as nausea or breast
swelling/tenderness if you have experienced a miscarriage.
What is a miscarriage?
A miscarriage is any pregnancy that ends spontaneously before the fetus can survive. A miscarriage is medically referred to as a spontaneous abortion. The World Health Organization defines this unsurvivable state as an embryo or fetus weighing 500 grams or less, which typically corresponds to a fetal age (gestational age) of 20 to 22 weeks or less. Miscarriage occurs in about 15%
to 20% of all recognized pregnancies, and usually occurs before the 13th week of
pregnancy. With the development of highly sensitive assays for hCG levels that can detect an early pregnancy even prior to the expected next
period (menstruation), researchers have been able to show that around 60%
to 70% of all pregnancies (recognized and unrecognized) are lost. Because the loss occurs so early, many miscarriages occur without the woman ever having known she was pregnant. Of those miscarriages that occur before the eighth week, 30% have no fetus associated with the sac or placenta. This condition is called blighted ovum, and many women are surprised to learn that there was never an embryo inside the sac.
As described above, some miscarriages occur before women recognize that they are pregnant. About 15% of fertilized eggs are lost before the egg even has a chance to implant (embed itself) in the wall of the uterus. A woman would not generally identify this type of miscarriage. Another 15% of conceptions are lost before eight weeks' gestation. Once fetal heart function is detected in a given pregnancy, the chance of miscarriage is less than 5%.
A woman who may be showing the signs of a possible miscarriage (such as
vaginal bleeding) may have her pregnancy referred to as a "threatened abortion."
What causes a miscarriage, and what are the tests for the different causes?
The cause of a miscarriage cannot always be determined.
The most common known causes of miscarriage in the first third of pregnancy (1st
trimester) are chromosomal abnormalities, collagen vascular disease (such as
lupus),
diabetes, other hormonal problems, infection, and congenital (present at
birth) abnormalities of the uterus. Chromosomal abnormalities of the fetus are
the most common cause of early miscarriages, including blighted ovum (see above). Each of
the causes will be described below.
Chromosomal abnormalities
Chromosomes are
microscopic components of every cell in the body that carry all of the genetic
material that determines hair color, eye color, and our
overall appearance and makeup. These chromosomes duplicate themselves and divide
many times during the process of development, and there are numerous points
along the way where a problem can occur. Certain genetic abnormalities are known
to be more prevalent in couples that experience repeated pregnancy losses. These
genetic traits can be screened for by blood tests prior to
trying to conceive.
Half of the fetal tissue from1st trimester miscarriages contain
abnormal chromosomes. This number drops to 20% with 2nd trimester miscarriages.
In other words, abnormal chromosomes are more common with 1st trimester than
with 2nd trimester miscarriages. First trimester miscarriages are so very common
that unless they occur more than once, they are not considered "abnormal" per
se. They do not prompt further evaluation unless they occur more than once. In
contrast, 2nd trimester miscarriages are more unusual, and therefore may trigger
evaluation even after a first occurrence. It is therefore clear that causes of
miscarriages seem to vary according to trimester.
Chromosomal abnormalities also become more common with
aging, and women over age 35 have a higher rate of miscarriage than younger
women. Advancing maternal
age is the most significant risk factor for early miscarriage in otherwise
healthy women.
Collagen vascular diseases
Collagen vascular diseases are illnesses in which a
person's own immune system attacks their own organs. These diseases can be
potentially very serious, either during or between pregnancies. In these
diseases, a woman makes antibodies to her own body's tissues. Examples of
collagen vascular diseases associated with an increased risk of miscarriage are
systemic lupus
erythematosus, and antiphospholipid antibody syndrome. Blood tests can confirm
the presence of abnormal antibodies and are used in the diagnose of these conditions.
Diabetes
Diabetes generally can be well managed during pregnancy,
if a woman and her health care practitioner work closely together. However, if the diabetes is
insufficiently controlled, not only is the risk of miscarriages higher, but the
baby can have major birth defects. Other problems can also occur in relation to
diabetes during pregnancy. Good control of blood sugars during pregnancy is very
important.
Hormonal factors
Hormonal factors may be associated with an increased risk
of miscarriage, including Cushing's Syndrome, thyroid disease, and
polycystic
ovary syndrome (PCOS). It also has been suggested that inadequate function of the
corpus luteum in the ovary (which produced progesterone necessary for maintenance of the very early
stages of pregnancy) may lead to miscarriage. Termed "luteal phase defect," this
is a controversial issue, since several studies have not supported the theory of
luteal phase defect as a cause of pregnancy loss.
Infections
Maternal infection with a large number of different organisms has been
associated with an increased risk of miscarriage. Fetal or placental infection by
the offending organism then leads to pregnancy loss. Examples of infections that
have been associated with miscarriage include infections by Listeria
monocytogenes, Toxoplasma gondii, parvovirus B19, rubella,
herpes simplex,
cytomegalovirus, and
lymphocytic choriomeningitis virus.
Abnormal structural anatomy
Abnormal anatomy of the uterus can also
cause miscarriages. In some women there can be a tissue bridge (uterine septum),
that acts like a partial wall dividing the uterine cavity into sections. The
septum usually has a very poor blood supply, and is not well suited for
placental attachment and growth. Therefore, an embryo implanting on the septum
would be at increased risk of miscarriage.
Other structural abnormalities can result from benign
growths in the uterus called fibroids.
Fibroid tumors (leiomyomata) are benign
growths of muscle cells in the uterus. While most fibroid tumors do not cause
miscarriages, (in fact, they are a rare cause of
infertility), some can
interfere with the embryo implantation and the embryo's blood supply, thereby causing miscarriage.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Herpes simplex infections are common and when they appear around the mouth and lips, people often refer to them as "cold sores" and "fever blisters." Canker sores are different than cold sores. Air droplets can spread the virus, as can direct contact with the fluid from the blisters. Cold sore treatment include over-the-counter medication as well as prescription medications.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Uterine fibroids are benign tumors that originate in the uterus and are usually round or semi-round in shape. The most common symptom of a uterine fibroid is abnormal vaginal bleeding. Other symptoms include pressure, pelvic pain, pressure on the bladder, or pain during a bowel movement. Treatment options vary from surgery to medication.
Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms including irregular or no menstrual periods, acne, obesity, and excess hair growth. Treatment of PCOS depends partially on the woman's stage of life and the symptoms of PCOS.
There are many types of thyroid disease. Some occur due to the function of the thyroid itself such as hypothyroidism, hyperthyroidism, Hashimoto's thyroiditis, etc. Some causes of thyroid disease occur due to problems with the structure of the thyroid gland such as goiters, thyroid nodules, and thyroid cancer. Treatment of thyroid disease depends on the cause of the disease.
Internal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
Normal vaginal bleeding (menorrhea) occurs through the process of menstruation. Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding. Causes of abnormal may arise from a variety of conditions.
Cushing's syndrome, sometimes referred to as hypercortisolism, is a hormonal disorder caused by prolonged exposure to high levels of the hormone cortisol. Symptoms may include obesity, thinning arms and legs, a rounded face, and increased fat around the neck. Some causes of Cushing's syndrome is from taking glucocorticoid hormones such as prednisone for inflammatory diseases. Treatment for Cushing's syndrome depends on the cause.
Mumps is an acute viral illness caused by the mumps virus. Symptoms of mumps include fever, headache, muscle aches, tiredness, and loss of appetite; followed by swelling of the salivary glands.
Infertility is the diminished ability to conceive a child. The primary cause of infertility in men is a sperm disorder. In women, the primary cause of infertility is an ovulation disorder. Most forms of infertility can be treated. Conventional infertility therapies include drugs or surgery.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
Benign uterine growths are tissue enlargements of the female womb (uterus). Three types of benign uterine growths are uterine fibroids, adenomyosis, and uterine polyps. Symptoms include: abdominal pressure, pelvic pain, and pain during intercourse. Diagnosis and treatment of benign uterine growths depends upon the type of growth.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Phenylketonuria (PKU) is a disorder that is inherited. PKU disorder increases the levels of phenylalanine in the blood. Phenylalanine is an amino acid that is obtained through diet, and is found in some artificial sweeteners. Signs and symptoms of PKU may vary from mild to severe. PKU has an autosomal ressesive pattern of inheritance.
Graves' disease is an autoimmune disease that affects the thyroid. Some of the symptoms of Graves' disease include hand tremors, rapid heartbeat, trouble sleeping, enlarged thyroid, thinning of the skin or fine brittle hair. Causes of Graves' disease are thought to be multifactorial such as genes, gender, stress, and infection. Treatment for Graves' disease is generally medication.
Listeria is a type of bacteria that can cause food poisoning. Listeriosis symptoms include diarrhea, nausea and fever. Pregnant women are 20 times more likely than other healthy adults to get listeriosis. Listeria infection is treated with antibiotics.
Birth defects have many causes and currently, are the leading cause of death for infants in the first year of life. Some of the causes of birth defects include genetic or chromosome problems. Exposure of the mother to rubella or German measles during pregnancy, or using drugs or alcohol during pregnancy. The treatment for birth defects depends upon the condition of the effected child.
Genetic disease is a disorder or condition caused by abnormalities in a person's genome. Types of genetic inheritance include single inheritance (for example, cystic fibrosis, sickle cell anemia, Marfan syndrome, and hemochromatosis), multifactoral inheritance, chromosome abnormalities (for example, Turner syndrome, and Klinefelter syndrome), and mitochondrial inheritance (for example, epilepsy and dementia).
Antiphospholipid syndrome (phospholipid antibody syndrome or Hughes syndrome) is an immune system disorder characterized by excessive blood clotting and/or pregnancy complications (premature miscarriages, unexplained fetal death, or premature birth) and the presence of antiphospholipid antibodies (cardiolipin or lupus anticoagulant antibodies) in the blood. Treatment focuses on preventing clotting by thinning the blood with the use of anticoagulants and aspirin.
Women's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.
Gestational diabetes is a condition that is first recognized during pregnancy and is characterized by high blood sugar. Approximately 4% of all pregnancies are diagnosed with gestational diabetes. Low blood sugar is prevented by hormones produced by the placenta during a woman's pregnancy. The actions of insulin are stopped by these hormones. Gestational diabetes is the result of the pancreas' s inability to produce enough insulin to overcome the effect of the increase hormones during pregnancy.
German measles is a disease that's caused by a virus. Symptoms include rash and fever for two to three days. The MMR (measles, mumps, and rubella) vaccine prevents this disease.
Your health care provider may refer you to a genetic professional. Universities and medical centers also often have affiliated genetic professionals, or can provide referrals to a genetic professional or genetics clinic. Genetic counseling provides patients and family members the tools to make the right choice in regard to test for a disease or condition.
Taking care of a disease such as diabetes is a life-long process. Learn how to care for yourself or loved one with diabetes in situations such as illness, work, school, travel, or a natural disaster.
Dilation and curettage (D&C) is a procedure in which the cervix of the uterus is expanded (dilated) so that the uterine lining (endometrium) can be removed with a spoon-shaped instrument called a curet or curette. The procedure is performed for a variety of reasons. Most commonly, this surgery is done in order to help determine the cause of abnormal uterine bleeding. It can also be done to help determine the degree of abnormality of the endometrium in cases of cancer or pre-cancerous cells that are detected by an in-office biopsy. D&C is also sometimes necessary to remove tissue after a miscarriage.
Why is a D&C done?
In general, a D&C is used to help determine the health of the uterine lining or to remove abnormal tissue. Occasionally, the procedure can correct some of the problems in the uterus such as polyps, scar tissue, or tissue overgrowth.
