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.
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."
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.
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