Miscarriage - threatened

Also known as: Threatened miscarriage, Threatened spontaneous abortion, Abortion - threatened or Threatened abortion

Definition

A threatened miscarriage is a condition that suggests a miscarriage might take place before the 20th week of pregnancy.

Causes, incidence, and risk factors

Some pregnant women have some vaginal bleeding, with or without abdominal cramps, during the first three months of pregnancy. When the symptoms indicate a miscarriage is possible, the condition is called a "threatened abortion." (This refers to a naturally occurring event, not medical abortions or surgical abortions.)

Miscarriage occurs in about half of pregnancies with first trimester bleeding.

For more information, see: Miscarriage

Symptoms

Symptoms of a threatened miscarriage include:

Abdominal cramps with or without vaginal bleeding
Vaginal bleeding during the first 20 weeks of pregnancy (last menstrual period was less than 20 weeks ago)

Note: During an actual miscarriage, low back pain or abdominal pain (dull to sharp, constant to intermittent) typically occurs, and tissue or clot-like material may pass from the vagina.

Signs and tests

Abdominal or vaginal ultrasound may be done to check the baby's development, heart beat, and amount of bleeding. A pelvic exam will be done to check the cervix.

The following blood tests may be performed:

Beta HCG (quantitative) test over a period of days or weeks to confirm whether the pregnancy is continuing
Complete blood count (CBC) to determine amount of blood loss
Pregnancy test to confirm pregnancy
Progesterone level
White blood count (WBC) with differential to rule out infection

Treatment

You may be told to avoid or restrict some forms of activity. Not having sexual intercourse is usually recommended until the warning signs have disappeared.

The use of progesterone is controversial. It might relax smooth muscles, including the muscles of the uterus. However, it also might increase the risk of an incomplete abortion or an abnormal pregnancy. Unless there is a luteal phase defect, progesterone should not be used.

Expectations (prognosis)

Many women with threatened miscarriage go on to have a normal pregnancy.

Complications

Anemia
Infection
Miscarriage
Moderate-to-heavy blood loss

Calling your health care provider

If you know you are (or are likely to be) pregnant and you have any symptoms of threatened miscarriage, contact your prenatal health care provider immediately.

Prevention

Some studies show that women who get prenatal care have better pregnancy outcomes, for themselves and their babies. Miscarriages are less likely if you receive early, comprehensive prenatal care and avoid environmental hazards such as x-rays, drugs and alcohol, high levels of caffeine, and infectious diseases.

It is better to find and treat health problems before you get pregnant than to wait until you're already pregnant. Many miscarriages that are caused by body-wide (systemic) diseases that can be prevented by detecting and treating the disease before becoming pregnant. Being obese or having uncontrolled diabetes can increase your risk for miscarriage.

References

Katz VL. Spontaneous and recurrent abortion: etiology, diagnosis, treatment. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 16.

American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 462: Moderate caffeine consumption during pregnancy. Obstet Gynecol.2010 Aug;116(2 Pt 1):467-8.

Cunnigham FG, Leveno KL, Bloom SL, et al. Abortion. In: Cunnigham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 23rd ed. New York, NY: McGraw-Hill; 2010:chap 9.

Review date:: November 21, 2010
Reviewed by:: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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