Definition
Miscarriage refers to the premature end of a pregnancy before the developing baby is able to survive outside the womb. Miscarriage can occur during the first or second trimester, before 20 weeks. Most occur in the first 12 weeks of pregnancy, and most miscarriages are unexpected and isolated events. About 15%-20% of recognized pregnancies end this way.
Prevention
Before you start to plan your next pregnancy consider the following regarding your health:
·   Is your diet ready to support another pregnancy?
·   Are there habits you should change prior to another pregnancy?
·   What medications are you taking and will they affect a pregnancy?
·   How is your health?
·   Are there issues you should resolve before trying another pregnancy?
·   Seek help to learn about your risks and what you can do to minimize them.
Symptoms
Symptoms include some or all of the following:
·   Vaginal bleeding
·   Pink or brown discharge
·   Cramping
·   Discharge of the products of conception (fetus, placenta, and surrounding membranes)
·   Fever
Diagnosis
You will be asked about your symptoms, the length of your pregnancy, and when you first noticed a change in your condition. The doctor will perform physical and pelvic exams.
Treatment
Immediate care usually involves observation only, especially in early or first trimester miscarriages. Medication may be indicated in the event of heavy bleeding or cramping. A dilation and evacuation (D&E) may be needed if all uterine contents are not spontaneously expelled. During a D&E, the doctor dilates the cervix, inserts a tool into the uterus, and suctions out remaining material.
You may need professional counseling to recover emotionally from the loss.
The goal of long-term treatment is to prevent future miscarriages. This is geared toward whatever caused past losses.
Medications
Medications to decrease the chance of miscarriage may include:
·   Antibiotics for infection
·   Progesterone supplements (if this hormone is below normal levels)
·   Aspirin and other medications to treat blood-clotting problems caused by immunologic disorders
Surgery
Many uterine physical abnormalities can be corrected to decrease the chance of another miscarriage. If the cervix is weak, the doctor can place a stitch (called a cerclage), usually at the beginning of the second trimester of the next pregnancy, to keep it closed until you are ready to deliver. If fibroids are a contributing factor, removing them may prevent another loss.
Support Services
Talking with a professional counselor often helps women deal with their loss. Some people benefit from participating in a support group.