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Miscarriages: Several Types Possible

Some of our patients have bleeding or an early miscarriage, or an evolving miscarriage, or a history of miscarriage when they are trying to get pregnant, and we spend time trying to discuss what did happen or what is really happening in these situations. This discussion is to help clarify those situations. 

Lots of terms have been applied to what is essentially a non-medical term: the miscarriage. If you have been pregnant, and had an ultrasound that diagnosed a on-going pregnancy and now you have miscarried, we term a complete pregnancy loss if all the tissue has passed, and the cervix is closed and on ultrasound the lining gets fairly thin to under 15 mm of thickness. Women may still have some bleeding, and this may go on until your next period.

If you have an incomplete pregnancy loss, you have begun to pass some of the pregnancy, but there is still tissue in the uterus, the cervix is still open. The ultrasound may appear to still contain the entire sac of pregnancy and the lining thickness can be very thick or somewhat thinner. There are situations where the pregnancy has failed to thrive, but no yet begun to pass. You may have heard the terms: missed abortion, blighted ovum, anembryonic pregnancy (a pregnancy sac but no fetal development).

This is not a molar pregnancy, which is a tumor of the placenta and very different. Many women have not yet even begun to have bleeding yet, and when they go for a routine exam or sonogram this is only found because there is no growth or development to the pregnancy or now the heart beat of the fetus cannot be found. There are distinct ultrasound features that your physician uses to determine that this is occurring, such as a fetus that is small, under 6 mm and not growing over a week, or one that is a bit larger than this but still has no heart beat.

Pregnancy gestational sacs seen on ultrasound that are big, over 20 mm but have no fetus or no extra structure like a yolk sac in them are another sign of this delayed pregnancy loss. Ultrasounds, pregnancy tests and pelvic examinations are the best tools to help figure out what is really going on. It cannot always be accomplished in one visit to the gyno, but often it can be.


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