“ It is a clinical entity where the process of miscarriage has started but has not progressed to a state from which recovery is impossible “

The etiology (causes) of threatened miscarriage, which refers to vaginal bleeding during the first 20 weeks of pregnancy without cervical dilation, can vary. Here are some potential causes:

1. Implantation Bleeding: Occurs when the embryo implants into the uterine lining, often around the time of the expected period.
2. Hormonal Changes: Fluctuations in hormone levels, particularly progesterone, can affect the stability of the uterine lining.
3. Subchorionic Hemorrhage: Bleeding between the placenta and the uterine wall.
4. Infections: Certain infections, such as bacterial vaginosis or sexually transmitted infections, can contribute to vaginal bleeding.
5. Cervical Changes: Incompetent cervix (weakening of the cervix) or cervical polyps.
6. Maternal Factors: Chronic conditions like diabetes or thyroid disorders, autoimmune diseases, or clotting disorders.
7. Trauma: Physical trauma or intercourse.
8. Environmental Factors: Exposure to certain chemicals or toxins.
9. Genetic Factors: Chromosomal abnormalities in the fetus.

It’s important to note that not all cases of threatened miscarriage progress to miscarriage.

COMPLICATION :

Threatened miscarriage itself refers to vaginal bleeding during early pregnancy without cervical dilation, and it doesn’t always lead to miscarriage. However, there can be potential complications associated with threatened miscarriage:

1. Increased Risk of Miscarriage: While not all cases of threatened miscarriage progress to miscarriage, there is a heightened risk compared to pregnancies without bleeding.
2. Emotional Stress: The uncertainty and anxiety associated with bleeding during pregnancy can be emotionally challenging for expecting parents.
3. Physical Complications: In some cases, the bleeding may be accompanied by cramping or pain, which can cause discomfort.
4. Infection: Any bleeding during pregnancy can potentially increase the risk of infection, particularly if there is prolonged or heavy bleeding.
5. Anemia: Significant or prolonged bleeding can lead to anemia, which may require medical intervention.
6. Impact on Pregnancy Outcome: In certain situations, ongoing bleeding or complications related to underlying causes (like infections or hormonal imbalances) could affect the overall health of the pregnancy.

SIGN AND SYMPTOMS :

Threatened miscarriage refers to vaginal bleeding during the first 20 weeks of pregnancy without cervical dilation. Here are the signs and symptoms typically associated with threatened miscarriage:

1. Vaginal Bleeding: This is the hallmark symptom of threatened miscarriage. The bleeding can vary from light spotting to heavier bleeding resembling a menstrual period. It may be accompanied by clotting.
2. Abdominal Pain: Mild to moderate cramping or abdominal pain may accompany the vaginal bleeding. The pain can be intermittent or persistent.
3. Back Pain: Some individuals may experience lower back pain, which can accompany the abdominal discomfort.
4. Loss of Pregnancy Symptoms: In some cases, there may be a decrease in typical pregnancy symptoms such as breast tenderness, nausea, or fatigue.

DIAGNOSIS :

Here are the key aspects of diagnosing threatened miscarriage:

1. Medical History: The healthcare provider will gather information about the patient’s medical history, including any previous pregnancies and any relevant medical conditions.
2. Symptoms: The main symptom is vaginal bleeding during the first 20 weeks of pregnancy, typically accompanied by mild abdominal pain or cramping. The nature and amount of bleeding (e.g., spotting versus heavy bleeding) are noted.
3. Physical Examination: A pelvic examination may be performed to assess the cervix for signs of dilation or abnormality. The provider will also check for tenderness or pain in the pelvic area.
4. Ultrasound: An ultrasound scan is crucial to evaluate the viability of the pregnancy. This can help determine the gestational age, location of the pregnancy (intrauterine or ectopic), and detect any fetal heartbeat. It can also identify other potential causes of bleeding, such as subchorionic hematoma.
5. Blood Tests: Blood tests may be ordered to measure levels of human chorionic gonadotropin (hCG) hormone and progesterone, which can provide additional information about the pregnancy’s viability and health.
6. Additional Tests: Depending on the clinical scenario, additional tests such as a complete blood count (CBC) to check for anemia, tests for infections, or genetic testing may be considered.

MANAGEMENT :

The management of threatened miscarriage depends on several factors, including the severity of symptoms, the gestational age of the pregnancy, and the findings from diagnostic tests such as ultrasound. Here are the key aspects of managing threatened miscarriage:

1. Evaluation and Assessment:
   • History and Physical Examination: The healthcare provider will gather information about the symptoms, perform a physical exam (including pelvic examination), and inquire about the patient’s medical history.
   • Ultrasound: An ultrasound scan is crucial to assess the viability of the pregnancy, determine the gestational age, and identify any potential causes of bleeding (e.g., subchorionic hematoma).
2. Monitoring:
   • Depending on the severity of symptoms and the findings from ultrasound, close monitoring may be recommended. This could involve serial ultrasounds and blood tests (such as hCG levels) to track the progress of the pregnancy.
3. Rest and Activity:
   • Bed rest may be recommended for a brief period if there is significant bleeding or pain. Avoiding strenuous activities and sexual intercourse may also be advised to reduce the risk of further complications.
4. Medications:
   • In some cases, medications may be prescribed to help support the pregnancy. This might include progesterone supplements, which can sometimes be used to support the uterine lining and maintain pregnancy.
5. Hydration and Pain Management:
   • Ensuring adequate hydration is important, especially if there is significant bleeding. Pain management medications may be prescribed if needed to alleviate discomfort.
6. Avoidance of Teratogens:
   • If the cause of threatened miscarriage is related to certain medications or environmental factors, discontinuing exposure to these substances may be necessary.
7. Psychological Support:
   • Dealing with the emotional stress of threatened miscarriage can be challenging. Counseling or support groups may be beneficial for individuals and their partners to cope with anxiety and grief.
8. Follow-Up:
   • Follow-up appointments with the healthcare provider are essential to monitor the progress of the pregnancy and ensure that any changes in symptoms are promptly addressed.