Various terminologies used with respect to miscarriages are unclear, creating confusion.
So, in this blog, I am making an attempt to analyze various guidelines proposed by different organizations currently.
RCOG and MISCARRIAGE :
As per RCOG,
Miscarriage is defined as a spontaneous loss of pregnancy before 24 weeks of pregnancy.
Early Miscarriage: is defined as, spontaneous loss of a pregnancy before 12 weeks gestation.
Late miscarriage (Second trimester or mid trimester loss), refers to a miscarriage that happens when there is loss of fetal heart activity after 12 completed weeks upto 24weeks of pregnancy.
If the fetal heart activity stops at or after 24 weeks of pregnancy, this is called a stillbirth.
In UK, 24 weeks of pregnancy is the legal age of viability.
ACOG and MISCARRIAGE:
ACOG Practice Bulletin : ACOG Practice Bulletin was developed by the committee on Practice Bulletins – Gynaecology, with the assistance of Sarah Prager, M.D; Vanessa K. Dalton, M.D, MPH; and Rebecca H. Allen, MD, MPH.
The information is put to help practitioners to make decisions about appropriate gynaecological and obstetric care. ACOG says, these guidelines should not be construed as dictating an exclusive course of treatment or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources and limitations unique to the institution or type of practice.
ACOG further says, early pregnancy loss, or loss of an intrauterinepregnancy within the first trimester, is encountered commonly in clinical practice. Obstetricians and Gynaecologists should understand the use of various diagnostics tools to differentiate between viable and nonviable pregnancies and offer the full range of therapeutic options to the patients, including expectant, medical, and surgical management. The purpose of the Practice Bulletin is to review diagnostic approaches and describe options for management of early pregnancy loss.
ACOG Definition of early pregnancy loss: Early pregnancy loss is defined as a nonviable, intrauterine pregnancy with either an empty gestational sac or a gestational sac containing an embryo without fetal heart activity within the first 12.6/7 weeks of gestation. (1)
In the first trimester, the terms miscarriage, spontaneous abortion, and early pregnancy loss are used interchangeably, and there is no consensus on the terminology in literature. However, early pregnancy loss will be the term used in the Practice Bulletin.
A patient however, presents with a period of amenorrhea or a positive pregnancy test, pain andor bleeding
CLINICAL PREGNANCY V/S BIOCHEMICAL PREGNANCY
Further secretions produce following effects :
Unfortunately, we do not know in biochemical pregnancies, where the implantation has occurred i.e. uterus or fallopian tube. So in these cases if biochemical pregnancy has happened, it could mean early intrauterine miscarriage or early tubal abortion.
It is estimated that biochemical pregnancies occur in upto or more than 60% of all pregnancies in humans. However, because of availability of beta hCG blood testing in all patients i.e. thoseconceiving spontaneously or by fertility treatment, biochemical pregnancies have become more common.
Biochemical pregnancy is frequently a retrospective diagnosis. When the blood test is a positive, all we know is that the patient is in the biochemical phase, of what we hope will become a clinical pregnancy. If the patient loses the pregnancy in the biochemical phase, we can say in retrospect that she had a biochemical pregnancy.
The causes for biochemical pregnancy could be similar to those causing clinical miscarriages
Biochemical Pregnancy And Repeated Pregnancy Loss ( RPL) :
It has been always a matter of debate whether biochemical pregnancy losses should be considered as part of the definition of RPL. ASRM states that pregnancy losses should include only those that can be documented by ultrasound or histopathology(2).
Biochemical pregnancy losses are very common in general population, with almost 60-80% of pregnancies thought to end in an early pre-clinical loss (3, 4). Another study shows that almost 20% of women in the general population may experience 3 biochemical pregnancy losses due to chance alone and do not require investigations. In spite of this, biochemical pregnancies are included as a part of definition of RPL by many clinicians, as women do sensitive, over the counter urine pregnancy test to confirm biochemical pregnancy, and are anxious to undergo investigative evaluation of RPL.
In a recent study from the European Society for Human Reproduction and Embryology (ESHRE) Early Pregnancies Special Interest Group found that, in patients with RPL, each early pregnancy loss confirmed only by a positive Beta-hCG test has a negative prognostic impact equal to that of a clinical miscarriage (5). This supports the concept that biochemical pregnancies should be included in the RPL diagnosis.
Various Definitions mentioned above are a bit confusing. Hence I feel any pregnancy loss before 24 weeks, with or without fetal heart, should be labeled as miscarriage.
The lyers went form clinic to clinic . They tried everything,including IVF. Nothing worked.But they were not the ones to give up hope! Finally,after 5 years of waiting,Nisha was born to them at our clinic.
An open letter from Dr Mugdha
Nisha is 21 now! she is hale and hearty; beautiful to look at and very very spirited. To me, she could have been no one other than that - knowing first hand how she was brought into the world.
It is beautiful story I love to tell,especially to those couples who have resigned to a life without a child.Read More
There are half a million cases where IVF has failed too;but that no way means the end of the road to parenthood. Dr Mohan Raut writes about his experience with Lymhocyte Immunisation Therapy.Read More