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| '''''Synonyms and Keywords:''''' Spontaneous abortion; Missed abortion; Incomplete abortion; Complete abortion; Inevitable abortion; Infected abortion | | '''''Synonyms and Keywords:''''' Spontaneous abortion; Missed abortion; Incomplete abortion; Complete abortion; Inevitable abortion; Infected abortion |
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| ==Overview==
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| '''Miscarriage''' is the natural or spontaneous end of a [[pregnancy]] at a stage where the [[embryo]] or the [[fetus]] is incapable of surviving, generally defined in humans at a [[gestation]] of prior to 20 weeks. Miscarriage is the most common complication of early pregnancy.<ref>{{cite web | last = Petrozza | first = John C | title = Early Pregnancy Loss | work = eMedicine | publisher = WebMD | date = August 29 2006 | url = http://www.emedicine.com/med/topic3241.htm | accessdate = 2007-07-20 }}<br>
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| {{cite web | title = Early Pregnancy Loss (Miscarriage) | work = Pregnancy-bliss.co.uk | publisher = The Daily Telegraph | year = 2007 | url = http://www.pregnancy-bliss.co.uk/miscarriage.html | accessdate = 2007-07-20 }}</ref> The medical term "spontaneous abortion" is used in reference to miscarriages because the medical term "abortion" refers to any terminated pregnancy, deliberately induced or spontaneous, although in common parlance it refers specifically to active termination of pregnancy.
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| ==Terminology== | | ==[[Miscarriage overview|Overview]]== |
| *Very early miscarriages - those which occur before the sixth week [[gestational age|LMP]] (since the woman's Last Menstrual Period) are medically termed early pregnancy loss<ref name="paternal smoking">{{cite journal | author=Venners S, Wang X, Chen C, Wang L, Chen D, Guang W, Huang A, Ryan L, O'Connor J, Lasley B, Overstreet J, Wilcox A, Xu X | title=Paternal smoking and pregnancy loss: a prospective study using a biomarker of pregnancy. | journal=Am J Epidemiol | volume=159 | issue=10 | pages=993-1001 | year=2004 | id=PMID 15128612 | url=http://aje.oxfordjournals.org/cgi/content/full/159/10/993}}</ref> or chemical pregnancy.<ref>{{cite web | title = What is a chemical pregnancy? | url http://www.babyhopes.com/articles/chemical-pregnancy.html | publisher = Baby Hopes | accessdate = 2007-04-27 }}</ref> Miscarriages that occur after the sixth week LMP are medically termed clinical spontaneous abortion.<ref name="paternal smoking" />
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| *In medical contexts, the word [[abortion]] refers to any process by which a [[pregnancy]] ends with the death and removal or expulsion of the [[fetus]], regardless of whether it's spontaneous or intentionally induced. Many women who have had miscarriages, however, object to the term abortion in connection with their experience, as it is generally associated with induced abortions. In recent years there has been discussion in the medical community about avoiding the use of this term in favor of the less ambiguous term miscarriage.<ref>{{cite journal |author=Hutchon D, Cooper S |title=Terminology for early pregnancy loss must be changed |journal=BMJ |volume=317 |issue=7165 |pages=1081 |year=1998 |pmid=9774309}}<br>
| | ==[[Miscarriage historical perspective|Historical Perspective]]== |
| {{cite journal |author=Hutchon D |title=Understanding miscarriage or insensitive abortion: time for more defined terminology? |journal=Am. J. Obstet. Gynecol. |volume=179 |issue=2 |pages=397-8 |year=1998 |pmid=9731844}}</ref>
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| *Labor resulting in live birth before the 37th week of pregnancy is termed [[premature birth]], even if the infant dies shortly afterward. Although long-term survival has never been reported for infants born from pregnancy shorter than 21 weeks, infants born as early as the 16th week of pregnancy may cry and live a few minutes or hours.<ref>{{cite paper | author = Patricia Lee June | title = A Pediatrician Looks at Babies Late in Pregnancy and Late Term Abortion | publisher = Presbyterians Pro-Life | date = November 2001 | url = http://www.ppl.org/PJune_PostViability_2001.html | accessdate = 2006-12-24 }}</ref>
| | ==[[Miscarriage classification|Classification]]== |
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| *A fetus that dies while in the uterus after about the 20th week of pregnancy is termed a [[stillbirth]]. [[Premature birth]]s or [[stillbirth]]s are not generally considered miscarriages, though usage of the terms and causes of these events may overlap.
| | ==[[Miscarriage pathophysiology|Pathophysiology]]== |
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| ==Classification== | | ==[[Miscarriage causes|Causes]]== |
| The clinical presentation of a threatened abortion describes any bleeding seen during pregnancy prior to viability, that has yet to be assessed further. At investigation it may be found that the fetus remains viable and the pregnancy continues without further problems. It has been suggested that bed rest improves the chances of the pregnancy continuing when a small subchorionic [[hematoma]] has been found on ultrasound scans.<ref name="pmid12841015">{{cite journal |author=Ben-Haroush A, Yogev Y, Mashiach R, Meizner I |title=Pregnancy outcome of threatened abortion with subchorionic hematoma: possible benefit of bed-rest? |journal=Isr. Med. Assoc. J. |volume=5 |issue=6 |pages=422-4 |year=2003 |pmid=12841015 |doi=}}</ref>
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| Alternatively the following terms are used to describe pregnancies that do not continue:
| | ==[[Miscarriage differential diagnosis|Differentiating Miscarriage from other Diseases]]== |
| * An [[Anembryonic gestation|empty sac]] is a condition where the gestational sac develops normally, while the embryonal part of the pregnancy is either absent or stops growing very early. Other terms for this condition are ''blighted ovum'' and ''anembryonic pregnancy''.
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| * An ''inevitable abortion'' describes where the fetal heart beat is shown to have stopped and the cervix has already dilated open, but the fetus has yet to be expelled. This usually will progress to a complete abortion.
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| * A ''complete abortion'' is when all products of conception have been expelled. ''Products of conception'' may include the [[trophoblast]], [[chorionic villi]], [[gestational sac]], [[yolk sac]], and [[fetal pole]] ([[embryo]]); or later in pregnancy the [[fetus]], [[umbilical cord]], [[placenta]], amniotic fluid, and [[amniotic sac|amniotic membrane]].
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| * An ''incomplete abortion'' occurs when [[biological tissue|tissue]] has been passed, but some remains ''[[in utero]]''.<ref name="MedlinePlus">{{cite web |author=MedlinePlus | authorlink =MedlinePlus | date = 2004-10-25 | url=http://www.nlm.nih.gov/medlineplus/ency/article/000904.htm | title =Abortion - incomplete | work =Medical Encyclopedia | accessdate =2006-05-24}}</ref>
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| * A ''missed abortion'' is when the embryo or fetus has died, but a miscarriage has not yet occurred. It is also referred to as ''delayed miscarriage''.
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| The following two terms consider wider complications or implications of a miscarriage:
| | ==[[Miscarriage epidemiology and demographics|Epidemiology and Demographics]]== |
| * A ''septic abortion'' occurs when the tissue from a missed or incomplete abortion becomes infected. The infection of the womb carries risk of spreading infection ([[septicaemia]]) and is a grave risk to the life of the woman.
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| * ''[[Habitual abortion|Recurrent pregnancy loss]]'' (RPL) or ''recurrent miscarriage'' (medically termed ''habitual abortion'') is the occurrence of 3 consecutive miscarriages. A large majority (85%) of women who have had two miscarriages will conceive and carry normally afterwards, so statistically the occurrence of three abortions at 0.34% is regarded as "habitual".<ref name="rcog2003">{{cite journal | author = Royal College of Obstetricians and Gynaecologists | authorlink = Royal College of Obstetricians and Gynaecologists | year = 2003 | month = May | title =The Investigation and Treatment of Couple with Recurrent Miscarriage | journal = Guideline | volume = No 17 |url=http://www.rcog.org.uk/resources/Public/pdf/Recurrent_Miscarriage_No17.pdf | format = PDF | accessdate = 2006-05-24}}</ref>
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| ==Pathophysiology== | | ==[[Miscarriage risk factors|Risk Factors]]== |
| When looking for gross or microscopic [[pathology|pathologic]] symptoms of miscarriage, one looks for the products of[[conception]]. Microscopically, these include [[villi]], [[trophoblast]], fetal parts, and background gestational changes in the [[endometrium]]. Genetic tests may also be performed to look for abnormal [[chromosome]] arrangements.
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| ==Causes== | | ==[[Miscarriage natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| Miscarriages can occur for many reasons, not all of which can be identified.
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| ===First Trimester===
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| Most miscarriages (more than three-quarters) occur during the first trimester.<ref name="webmd">{{cite web | last = Rosenthal | first = M. Sara | title = The Second Trimester | work = The Gynecological Sourcebook | publisher = WebMD | date = 1999 | url = http://www.webmd.com/content/article/4/1680_51802.htm | accessdate = 2006-12-18 }}</ref>
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| Chromosomal abnormalities are found in more than half of embryos miscarried in the first 13 weeks. A pregnancy with a genetic problem has a 95% chance of ending in miscarriage. Most chromosomal problems happen by chance, have nothing to do with the parents, and are unlikely to recur.<!--
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| --><ref name="PDR Family Guide 1994">{{cite web |author= |year= |title=Miscarriage: Causes of Miscarriage |url=http://www.healthsquare.com/fgwh/wh1ch27p3.htm |publisher=[http://www.healthsquare.com/about.htm HealthSquare.com] |accessdate=2007-09-18}}<br> taken word-for-word from pp. 347-9 of: <br>
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| {{cite book |author= |year=1994 |title=The PDR Family Guide to Women's Health and Prescription Drugs |location=Montvale, NJ |publisher=Medical Economics |isbn=1-56363-086-9 |chapter=Chapter 27. What To Do When Miscarriage Strikes |pages=pp. 345-50}}</ref> Genetic problems are more likely to occur with older parents; this may account for the higher miscarriage rates observed in older women.<!--
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| --><ref>{{cite web | title = Pregnancy Over Age 30 | work = MUSC Children's Hospital | url = http://www.musckids.com/health_library/hrpregnant/over30.htm | accessdate = 2006-12-18 }}</ref>
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| Another cause of early miscarriage may be [[progesterone]] deficiency. Women diagnosed with low progesterone levels in the second half of their menstrual cycle ([[luteal phase]]) may be prescribed progesterone supplements, to be taken for the first trimester of pregnancy.<ref name="PDR Family Guide 1994" />
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| ===Second Trimester===
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| Up to 15% of pregnancy losses in the second trimester may be due to [[uterine malformation]], growths in the uterus ([[fibroids]]), or [[Cervical incompetence|cervical problems]].<ref name="PDR Family Guide 1994" /> These conditions may also contribute to [[premature birth]].<ref name="webmd" />
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| One study found that 19% of second trimester losses were caused by problems with the [[umbilical cord]]. Problems with the [[placenta]] may also account for a significant number of later-term miscarriages.<!--
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| --><ref>{{cite journal | author = Peng H, Levitin-Smith M, Rochelson B, Kahn E | title = Umbilical cord stricture and overcoiling are common causes of fetal demise. | journal = Pediatr Dev Pathol | volume = 9 | issue = 1 | pages = 14-9 | year = | id = PMID 16808633}}</ref>
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| ==Epidemiology and Demographics==
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| ===Prevalence===
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| Determining the [[prevalence]] of miscarriage is difficult. Many miscarriages happen very early in the pregnancy, before a woman may know she is pregnant. Treatment of women with miscarriage at home means medical statistics on miscarriage miss many cases.<!--
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| --><ref name="bmj1997">{{cite journal | author=Everett C | title=Incidence and outcome of bleeding before the 20th week of pregnancy: prospective study from general practice. | journal=BMJ | volume=315 | issue=7099 | pages=32-4 | year=1997 | id=PMID 9233324 | url=http://bmj.bmjjournals.com/cgi/content/full/315/7099/32}}</ref> Prospective studies using very sensitive early pregnancy tests have found that 25% of pregnancies are miscarried by the sixth week [[gestational age|LMP]] (since the woman's Last Menstrual Period).<!--
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| --><ref name="implantation">{{cite journal | author=Wilcox AJ, Baird DD, Weinberg CR | title=Time of implantation of the conceptus and loss of pregnancy. | journal=New England Journal of Medicine | volume=340 | issue=23 | pages=1796-1799 | year=1999| id=PMID 10362823}}</ref><!--
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| --><ref name="epl">{{cite journal | author = Wang X, Chen C, Wang L, Chen D, Guang W, French J | title = Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study. | journal = Fertil Steril | volume = 79 |issue = 3 | pages = 577-84 | year = 2003 | id = PMID 12620443}}</ref> The risk of miscarriage decreases sharply after the 8th week, i.e. when the [[fetus|fetal]] stage begins.<ref>[http://news.bbc.co.uk/2/hi/health/2176898.stm Q&A: Miscarriage]. (August 6 , 2002). ''BBC News.'' Retrieved January 17, 2007. Also see [[Lennart Nilsson]], A Child is Born 91 (1990)(At eight weeks, "the danger of a miscarriage . . . diminishes sharply.")</ref> Clinical miscarriages (those occurring after the sixth week LMP) occur in 8% of pregnancies.<ref name="epl" />
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| The prevalence of miscarriage increases considerably with age of the parents. Pregnancies from men younger than twenty-five years are 40% less likely to end in miscarriage than pregnancies from men 25-29 years. Pregnancies from men older than forty years are 60% more likely to end in miscarriage than the 25-29 year age group.<!--
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| --><ref>{{cite journal | author = Kleinhaus K, Perrin M, Friedlander Y, Paltiel O, Malaspina D, Harlap S | title = Paternal age and spontaneous abortion | journal = Obstet Gynecol | volume = 108 | issue = 2 | pages = 369-77 | year = 2006 | id = PMID 16880308}}</ref> The increased risk of miscarriage in pregnancies from older men is mainly seen in the first trimester.<!--
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| --><ref>{{cite journal | author = Slama R, Bouyer J, Windham G, Fenster L, Werwatz A, Swan S | title = Influence of paternal age on the risk of spontaneous abortion. | journal = Am J Epidemiol | volume = 161 | issue = 9 | pages = 816-23 | year = 2005 |id = PMID 15840613}}</ref> In women, by the age of forty-five, 75% of pregnancies may end in miscarriage.<!--
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| --><ref>{{cite journal | author = Nybo Andersen A, Wohlfahrt J, Christens P, Olsen J, Melbye M | title = Maternal age and fetal loss: population based register linkage study | journal = BMJ | volume = 320 | issue = 7251 | pages = 1708-12 | year = 2000 | id = PMID 10864550}}</ref>
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| ==Risk Factors==
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| Pregnancies involving more than one fetus are at increased risk of miscarriage.<ref name="PDR Family Guide 1994" />
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| Uncontrolled diabetes greatly increases the risk of miscarriage. Women with controlled diabetes are not at higher risk of miscarriage. Because diabetes may develop during pregnancy ([[gestational diabetes]]), an important part of [[prenatal care]] is to monitor for signs of the disease.<ref name="PDR Family Guide 1994" />
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| [[PCOS|Polycystic ovary syndrome]] is a risk factor for miscarriage, with 30-50% of pregnancies in women with PCOS being miscarried in the first trimester. Two studies have shown treatment with the drug [[metformin]] to significantly lower the rate of miscarriage in women with PCOS (the metformin-treated groups experienced approximately one-third the miscarriage rates of the control groups).<ref>{{cite journal |author=Jakubowicz DJ, Iuorno MJ, Jakubowicz S, Roberts KA, Nestler JE |title=Effects of metformin on early pregnancy loss in the polycystic ovary syndrome |journal=J. Clin. Endocrinol. Metab. |volume=87 |issue=2 |pages=524-9 |year=2002 |pmid=11836280 |url=http://jcem.endojournals.org/cgi/content/full/87/2/524 |accessdate=2007-07-17}}<br>
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| {{cite journal |author=Khattab S, Mohsen IA, Foutouh IA, Ramadan A, Moaz M, Al-Inany H |title=Metformin reduces abortion in pregnant women with polycystic ovary syndrome |journal=Gynecol. Endocrinol. |volume=22 |issue=12 |pages=680-4 |year=2006 |pmid=17162710 |doi=10.1080/09513590601010508}}</ref> However, a 2006 review of metformin treatment in pregnancy found insufficient evidence of safety and did not recommend routine treatment with the drug.<ref>{{cite journal |author=Lilja AE, Mathiesen ER |title=Polycystic ovary syndrome and metformin in pregnancy |journal=Acta obstetricia et gynecologica Scandinavica |volume=85 |issue=7 |pages=861-8 |year=2006 |pmid=16817087 |doi=10.1080/00016340600780441}}</ref>
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| [[Hypertension|High blood pressure]] and certain illnesses (such as [[rubella]] and [[chlamydia]]) increase the risk of miscarriage.<ref name="PDR Family Guide 1994" />
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| Tobacco (cigarette) smokers have an increased risk of miscarriage.<!--
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| --><ref name="x">{{cite journal | author=Ness R, Grisso J, Hirschinger N, Markovic N, Shaw L, Day N, Kline J | title=Cocaine and tobacco use and the risk of spontaneous abortion. | journal=N Engl J Med | volume=340 | issue=5 | pages=333-9 | year=1999 | id=PMID 9929522}}</ref> An increase in miscarriage is also associated with the father being a cigarette smoker.<!--
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| --><ref name="paternal smoking" /> The husband study observed a 4% increased risk for husbands who smoke less than 20 cigarettes/day, and an 81% increased risk for husbands who smoke 20 or more cigarettes/day.
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| Severe cases of [[hypothyroidism]] increase the risk of miscarriage. The effect of milder cases of hypothyroidism on miscarriage rates has not been established. Certain immune conditions such as [[Autoimmunity|autoimmune disease]]s greatly increase the risk of miscarriage.<ref name="PDR Family Guide 1994" />
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| Cocaine use increases miscarriage rates.<ref name="x" />
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| Physical trauma, exposure to environmental toxins <ref name=health.am>{{cite web | title =Miscarriage: An Overview | publisher=Armenian Medical Network | url=http://www.health.am/pregnancy/more/miscarriage_an_overview/ | year = 2005 | accessdate=2007-09-19}}</ref>, [[obesity]], high [[caffeine]] intake (> 300 mg/day), high levels of [[alcohol]] consumption, high fever (100°F or higher) , use of an [[IUD]] during the time of conception <ref name=health.am /> and use of [[Non-steroidal anti-inflammatory drug|NSAID]]s have also been linked to increased risk of miscarriage.
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| ==Diagnosis== | | ==Diagnosis== |
| | | [[Miscarriage history and symptoms|History and Symptoms]] | [[Miscarriage physical examination|Physical Examination]] | [[Miscarriage laboratory findings|Laboratory Findings]] | [[Miscarriage ultrasound|Ultrasound]] | [[Miscarriage other imaging findings|Other Imaging Findings]] | [[Miscarriage other diagnostic studies|Other Diagnostic Studies]] |
| ===History and Symptoms===
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| The most common symptom of a miscarriage is bleeding;<!--
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| --><ref name="risk factors">{{cite journal | author = Gracia C, Sammel M, Chittams J, Hummel A, Shaunik A, Barnhart K | title = Risk factors for spontaneous abortion in early symptomatic first-trimester pregnancies | journal = Obstet Gynecol | volume = 106 | issue = 5 Pt 1 | pages = 993-9 | year = 2005 | id = PMID 16260517}}</ref> bleeding during pregnancy may be referred to as a ''threatened abortion''. Of women who seek clinical treatment for bleeding during pregnancy, about half will go on to have a miscarriage.<ref name="bmj1997" /> Symptoms other than bleeding are not statistically related to miscarriage.<ref name="risk factors" />
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| ===Laboratory Findings===
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| *Serial [[human chorionic gonadotropin]] (HCG) testing. Women pregnant from [[assisted reproductive technology|ART]] methods, and women with a history of miscarriage, may be monitored closely and so detect a miscarriage sooner than women without such monitoring.
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| ===Ultrasound===
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| Miscarriage may also be detected during an ultrasound exam. Several medical options exist for managing documented nonviable pregnancies that have not been expelled naturally.
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| ==Treatment== | | ==Treatment== |
| ===Medical Therapy===
| | [[Miscarriage medical therapy|Medical Therapy]] | [[Miscarriage surgery|Surgery]] | [[Miscarriage primary prevention|Primary Prevention]] | [[Miscarriage secondary prevention|Secondary Prevention]] | [[Miscarriage cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Miscarriage future or investigational therapies|Future or Investigational Therapies]] |
| Blood loss during early pregnancy is the most common symptom of both miscarriage and of [[ectopic pregnancy]]. Pain does not strongly correlate with miscarriage, but is a common symptom of ectopic pregnancy.<ref name="risk factors" /> In the case of concerning blood loss, pain, or both, [[Obstetric ultrasonography|transvaginal ultrasound]] is performed. If a viable intrauterine pregnancy is not found with ultrasound, serial [[human chorionic gonadotropin|βHCG]] tests should be performed to rule out ectopic pregnancy, which is a life-threatening situation.<ref name="diagnostic">{{cite journal | author = Yip S, Sahota D, Cheung L, Lam P, Haines C, Chung T | title = Accuracy of clinical diagnostic methods of threatened abortion | journal = Gynecol Obstet Invest | volume = 56 | issue = 1 | pages = 38-42 | year = 2003 | id = PMID 12876423}}</ref><ref name="followHCG">{{cite journal | author = Condous G, Okaro E, Khalid A, Bourne T | title = Do we need to follow up complete miscarriages with serum human chorionic gonadotrophin levels? | journal = BJOG | volume = 112 | issue = 6 | pages = 827-9 | year = 2005 | id = PMID 15924545}}</ref>
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| If the bleeding is light, making an appointment to see one's doctor is recommended. If bleeding is heavy, there is considerable pain, or there is a fever, then emergency medical attention should be sought.
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| No treatment is necessary for a diagnosis of complete abortion (as long as ectopic pregnancy is ruled out). In cases of an incomplete abortion, empty sac, or missed abortion there are three treatment options:
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| *With no treatment ([[watchful waiting]]), most of these cases (65-80%) will pass naturally within two to six weeks.<ref name="afp">{{cite journal | author = Kripke C | title = Expectant management vs. surgical treatment for miscarriage | journal = Am Fam Physician | volume = 74 | issue = 7 | pages = 1125-6 | year = 2006 | id = PMID 17039747 | url= http://www.aafp.org/afp/20061001/cochrane.html#c2 | accessdate = 2006-12-31 }}</ref> This path avoids the side effects and complications possible from medications and surgery.<ref>{{cite journal | author = Tang O, Ho P | title = The use of misoprostol for early pregnancy failure. | journal = Curr Opin Obstet Gynecol | volume = 18 | issue = 6 | pages = 581-6 | year = 2006 | id = PMID 17099326}}</ref>
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| *Medical management usually consists of using [[misoprostol]] (a [[prostaglandin]], brand name Cytotec) to encourage completion of the miscarriage. About 95% of cases treated with misoprostol will complete within a few days.<ref name="afp" />
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| ===Surgery===
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| Surgical treatment (most commonly [[vacuum aspiration]], sometimes referred to as a D&C or D&E) is the fastest way to complete the miscarriage. It also shortens the duration and heaviness of bleeding, and is the best treatment for physical pain associated with the miscarriage.<ref name="afp" /> In cases of repeated miscarriage or later-term pregnancy loss, D&C is also the best way to obtain tissue samples for [[#Pathology|pathology examination]].
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| ===Psychological Aspects===
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| Although a woman physically recovers from a miscarriage quickly, psychological recovery for parents in general can take a long time. People differ a lot in this regard: some are 'over it' after a few months, others take more than a year. Still others may feel relief or other less negative emotions.
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| For those who do go through a process of [[grief]], it is often as if the baby had been born but died. How short a time the fetus lived in the womb may not matter for the feeling of loss. From the moment pregnancy is discovered, the parents can start to bond with the unborn child. When the child turns out not to be viable, dreams, fantasies and plans for the future are disturbed roughly.
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| Besides the feeling of loss, a lack of understanding by others is often important. People who have not experienced a miscarriage themselves may find it hard to [[empathy|empathize]] with what has occurred and how upsetting it may be. This may lead to unrealistic expectations of the parents' recovery. The pregnancy and miscarriage are hardly mentioned anymore in conversation, often too because the subject is too painful. This can make the woman feel particularly isolated.
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| Interaction with pregnant women and newborn children is often also painful for parents who have experienced miscarriage. Sometimes this makes interaction with friends, acquaintances and family very difficult.<ref name="David Vernon">{{cite web |author=David Vernon| date = 2005 | url=http://web.mac.com/david.vernon/iWeb/Having%20a%20Great%20Birth%20in%20Australia/Welcome%20-%20Great%20Birth.html | title =Having a Great Birth in Australia | }}</ref>
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| ==Related Chapters== | | ==Case Studies== |
| * [[Childbirth]]
| | [[Miscarriage case study one|Case #1]] |
| * [[Stillbirth]]
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| * [[Sudden antenatal death syndrome]]
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| * [[Premature birth]]
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| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |
| | {{WH}} |
| | {{WikiDoc Sources}} |
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| [[Category:Abortion]] | | [[Category:Abortion]] |
| [[Category:primary care]]
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| [[Category:Obstetrics]] | | [[Category:Obstetrics]] |
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| [[Category:Disease]] | | [[Category:Disease]] |
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| [[cs:Potrat]]
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| [[da:Spontan abort]]
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| [[de:Fehlgeburt]]
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| [[es:Aborto espontáneo]]
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| [[fr:Fausse couche]]
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| [[hi:गर्भस्राव]]
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| [[it:Aborto#Aborto_spontaneo]]
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| [[he:הפלה טבעית]]
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| [[lt:Persileidimas]]
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| [[nl:Miskraam]]
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| [[ja:流産]]
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| [[pl:Poronienie]]
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| [[pt:Aborto espontâneo]]
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| [[sq:Aborti]]
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| [[fi:Keskenmeno]]
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| [[sv:Missfall]]
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| [[tr:Düşük]]
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| [[vi:Hư thai]]
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| [[zh:流产]]
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| {{WH}}
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| {{WikiDoc Sources}}
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