Second Trimester Miscarriage

Loss of pregnancy within first twenty weeks, well before the fetus is able to survive outside the womb, is termed as a miscarriage. Miscarriages occur in about 15% of recognized pregnancies. According to the statistics, about 40 percent of all pregnancies may end in miscarriage, because many times, miscarriage occurs before a woman realizes that she is pregnant. Miscarriage after twenty weeks is considered a 'stillbirth'. Second trimester miscarriage is less common when compared with miscarriage in the first trimester.

Miscarriage during Second Trimester

Symptoms

• Vaginal spotting, bleeding and cramps.
• Lower back pain
• Abdominal pain
• Fluid leaking from the vagina
• Passing of tissue or blood clots through the vagina

Causes

• Increased age, especially if more than 35
• Uterine fibroids (noncancerous growths in the uterus)
• Auto immune disease, wherein the body mistakenly considers the fetus a threat and attacks it
• Chromosomal abnormalities
• Physical problems with the uterus or by a weakened cervix that dilates prematurely.
• Excessive smoking, alcohol abuse, drug addiction
• Infections or inflammation of the uterus or fetal membranes leading to premature rupture of membranes and early labor.
• Diabetes, serious infections, hormonal problems, thyroid problems, systemic lupus erythematosus and other autoimmune disorders in mother, are responsible for both early and second trimester miscarriage. Those women who already had two or more miscarriages, are more prone to miscarriage during the second trimester.

Procedure
Second trimester surgical abortion is performed for miscarriage management. The procedure is known as dilation and evacuation (D and E). It is typically performed over a two-day period but doesn't require an overnight stay in the hospital.

The first day visit may take about 2.5 hours while the second visit may take about 4-5 hours. The whole procedure can be performed in one day also, depending on circumstance. The woman will undergo a physical exam and ultrasound. The doctor will give her oral pain killers and antianxiety medications for relaxation. With the help of certain medications and small dilating sticks, called laminaria or dilapan, cervical softening and dilating can be achieved. Laminaria are thin sticks made from a special seaweed material that widen as they absorb moisture from your body. These are placed in the cervix, depending on the term of the pregnancy and the medical history. It takes about 5-10 minutes for laminaria insertion.

Before the actual process of surgical evacuation of uterus, medication will be administered intravenously (IV) in your arm to induce anesthesia or loss of consciousness. The doctor will remove the laminaria. With the help of suction and gynecological instruments he will empty the uterus, with ultrasound guidance. The procedure may take from 15-45 minutes. The patient will be in the recovery room under observation, for about two hours. There might be some cramping and/or spotting. Antibiotics will be given to prevent infection.

Tests and Treatment
If a woman has a miscarriage in the second trimester, the doctor usually recommends the following tests to help determine the exact cause.

• Blood tests to check for chromosome abnormalities in both parents and certain hormonal problems and immune-system disorders in the mother.
• Endometrial biopsy
• Testing for chromosomal abnormalities in tissue from the miscarriage

The treatment depends upon the results of these tests. The underlying cause of the miscarriage is treated accordingly, so as to avoid miscarriage in future. Sufficient rest, medications and healthy diet help avoid excessive bleeding after miscarriage. The woman should consult her doctor before conceiving after a miscarriage.

Most miscarriages occur during the first trimester but uterine or cervical abnormalities, chromosome complications and immune system disorders, mainly account for the second trimester miscarriage. Pregnant women should always follow the instructions of the doctor religiously and take care of themselves, to prevent miscarriages.