SECOND TRIMESTER PREGNANCY LOSS
Miscarriage (i.e., pregnancy loss) is the spontaneous loss of a pregnancy before the 20th week. About 10 to 20 percent of known pregnancies end in miscarriage. But the actual number is likely higher because many miscarriages occur so early in pregnancy that a woman doesn’t realize she’s pregnant. In 2007, Mayo Clinic estimated that rates of pregnancy loss decrease as the pregnancy progresses. Generally, about 10 to 20 percent of all recognized pregnancies and 30 to 40 percent of all conceptions end in pregnancy loss. 4–6 Miscarriages that occurs at 13 to 14 weeks’ gestation usually reflects a pregnancy loss that happened one to two weeks earlier.
Causes Pregnancy loss during the second trimester (i.e., 13 to 27 weeks’ gestation) is rare (Bierman, 1962) and often is not distinguished from first trimester pregnancy loss. However, a true second trimester loss should be considered a unique entity, and an appropriate evaluation is indicated. Pregnancy loss is considered a miscarriage when it occurs before 20 weeks’ gestation; after this time it is considered a stillbirth. Nevertheless, there is considerable overlap between these definitions, and definitions vary by state (Gynaecol Obstet, 1996). Second trimester miscarriage should be regarded as an important event in a woman’s obstetric history, but, fetal abnormalities, including chromosomal problems, and maternal anatomic factors, immunologic factors, infection, and thrombophilia should be considered; however, a cause-and-effect relationship may be difficult to establish.
Prevention
• A thorough history and physical examination should include inquiries about previous pregnancy loss. Laboratory tests may also identify treatable etiologies.
• Although there is limited evidence that specific interventions improve outcomes, management of contributing maternal factors (e.g., smoking, substance abuse) is essential.
• Preventive measures, including vaccination and folic acid supplementation, are recommended regardless of risk.
• Management of associated chromosomal factors requires consultation with a genetic counselor or obstetrician.
• The family physician can play an important role in helping the patient and her family cope with the emotional aspects of pregnancy loss.
• A thorough history and physical examination should include inquiries about previous pregnancy loss. Laboratory tests may also identify treatable etiologies.
• Although there is limited evidence that specific interventions improve outcomes, management of contributing maternal factors (e.g., smoking, substance abuse) is essential.
• Preventive measures, including vaccination and folic acid supplementation, are recommended regardless of risk.
• Management of associated chromosomal factors requires consultation with a genetic counselor or obstetrician.
• The family physician can play an important role in helping the patient and her family cope with the emotional aspects of pregnancy loss.