If your placenta—the structure that's attached to the wall of the uterus and gives nutrients to your baby via the umbilical cord—suddenly peels off the wall of the uterus before you're ready to give birth, this can prevent your developing baby from getting necessary nutrients and oxygen. Symptoms of placental abruption include vaginal bleeding, abdominal pain, uterine contractions, cramping, and back pain during the last 12 weeks of pregnancy.
Cervical insufficiency , also known as an incompetent cervix, means your cervix is weak and begins dilating and opening too soon. Some women experience cervical insufficiency after having a challenging birth or after having a cervical procedure such as loop electrosurgical excision procedure LEEP , laser ablation, or cold knife conization.
Others develop the condition due to congenital uterine malformations. Symptoms of cervical insufficiency include backache, vaginal bleeding, abdominal cramps, pelvic pressure, and vaginal discharge, usually between 14 and 20 weeks of pregnancy. Some are completely asymptomatic. Uterine infection is another possible cause of miscarriage, although it is a more common cause in developing countries than in the United States. Chronic diseases in the mother can also increase the risk for pregnancy loss.
Other chronic conditions carry an inherent risk of pregnancy loss depending on their severity. Examples include:. The risk can be further increased in women who smoke , are obese , or have hormone problems. Thrombophilia is an increased risk of forming blood clots in blood vessels like veins and arteries that may be due to a genetic abnormality or a problem with your immune system, such as in lupus.
This can cause problems involving your placenta and your umbilical cord. Symptoms of thrombophilia include pain, swelling, and tenderness in your leg, usually in your calf, as well as red or warm skin particularly at the back of your leg below the knee. Any trauma such as an automobile accident, fall, or being hit in the abdomen can hurt both you and your developing baby and potentially cause a miscarriage. In a car, always wear a seat belt, placing the lap belt under the uterus and putting the shoulder strap between your breasts.
Avoid high-impact physical activities that might cause you to lose your balance. Try not to let your kids roughhouse with you, if you can avoid it. Cocaine and methamphetamine are especially linked to miscarriage. Studies have shown that the use of illegal drugs has been associated with low birth weight, premature labor, placental abruption, and fetal death. Alcohol has also been cited as a cause of pregnancy loss during not only the first trimester but the second trimester as well.
Sometimes a pregnancy loss occurs for no apparent reason and, no matter how much a doctor investigates, no cause can be found. In some cases, however, these symptoms may be a sign of a…. A stroke occurs when blood flow is blocked to a part of the brain. Brain cells become deprived of oxygen and begin to die.
As brain cells die, people…. A new study finds that epidurals do not affect child development in their later years. A fetal arrhythmia is an irregular heart rate — too fast, too slow, or otherwise outside the norm.
It's often benign. Postpartum diarrhea after a C-section is normal. Health Conditions Discover Plan Connect. Medically reviewed by Debra Rose Wilson, Ph. Miscarriages in the second trimester before 20 weeks may be caused by several different factors, which can include: Uterine septum.
A wall, or septum, inside the uterus divides it into two separate parts. Incompetent cervix. When the cervix opens too soon, causing early birth. Autoimmune diseases. Examples include lupus or scleroderma. These diseases can occur when your immune system attacks healthy cells.
Chromosomal abnormalities of the fetus. Other causes of bleeding in the second trimester include: early labor problems with the placenta, such as placenta previa placenta covering the cervix placental abruption placenta separating from the uterus These problems are more common in the third trimester, but they can also occur late in the second trimester. Preterm labor. Various conditions may cause preterm labor, such as: bladder infection smoking chronic health condition, like diabetes or kidney disease Risk factors for preterm labor include: a previous preterm birth twin pregnancies multiple pregnancies extra amniotic fluid the fluid surrounding the fetus infection of the amniotic fluid or amniotic membranes Symptoms The signs and symptoms of preterm labor may be subtle.
They can include: vaginal pressure low back pain frequent urination diarrhea increased vaginal discharge tightness in the lower abdomen In other cases, the symptoms of preterm labor are more obvious, such as: painful contractions leakage of fluid from the vagina vaginal bleeding Call your doctor if you have these symptoms and are worried about being in labor. It can often include: hospitalization antibiotics steroids, such as betamethasone medications that can stop labor, such as terbutaline If there are signs of an infection, labor may be induced to avoid serious complications.
Cervical insufficiency or incompetence is classically associated with second trimester loss after painless cervical dilation i. Typically the membranes balloon into the vagina; this is followed by rupture of membranes, contractions, and expulsion of a premature fetus.
There is usually a history of second or third trimester loss. Patients should be questioned about cervical trauma during previous vaginal deliveries and any history of cone biopsy. The diagnosis suggested by history and physical examination can be confirmed with hysterography or transvaginal ultrasonography.
A meta-analysis of 31 studies on the effect of thrombophilic disorders in pregnancy loss showed that a nonrecurrent pregnancy loss after 20 to 24 weeks' gestation is associated with factor V Leiden, protein S deficiency, and the prothrombin GA mutation.
These antibodies cause placental thrombosis and have emerged as well-established risks for second and third trimester pregnancy loss. In patients who have had a pregnancy loss before 20 weeks, there is insufficient evidence to recommend for or against such a work-up after the loss. Management of thrombophilic conditions and antiphospholipid antibodies is done after a pregnancy loss and is typically beyond the scope of most family physicians; however, combination therapy with heparin and aspirin may reduce rates of pregnancy loss by 54 percent in women with antiphospholipid antibody syndrome who have had a previous loss.
Infection has been implicated in 10 to 25 percent of second trimester pregnancy losses. Infection is more closely linked to pregnancy loss in developing countries. Nevertheless, rubella and influenza vaccination is prudent in all pregnant women, and treating bacterial vaginosis may prevent premature labor in women with a history of preterm birth. After a second trimester loss, all patients warrant a thorough history and physical examination to look for factors that might predispose them to another loss.
Ideally, this work-up should be done during preconception counseling. The history should include symptoms and signs of pregnancy loss, chronic maternal medical conditions that may contribute to pregnancy loss, family history that suggests genetic problems, medication use as an indication of underlying illness, environmental exposures, substance abuse, trauma, and obstetric history.
A detailed review of the pregnancy should be performed, including vital signs, weight gain, dating parameters, ultrasonography, and laboratory tests. If the loss is a stillbirth, pathologic examination of the fetus and placenta is advocated; chromosomal analysis should also be performed, if possible. Particularly, asymptomatic patients should not be treated for bacterial vaginosis. Detailed work-up and management of many of the maternal factors associated with second trimester pregnancy loss often require referral to an obstetrician or perinatologist; however, the family physician can still play an important role.
If a maternal medical illness appears to have contributed to the pregnancy loss, the family physician should optimize management of the patient's diabetes, thyroid disease, or hypertension. Nutritional education and folic acid supplementation can improve maternal illness and help prevent neural tube defects.
Smoking, alcohol consumption, and substance abuse have been implicated in poor fetal outcomes; therefore, patients should be offered counseling and treatment, even if the roles of these activities in the pregnancy loss are not well established. Although trauma is an uncommon cause of pregnancy loss, advocacy for the prevention of physical abuse can be initiated and coordinated by the family physician. Patients who have had an unexplained pregnancy loss should be offered genetic counseling with an option for karyotype analysis, even though these interventions have few measurable outcomes.
The family physician is in an ideal position to address psychological factors in women who have had a second trimester pregnancy loss. After an early pregnancy loss, women experience the same emotional and psychological reactions as those who have experienced any type of death; however, the duration of the distress is typically shorter. Patients initially go through recognizable emotions, including shock, searching, and yearning.
Often, the patient will have intense preoccupation with seeing or hearing the infant, and there may be a period of disorganization, with features similar to those of depression, before she gradually adjusts and is able to move on. Many patients must also cope with their emotional responses during a subsequent pregnancy.
Women who have had a pregnancy loss often have a strong impetus to become pregnant again. During the next pregnancy, these patients may have intense anxiety and ambivalence, with little emotional attachment.
They may also be overprotective of the child after birth. Support groups for parents who have had a pregnancy loss can be invaluable. There are many Internet resources available.
However, there is no evidence from randomized trials to indicate any benefit from providing specific psychological support or counseling after a pregnancy loss. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Address correspondence to Thomas C. Reprints are not available from the authors. The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.
Army Medical Department or the U. Army Service at large. Public Health Rep. Flint S, Gibb DM. Recurrent second trimester miscarriage. Curr Opin Obstet Gynecol. Perinatal and infant mortality statistics. Int J Gynaecol Obstet. A: It will be important to meet with a genetic counselor, if possible, before your next pregnancy, who can also review the details of the available tests.
The counselor can also talk with you more about your history and your family history to make sure no genetic or familial medical problems are missed. There are a few different tests, all of which can be performed early in pregnancy, depending on what is right for you.
Screening for some of the most common chromosomal abnormalities just from your blood called NIPT or non-invasive prenatal testing. First trimester screening can be performed between 11 and 14 weeks which involves a blood test and an ultrasound examination. In some situations, chorionic villus sampling a biopsy of the placenta or expanded prenatal screening may be indicated.
Our specialists and genetic counselors can work with you and your family to help you understand all of these tests and figure out what approach is right for you. Q: After a second trimester loss, how long should I wait before I try to conceive again? A: There is really no good information available to show the absolute right answer to that question. First, it may take a month or two to have any testing completed to help figure out why you had a second trimester loss.
We know that it takes some time for your uterus and your body to get back to normal. The specialists at UC Davis usually recommend waiting at least 3 months after a second trimester loss before trying again to get pregnant. Toggle navigation. Understanding Second Trimester Miscarriage. Why see a UC Davis Health specialist? Symptoms of a second trimester loss Bleeding: Most commonly, bleeding is a sign of a problem with the placenta and does not indicate a fetal demise.
But, bleeding can be a sign that the cervix is opening without labor called cervical insufficiency. With cervical insufficiency, the cervix begins to open early without contractions; as the cervix opens more, contractions then follow.
Cramping: Pregnancy losses in the second trimester can be due to early labor. Loss of fetal movement: This can indicate a fetal demise. Most women can feel the baby moving by the 20th week. Decreased fetal movement is more commonly a sign that there is a problem with the pregnancy and only rarely does it mean the fetus has died. What causes a second trimester loss? Treatment of a second trimester loss It is typically not safe for a woman to wait for the pregnancy to deliver on its own with a second trimester loss.
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