Early Pregnancy Loss: Symptoms, Causes, and Treatments

Knowing about pregnancy followed by miscarriage?

Hello Doctor: My period was supposed to arrive on August 1, but it didn't.
From August 1 to August 5, I noticed bright red blood when wiping after using the restroom, which made me think my period was starting.
However, after using a sanitary pad, it remained clean, and I experienced some abdominal pain.
(Since I have been married for less than a year, my periods have been regular, although I have had two instances of a 33-day cycle.) On August 5, I bought a pregnancy test, and the result showed two lines, one dark and one faint.
However, later that afternoon, I experienced heavy bleeding and initially thought it was just a late period, not realizing the timing coincided with the pregnancy test.
From August 5 to August 8, the bleeding was lighter than usual, and I felt something was off but decided to observe further.
On August 9, I began to experience pain in my ovaries and uterus, feeling as if someone was squeezing them hard, which was very uncomfortable.
After resting for a few hours, I felt better, but from August 5 to August 9, I had a sensation of bloating and soreness in my pelvis.
On August 10, I went to a maternal and child hospital for an examination, where an ultrasound showed that my uterus was filled with blood.
However, the doctor did not inform me whether this indicated a miscarriage, only mentioning the presence of a fibroid.
I was later prescribed medication to stop the bleeding.
By August 15, the bleeding had stopped, but during a follow-up visit, the doctor mentioned that there were still some remnants in the endometrium and later diagnosed me with vaginitis, prescribing progesterone, suppositories, and ointment.
I would like to ask the doctor: 1.
Do the above symptoms indicate a miscarriage? (I was quite busy at work last month and under a lot of stress, so I didn't pay much attention to whether I was pregnant, and the faint and dark lines made me a bit suspicious.) 2.
Can I take progesterone and supplements at the same time? 3.
The doctor said that after taking progesterone for a week, my period would come again in a few days.
Would this period be considered a normal menstrual cycle? I am worried about irregular cycles affecting my ability to conceive.
4.
I had a urinary tract infection two weeks before the pregnancy test; could this have influenced a miscarriage?

Xiao Mei, 30~39 year old female. Ask Date: 2017/08/17

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On August 1, my period was supposed to start, but it didn't.
From August 1 to August 5, I noticed bright red blood when wiping after using the restroom, which I thought was the onset of my period.
However, after using a sanitary pad, it remained clean, and I experienced cramping in my lower abdomen.
(Since I have been married for less than a year, my periods have been regular each month, although I have had two instances where my cycle was 33 days long.) On August 5, I purchased a pregnancy test, and the result showed two lines, one dark and one faint.
However, later that afternoon, I experienced heavy bleeding and initially thought it was just a late period, not realizing the timing of the pregnancy test and my period coincided.
From August 5 to August 8, the bleeding was lighter than usual, which made me feel uneasy, but I decided to monitor the situation.
On August 9, I began experiencing severe pain in my ovaries and uterus, feeling as if someone was squeezing them tightly, which was very uncomfortable.
After resting for a few hours, I felt somewhat better, but from August 5 to August 9, I experienced pelvic pressure and soreness.
On August 10, I went to a women's and children's hospital for an examination, where an ultrasound showed my uterus filled with blood.
The doctor did not inform me whether this indicated a miscarriage but mentioned the presence of submucosal fibroids and prescribed medication to stop the bleeding.
By August 15, the bleeding had ceased, but during a follow-up visit, the doctor noted that there were still remnants in the endometrium and later diagnosed me with vaginitis, prescribing progesterone, suppositories, and ointment.
I would like to ask the doctor the following questions: 1.
Do the symptoms described indicate a miscarriage? (I was quite busy at work last month and under a lot of stress, so I didn't pay much attention to the possibility of being pregnant, and the faint line on the test made me somewhat suspicious.) 2.
Can I take progesterone and supplements simultaneously? 3.
The doctor mentioned that after taking progesterone for a week, my period would return in a few days; would this period be considered a normal menstrual cycle? I am concerned about irregular cycles affecting my ability to conceive.
4.
I had a urinary tract infection two weeks before the pregnancy test; could this have contributed to a miscarriage? Answer: Blood tests and a pelvic exam, along with an ultrasound, are necessary.
Please provide the relevant information and consider consulting another physician.

Reply Date: 2017/08/17

More Info

Early pregnancy loss, often referred to as miscarriage, is a common occurrence that can happen for various reasons. Understanding the symptoms, causes, and treatments associated with early pregnancy loss is crucial for any individual who may be experiencing these issues.

Symptoms of Early Pregnancy Loss
The symptoms of early pregnancy loss can vary, but they typically include:
1. Vaginal Bleeding: This can range from light spotting to heavy bleeding. In some cases, women may mistake this for a late period.

2. Abdominal Pain: Many women report cramping or pain in the lower abdomen, which can feel similar to menstrual cramps.

3. Tissue Passing: Some women may pass tissue or clots, which can be a sign of miscarriage.

4. Loss of Pregnancy Symptoms: A sudden decrease in pregnancy symptoms, such as breast tenderness or nausea, can also indicate a loss.

In your case, the presence of bright red blood, abdominal pain, and the ultrasound findings of blood in the uterus suggest that you may be experiencing a miscarriage. However, it is essential to consult with a healthcare provider for a definitive diagnosis.

Causes of Early Pregnancy Loss
There are several potential causes of early pregnancy loss, including:
1. Chromosomal Abnormalities: The most common reason for miscarriage is chromosomal abnormalities in the embryo, which prevent normal development.

2. Hormonal Issues: Hormonal imbalances, such as low progesterone levels, can affect the ability of the uterus to sustain a pregnancy.

3. Uterine Abnormalities: Conditions such as fibroids or an abnormal shape of the uterus can interfere with implantation and growth.

4. Infections: Certain infections can lead to miscarriage, although this is less common.

5. Lifestyle Factors: High levels of stress, smoking, excessive alcohol consumption, and drug use can increase the risk of miscarriage.

In your situation, the stress from work and the urinary tract infection you experienced could potentially contribute to complications, but they are not direct causes of miscarriage.

Treatments and Management
If a miscarriage is suspected or confirmed, the treatment options may include:
1. Expectant Management: Allowing the body to pass the tissue naturally without intervention.

2. Medical Management: Medications such as misoprostol can be prescribed to help expel the tissue.

3. Surgical Management: In cases where the tissue does not pass naturally, a procedure called dilation and curettage (D&C) may be necessary to remove remaining tissue from the uterus.

In your case, the doctor prescribed medications to help manage bleeding and inflammation, which is a standard approach. The use of progesterone (黄体素) can help support the uterine lining, especially if there are concerns about hormonal levels.

Questions Addressed
1. Is this a miscarriage?: Based on your symptoms and ultrasound findings, it is possible that you are experiencing a miscarriage. However, only a healthcare provider can provide a definitive diagnosis.

2. Can I take progesterone and supplements together?: Generally, it is safe to take progesterone and prenatal supplements together, but you should always consult your healthcare provider for personalized advice.

3. Will my next period be normal?: If you experience a withdrawal bleed after stopping progesterone, it may not be a typical menstrual cycle. It can take time for your body to regulate after a miscarriage, but this does not necessarily mean it will be difficult to conceive again.

4. Could a urinary tract infection cause a miscarriage?: While infections can pose risks during pregnancy, a urinary tract infection is not typically a direct cause of miscarriage. However, it is essential to treat any infections promptly to avoid complications.

Conclusion
Early pregnancy loss can be a challenging experience, both physically and emotionally. It is crucial to seek medical advice and support during this time. If you have further concerns or experience any new symptoms, do not hesitate to contact your healthcare provider for guidance and support. Remember, many women go on to have successful pregnancies after experiencing a miscarriage.

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