Spontaneous Abortion **1. Definition and Overview:  Spontaneous abortion, also known as a miscarriage, is the loss of a pregnancy before the 20th week of gestation. It is a common occurrence, with estimates suggesting that approximately 10-20% of clinically recognized pregnancies end in miscarriage. It is characterized by the natural cessation of fetal development and pregnancy. **2. Causes and Risk Factors:  Chromosomal Abnormalities: The most common cause of spontaneous abortion is chromosomal abnormalities in the fetus. These genetic anomalies often result from errors during fertilization or early cell division and are usually not related to the parents' genetic material.  Maternal Factors: Several maternal conditions can increase the risk of miscarriage, including:  o Age: Advanced maternal age (over 35) is associated with a higher risk of chromosomal abnormalities and miscarriage. o Chronic Conditions: Health issues such as diabetes, thyroid disorders, and autoimmune diseases (e.g., lupus) can contribute to pregnancy loss. o Lifestyle Factors: Smoking, excessive alcohol consumption, and illicit drug use are associated with a higher risk of miscarriage. o Anatomic Abnormalities: Uterine abnormalities such as septate uterus or fibroids may increase the risk of miscarriage. Environmental Factors: Exposure to certain environmental toxins, such as pesticides or radiation, can also play a role. **3. Clinical Presentation:  Symptoms: Symptoms of spontaneous abortion can vary but often include vaginal bleeding, cramping or abdominal pain, and passage of tissue or clots from the vagina. Symptoms may occur suddenly or gradually.  Types of Miscarriage: o Threatened Abortion: Bleeding occurs, but the cervix remains closed, and the pregnancy may continue. o Incomplete Abortion: Some fetal or placental tissue remains in the uterus, often accompanied by bleeding and cramping. o Complete Abortion: All fetal and placental tissue is expelled from the uterus, and symptoms usually resolve. o Missed Abortion: The fetus has died, but the pregnancy is not expelled, and symptoms may be minimal or absent. o Recurrent Abortion: Three or more consecutive miscarriages occur, warranting further investigation. **4. Diagnosis:  Clinical Evaluation: Diagnosis begins with a detailed medical history and physical examination. The presence of symptoms such as bleeding and cramping helps guide diagnosis.  Ultrasound: Transvaginal ultrasound is commonly used to assess the status of the pregnancy, determine fetal viability, and evaluate for signs of miscarriage.  Blood Tests: Serum hCG levels are measured to monitor pregnancy progression. Declining levels may indicate miscarriage. Additional tests may be conducted to assess maternal health and possible underlying causes. **5. Management:  Expectant Management: In cases of incomplete or threatened abortion, expectant management may be employed, allowing the body to naturally expel the pregnancy tissue.  Medical Management: Medications such as misoprostol may be used to facilitate the expulsion of tissue in cases of incomplete abortion.  Surgical Management: Procedures like dilation and curettage (D&C) or dilation and evacuation (D&E) may be necessary to remove retained tissue and prevent complications. **6. Emotional and Psychological Support:  Support: Experiencing a miscarriage can be emotionally challenging. Providing psychological support and counseling is important for coping with grief and loss. Support groups and professional counseling may be beneficial for individuals and couples. **7. Follow-Up and Future Pregnancies:  Follow-Up: Follow-up care includes monitoring for any complications and ensuring complete recovery. Further evaluation may be necessary for recurrent miscarriages or underlying health conditions.  Future Pregnancies: Most women who experience a miscarriage go on to have successful pregnancies in the future. It is important to address any underlying issues and maintain regular prenatal care in subsequent pregnancies.