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Abdominal cramps
Vaginal spotting or bleeding
A period that is heavier than usual.
If you're experiencing any of these signs or symptoms, you may be having a
miscarriage. But not all bleeding in the first trimester ends in miscarriage. So be sure
to see your doctor right away if you have any of these signs.
June 5, 2003 -- Stress has long been suspected as a possible cause of miscarriage,
with several studies indicating an increased risk among women reporting high levels
of emotional or physical turmoil in their early months of pregnancy or just
before conception. But while a relationship has been noted, researchers didn't know
exactly how a woman's stress could cause miscarriage.
In what may prove to be a breakthrough finding, a team of scientists from Tufts
University and Greece have identified a suspected chain reaction detailing exactly
how stress hormones and other chemicals wreak havoc on the uterus and fetus.
Their report, in the June issue of Endocrinology, may help explain why women
miscarry for no obvious medical reasons and why some women have
repeated miscarriages. And it could lead to measures to prevent miscarriage -medically known as "spontaneous abortion."
Researchers have long known that during times of stress, the brain releases several
hormones -- including one called corticotropin-releasing hormone (CRH). In past
research, women who deliver prematurely or have low-birth-weight babies were
often found to have high levels of CRH in their bloodstream, and other studies show
a greater risk of miscarriage in women reporting stress. CRH is a hormone
the brain secretes in reaction to physical or emotional stress, and it is also produced
in the placenta and the uterus of a pregnant woman to trigger
uterine contractions during delivery.
But this new research suggests that CRH and other stress hormones may also be
released elsewhere in the body, where it specifically targets localized mast cells -those best known for causing allergic reactions. Mast cells are abundant in the
uterus. During stress, the local release of CRH causes these mast cells to secrete
substances that can cause miscarriages.
In their study of 23 women, the scientists found that those who had previous multiple
miscarriages had significantly high levels of CRH and another hormone, urocortin, in
the tissues of their fetuses when compared with women who miscarried once or
those who had had abortions.
The lead researcher tells WebMD what's especially intriguing is that high amounts of
these stress hormones were found only in uterine mast cells -- and not in the
women's bloodstream, adding credence to his theory that CRH may be released
locally.
And Theohardies says he is hopeful that with his new research, women at risk of
miscarriage may be able to take preventative measures, especially when under
stress during pregnancy. "We know how to block the action of CRH on mast cells, so
perhaps we could give women at risk a vaginal suppository with drugs that block
CRH receptors."
But more immediately, he says his finding offers more proof of the hazards of
emotional stress on pregnancy. "We now know the effects of stress (on the fetus) are
very real and produce a specific physiologic reaction in the uterus," he tells WebMD.
"So you really need to reduce it whatever way you can."
Anembryonic pregnancy
Dr Henry Knipe and A.Prof Frank Gaillard et al.
Anembryonic pregnancy is a form of a failed early pregnancy, where a gestational sac develops, but
the embryo does not form. The term blighted ovum is synonymous with this, but is falling out of
favour and is best avoided.
Clinical presentation
The patient may be asymptomatic, presenting for an early pregnancy ultrasound. Alternatively, she
may present with vaginal bleeding in early pregnancy. Due to falling hCG levels, the clinical signs of
pregnancy tend to subside.
Pathology
In anembryonic pregnancy, a blastocyst is formed from a fertilised ovum but the fetal
pole/embryo never develops, though histologically some fetal material can be demonstrated in most
cases.
Human chorionic gonadotropin (beta-hCG) is formed due to invasion of endometrium by the
syncytiotrophoblast, and as a result there is a positive pregnancy test and clinical signs of pregnancy
are present.
Radiographic features
Ultrasound
An anembryonic pregnancy may be diagnosed when there is no fetal pole identified on endovaginal
scanning 4, and:
the size of the gestational sac is such that a fetal pole should be seen: MSD 25 mm on TVS
(by RCOG criteria)
Or
Other ancillary features have been described, and may be considered poor prognostic factors, but do
not contribute to the formal diagnosis of a failed pregnancy. These include:
Differential diagnosis
Conditions that cause an empty gestational sac include:
pseudogestational sac
References