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Medical Disability Advisor  >  Miscarriage

Miscarriage

Related Terms

  • Spontaneous Abortion

Specialists

  • Emergency Medicine Physician
  • Family Practice Physician
  • Gynecologist
  • Obstetrician / Gynecologist

Comorbid Conditions

  • Blood disorders
  • Pre-existing psychological problems (depression)

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Factors Influencing Duration

Abortions that are incomplete or missed or those resulting in infection or hemorrhage will require a longer period of disability than will an uncomplicated abortion. Severe depression or grief reaction due to pregnancy loss may increase the length of disability.

Duration Trends from Reference Data

DURATION TRENDS
 ICD-9-CM: 634, 634.9  
CasesMeanMinMaxNo Lost TimeOver 6 Months
2057200960.1%0%
 
  
 
Percentile:5th25thMedian75th95th
Days:510162748
 
  
 

Differences may exist between the duration tables and the reference graphs. Duration tables provide expected recovery periods based on the type of work performed by the individual. The reference graphs reflect the actual experience of many individuals across the spectrum of physical conditions, in a variety of industries, and with varying levels of case management. Selected graphs combine multiple codes based on similar means and medians.

Medical Codes

ICD-9-CM:
634 - Spontaneous Abortion, Includes Miscarriage
634.1 - Spontaneous Abortion, Complicated by Delayed or Excessive Hemorrhage
634.10 - Spontaneous Abortion, Complicated by Delayed or Excessive Hemorrhage, Unspecified
634.11 - Spontaneous Abortion, Complicated by Delayed or Excessive Hemorrhage, Incomplete
634.12 - Spontaneous Abortion, Complicated by Delayed or Excessive Hemorrhage, Complete
634.7 - Spontaneous Abortion with Other Specified Complications
634.70 - Spontaneous Abortion with Other Specified Complications, Unspecified
634.71 - Spontaneous Abortion with Other Specified Complications, Incomplete
634.72 - Spontaneous Abortion with Other Specified Complications, Complete
634.8 - Spontaneous Abortion with Unspecified Complication
634.80 - Spontaneous Abortion with Unspecified Complication, Unspecified
634.81 - Spontaneous Abortion with Unspecified Complication, Incomplete
634.82 - Spontaneous Abortion with Unspecified Complication, Complete
634.9 - Spontaneous Abortion without Mention of Complication
634.90 - Spontaneous Abortion without Mention of Complication, Unspecified
634.91 - Spontaneous Abortion without Mention of Complication, Incomplete
634.92 - Spontaneous Abortion without Mention of Complication, Complete

Definition

A miscarriage, or spontaneous abortion, is a pregnancy loss that occurs prior to 20 weeks. Most miscarriages occur in the first 12 weeks of pregnancy (first trimester). A miscarriage is a naturally occurring and involuntary event in which the fetus and placenta are separated from the uterine wall. It should not be confused with an elective or induced abortion, which is a planned surgical procedure.

There are three types of miscarriages or spontaneous abortions. A complete abortion occurs when all the contents of the uterus are expelled through the vagina. An incomplete abortion occurs when some of the fetus or placenta remains in the uterus, and a missed abortion occurs when the fetus has died but remains in the uterus.

Three or more miscarriages in a row may be called "habitual abortion." This condition occurs rarely. Often, the reason for habitual abortion is unknown. It is possible for each miscarriage to have a different cause.

The most common cause of a spontaneous abortion is a fetus that is genetically abnormal. Women with uterine abnormalities, uterine tumors, weakened (incompetent) cervixes, over- or undersecretion of certain hormones, low levels of progesterone, immunity problems, acute and chronic infections, kidney problems, diabetes, and thyroid problems have a greater risk of miscarriage.

Risk: Drug or alcohol abuse, exposure to environmental or industrial toxins, smoking, malnutrition, and the use of nonsteroidal anti-inflammatory drugs have all been found to increase the risk of miscarriage.

Additionally, as women age, their risk of miscarriage increases.

Incidence and Prevalence: Approximately 10% to 15% of all known pregnancies end in spontaneous abortion (Lex). Percentages are approximate since a miscarriage may occur before the woman realizes she is pregnant.

Source: Medical Disability Advisor



History

History: Women may report vaginal bleeding, cramping, and the passing of large clots or tissue. There may also be a gush of fluid from the rupture of the amniotic sac. Additionally, there may no longer be signs of pregnancy such as breast tenderness or nausea. It is important to keep in mind that the woman may not know that she is pregnant.

Physical exam: A miscarriage is confirmed if the pelvic exam reveals tissue protruding through an open cervix or if the cervix is found to be dilated and open, indicating imminent expulsion of tissue. A missed abortion can be suspected from the disappearance of pregnancy symptoms. The most common sign of a missed abortion is a uterus that is smaller than expected.

Tests: A pregnancy test should be done. Blood tests that measure quantitative levels of human chorionic gonadotropin (hCG) may be done and then repeated in several days to see if the level is increasing or decreasing. If the passed tissue is recovered, laboratory analysis can determine if it is of fetal origin. A complete blood count (CBC) will be done if the degree of blood loss needs to be determined. A white blood count (WBC) with differential can be used to rule out potential infection. In some instances, an ultrasound can also be used to confirm fetal death.

If there is "habitual abortion" (3 or more miscarriages in a row), evaluation may include genetic studies, tests to rule out chronic infections or hormonal dysfunction, and x-ray imaging of the uterus and fallopian tubes (hysterosalpingography).

Source: Medical Disability Advisor



Treatment

With an uncomplicated, complete abortion, in which all fetal tissue is passed out of the uterus, no unusual medical treatment is required. Follow-up care is necessary to check for infection or excessive blood loss.

An incomplete or missed abortion, in which some of the fetal tissue remains in the uterus, may require removal by D&C (dilation and curettage or suction curettage). If this is not done, the tissue remaining inside the uterus can cause an infection or delayed bleeding. The D&C may be done under general anesthesia at the outpatient department of a hospital or clinic. Women who develop infection require treatment with antibiotics. Severe bleeding may require a blood transfusion and hospitalization. Women who have habitual abortions need special tests to determine the reason and should see a specialist familiar with the care of such cases.

Rh-negative women are given Rh(D) immune globulin to prevent future Rh complications. Psychological treatment such as counseling or psychotherapy may be indicated for help in coping with the loss of the pregnancy. Some women may also benefit from attending support groups with other women who have experienced a miscarriage.

Source: Medical Disability Advisor



Prognosis

Complete physical recovery is expected. The majority of women who miscarry can eventually carry a baby to full term.

Source: Medical Disability Advisor



Complications

Complications may include infection, severe bleeding, or complications from a D&C and/or blood transfusion. Anemia may occur due to severe blood loss or hemorrhage. Psychological depression may slow overall physical recovery.

Source: Medical Disability Advisor



Return to Work (Restrictions / Accommodations)

At first, work responsibilities may need to be largely sedentary, and long periods of standing may need to be avoided. Until healing is complete, heavy work, especially involving heavy lifting, may be restricted.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Has the woman had a complete, incomplete, or missed spontaneous abortion or miscarriage?
  • Has the woman had previous miscarriages? What is her age?
  • Does the woman have risk factors such as acute and chronic infections, certain symptomless infections of the genital tract, or the necessity of abdominal surgery during pregnancy?
  • Does the woman have diabetes, thyroid problems, cardiac or renal disease, or malnutrition? Does she smoke?
  • Does the woman report vaginal bleeding, cramping, or passing large clots or tissue?
  • Did the woman report a gush of fluid?
  • Does the woman complain of a foul-smelling or cloudy vaginal discharge?
  • On pelvic exam, did the physician find tissue protruding through an open cervix or an open and dilated cervix?
  • Has the woman had a blood or urine pregnancy test?
  • Was laboratory analysis of any passed tissue done?
  • Did the woman have a CBC with WBC differential?
  • Was it necessary for the woman to have an ultrasound?
  • Were genetic studies, tests to rule out chronic infections or hormonal dysfunction, or hysterosalpingography indicated?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Did the woman have an uncomplicated complete miscarriage? Did she follow-up with her physician as scheduled?
  • Did the woman require hospitalization or a blood transfusion? Antibiotics?
  • Did the woman have an incomplete or missed miscarriage?
  • Was it necessary for the woman to have a D&C?
  • Was it necessary to induce labor?
  • Is the woman Rh negative? Was she given Rh(D) immune globulin?
  • If necessary, did the woman seek psychiatric counseling? Attend a support group?

Regarding prognosis:

  • Is the woman's employer able to accommodate any necessary restrictions?
  • Does the woman have any conditions that may affect her ability to recover?
  • Does the woman have any complications such as infection, severe bleeding, or complications from a D&C and/or blood transfusion? Does she have anemia? Does she experience depression?

Source: Medical Disability Advisor



Cited References

Lex, Joseph R., Verena Valley, and Chester D. Shermer. "Miscarriage." eMedicine Consumer Health. Eds. Richard Harrigan, Francisco Talavera, and Lee P. Shulman. 7 Sep. 2004. Medscape. 22 Nov. 2004 <http://www.emedicinehealth.com/>.

Source: Medical Disability Advisor






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