Talk:Miscarriage

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"In the past, a frequently used euphemism for miscarriage was to say that the mother "lost the baby". This phrase is not as popular in current times, because there is less of a cultural stigma on discussing issues related to reproduction, and because some people feel that it carries the connotation that the expectant mother was, somehow, at fault for the miscarriage."

I don't see evidence of any of those points having any validity. This seems like, rather than inserting useful information, this is more somebody inserting their PC opinion into the article. In each miscarriage that I've known about, the phrase in question is exactly the term that has been used to describe it. The idea of it connoting responsibility on the mother's part never occurred to me until I read this article. I'm erasing the paragraph. Mr. Billion 19:10, 8 Mar 2005 (UTC)

My wife and I have been going through fertility treatment for almost three years now and have experienced three miscarriages. In conversations among friends who've gone through the same experience, as well as at group counseling sessions, the families I've met generally refer to it as a miscarriage, though it's not uncommon to hear that they've "experienced a loss." I've never hear any of them argue one way or another for these terms; I think they just use what's most comfortable to them. I imagine all of us who've gone through this are comfortable with the term "loss" because it's captures the grieving element. But I haven't heard anyone avoid the term because they think it suggests the mother is (or feels) at fault. I think almost all women feel that it "their fault" even though that's usually not the case. Time and time again you hear in counseling "what did I do wrong? Could have I done anything to prevent it?" It's a normal part of the grieving process.... --Acarvin 20:16, 13 December 2005 (UTC)

It is unfortunate this article only perspective is medical. Management of pregnancy loss is not ONLY about removing a dead thing and surrounding tissues. There is always a psychological consequence of a loss and it the physical and psychological consequences of several miscarriages should be explored for the article to become a decent resource. Anthere 23:51, 2 May 2005 (UTC)

Contents

[edit] Ratio of miscarriages seems high

Article says 15 percent - which seems way too high. -St|eve 06:08, 5 August 2005 (UTC)

No this rate is correct. 20% have bleeding in first 20weeks and in all 15% do miscarry. I'll add the BMJ referrence to the article. -David Ruben 21:06, 5 August 2005 (UTC)

this ratio is particularly bad in our specees.authers have far better statistics.our big brain and low genetic diversity is to be blamed,or something like that.--Ruber chiken 18:37, 23 May 2006 (UTC)

I would like to see something on rates of miscarriage in twin pregnancies - I don't know enough about it to do it myself but am pregnant with a (so far) surviving one of an initial twin pregnancy, and came here to see if there was anything on the survival rates if one twin miscarries.

This statement: Up to 78% of all conceptions may fail, in most cases before the woman even knows she is pregnant. references this article: [1] but I cannot find where in the article that statement is supported. Could someone help me out? Lyrl 22:48, 5 June 2006 (UTC)

[edit] The grief section- neutral?

"From the moment a woman becomes pregnant she starts to bond with her unborn child." Um, I don't think this is physically possible. If many women do not know they are pregnant when they have a miscarriage as pointed out earlier in the article (and indeed many never know and chalk it up to a heavy period) then how on earth can they be bonding with the child? I have also added the fact that people do indeed induce miscarriages and may therefore welcome one to the grief section- there are people who really do not want children and do not mourn a miscarriage; it is, after all, the same result as having an abortion, which many women elect to do. --Dandelions 17:53, 28 September 2005 (UTC)

Dandelions - What a horrible thing to say. Miscarriage is NOT abortion! People that have abortions need to use contraception. They ELECT to have an abortion - no woman "elects" to have a miscarriage. I think you would find if you actually spoke to women that have had miscarriages that all of them suffer with grief and would never actually welcome a miscarriage or the feeling it brings. You are also reading the article out of context, it is quite obvious that if the woman doesn't know she is pregnant then there is no bonding, I don't think that is suggested here. There are also a lot of women that monitor their cycle and find out they are pregnant BEFORE their period is actually due, which would put them in the category of feeling like they are having a heavy period when their period is due when they are actually aware that they are miscarrying. You need help with empathy and compassion. I think this is a subject that you need to stay aware from in the future. I truely pity any woman that crosses your path. 203.164.19.57 (talk · contribs).

Will you please avoid personal attacks? You also deleted Dandelion's post - please do not refactor material without consensus, especially if you are attacking exactly that material.

Dandelion is quite right in asserting that a woman can only bond with a child when she knows she's pregnant, and some women (e.g. the ones that have abortus provocatus) do not bond for one reason or the other. JFW | T@lk 15:55, 20 November 2005 (UTC)

I agree with Dandelion. It is limiting to say that a miscarriage (if the pregnancy is known) only induces grief. I have friends who have had miscarriages and were relieved, some were glad, as they did not want the pregnancy. Contraception is not 100% effective. A person who reads this miscarriage entry should not be led to believe that there is something wrong with a person who does not feel grief after a miscarriage. Compassion does not apply to only certain people, personal attacker above. I made minor edits to include more responses as normal. Whole Shebang 02:41, 13 December 2005 (UTC)

Perhaps the article needs to say something to the effect that women (and their partners) who are looking forward to parenthood experience grief. I'm sure there are cases where women who didn't want to be pregnant in the first place don't experience grief, but for women who do want to be pregnant, it's often one of the most traumatic experiences in their lives. That's certainly been the case for me and my wife. I know there are exceptions, of course, but generally speaking, couples who were happy to have been pregnant take the loss with much grief , anger and a sense of helplessnless. --Acarvin 20:20, 13 December 2005 (UTC)

First of all, medically miscarriage is often called 'spontaneous abortion'. So in that sense it is an abortion. Secondly even if the pregnancy was not planned, the woman can feel very bereaved. My friend experienced this. As soon as the couple decide to keep the embryo, they will start bonding and planning their life for the arrival. But I agree, there are women who are relieved if they were not happy about the pregnancy (one ther friend lost her fetus at 20 weeks, but she was relieved as it was an accident). Every case is different. As I have experience of miscarriage myself, I feel people should be made more aware of how common tbis is, and how bereaved, sad and angry a lot of the women feel. Often you don't get any support. Often people (friends, family, colleagues) make comments about 'it being nothing yet anyway' and 'it is better if it end this way then having a handicapt child'. This does not help the woman or couple but just causes more pain.—The preceding unsigned comment was added by Ebosman (talk • contribs) 12:28, 27 July 2006 (UTC)

[edit] Frequency chart

A chart of length of pregnancy and frequency of miscarriages would probably be helpful for many people.

[edit] Experience

I think the information added to this section of this edit is important - the article was missing the basic description of symptoms, investigation and likely treatment. However:

  • Some of this duplicates the more techical discussion on the various types later (not necessarily bad - WP articles often have repeatition with later sections elaborating and giving greater detail than the opening overview sections)
  • There is already a later section of 'Management' which is unecessary splitting of the topic.
  • 'Experience' is a weak term, and not used as standard in other health related articles.
  • This article needs the addition of section headings of 'Symptoms', 'Investigation' and moving the 'Management' section up.
  • However this would make the 'Causes' section seem out of place

- ideas anyone of how to reorder this article both for some logical sequence but also keeping a general overview at the start (I tried a few ways but none seemed satisfactory) ? David Ruben Talk 04:32, 20 January 2006 (UTC)

[edit] Habitual abortion (N96)

The section on Habitual Abortion may be misquoting statistics from the study that it references.

Above posted by User:199.1.42.30 14:48, 16 May 2006

[edit] External links

There seem to be quite a few grief sites in the external link section. I'm concerned that we don't really have a way to evaluate the quality of these sites in order to include only the best ones. And there are entirely too many of them to allow every miscarriage grief site to be included.

I'm wondering if we should just delete all the grief sites and only include informational webpages in the external links section? Lyrl Talk Contribs 19:40, 3 September 2006 (UTC)

Although the quality of the sites may not have been evaluated, as one who has experienced several miscarriages, I found the grief site links very useful. I think that one or two grief sites should be allowed to stay on the list.

—Preceding unsigned comment added by 128.187.164.25 (talk • contribs) 22:28, 4 October 2006
If included support sites are listed merely as examples, then this is not an appropriate use of external links. A website should be included under EL for fair specific reasons: it is mentioned in teh article, it specifically adds information to a level not appropriate directly within wikipedia, it is a major organisation (e.g. UK or US national organisation). But to cherry pick just a select few is unfair on other non-icluded websites and not the purpose of external links - wikipedia is not a directory service (that's what learning to perform a search on Google et al is about). So my twopence of opinion is delete non-notable (i.e. no national recognistion by media, government or the relevant specialist bodies) support sites. David Ruben Talk 22:20, 4 October 2006 (UTC)

[edit] A little ambigious

About 30% of fertilized eggs are actually lost before the woman knows she is pregnant and may only be noticeable by slightly increased blood loss.

Does this include only miscaried or born babies as well ?---- Xil/talk 21:15, 18 December 2006 (UTC)

Of embryos that are created, at least 30% never implant in the uterus. There is no way to detect pregnancy before implantation, so the woman involved would never know she had conceived. (The statement in the quote above about increased blood loss is false and I have removed it from the article.) Lyrl Talk Contribs 02:04, 19 December 2006 (UTC)

[edit] Before implantation - should this article address that?

Some sources consider an embryo that does not implant (and therefore could not have been detected with the normal pregnancy tests) to still be a miscarriage. (Search for the term "before implantation" on the following pages: [2] [3] [4] [5]).

Should rates of fertilization-but-no-implantation be addressed on this page? Lyrl Talk C 14:38, 2 January 2007 (UTC)

[edit] Premature birth

I had originally written the premature birth section to point out why the phrase "premature birth" might be used at a point in gestation that most sources would call it a "miscarriage". Thus the specific (cited!) reference to infants crying after being born at 16 weeks of gestation; even though that falls before the 20-week "cutoff" for not being a miscarriage, I don't think anyone is going to call something that results in a crying baby a "miscarriage".

The section has now been edited to discuss survival rates of premature births, which seems outside the scope of the "miscarriage" article. I gather there was something that struck the editor as not right about my description, but I don't think this was the most appropriate way to fix it.

Any perspectives from other editors on what should be done with that section? Lyrl Talk C 02:49, 17 January 2007 (UTC)

As an obstetrician working in the UK I frequently deal with pregnancy loss. From a medical point of view, premature birth is used to describe babies delivered between 24 and 37 weeks. As for a baby crying at 16 weeks gestation, I find this completely unbelievable. The lungs at that gestation are simply not formed enough to permit breathing or air movement of any kind, lacking the cartilage and surfactant required to keep them patent. For a mid-trimester miscarriage at 16 weeks gestation the lifespan of these unfortunate babies is measured in seconds. There may be signs of life, such as heartbeat and small movements, but certainly not crying. I note the reference is from the presbytarian pro-life movement, I would have to treat anything produced by such a religious, openly biased organisation with extreme dubiaty, particularly with regard to such a sensitive issue as the viability of fetal life. The facts are that regardless of what the fetus does following it's expulsion it is called a miscarriage. If it survives the immediate delivery for several minutes then it would be classed as an early neonatal death. It doesn't matter what people's opinions are and what one person would or wouldn't call a miscarriage. Medico-legally and in terms of definition the appropriate word is miscarriage. 86.1.205.82 (talk) 11:24, 29 March 2008 (UTC)

Very sad that the Obstetrician(and we only have his word for it!) should use this talk page to make an outright religious attack on Christians.Maybe their reference is right.We need more Obstetricians who are willing to be openly identified as such to give us their views.This person goes against the so called neutrality of the Wikipedia.Rosenthalenglish (talk) 13:13, 29 March 2008 (UTC)

Not at all. This editor simply notes that the source used is biased. By noting this does not make the changes non-neutral. Gillyweed (talk) 23:45, 29 March 2008 (UTC)

[edit] Miscarriage can be caused by Thrombophilia

I am trying to raise awareness of the dangers that genetic blood clotting disorders such as Factor V Leiden and Prothrombin 20210A (both of which I have) cause to women and unborn babies.

1 in 40 women have one or more of these disorders and many of them don't know. I know from experience within my family that these disorders cause miscarriage. So many women have lost multiple babies when it could have been prevented.

I have created a small website with the help of my husband which I hope will be a help to women in my situation.

My web address is www.thrombo.co.uk

84.64.101.251 13:02, 26 February 2007 (UTC)

[edit] Term Mother rather than woman

On one occasion I think the term Mother rather than woman is more suitable in the text. Does anyone agree or disagree with the small changed I've made--McNoddy 07:35, 23 May 2007 (UTC)

"Woman" is used five other times in this article. If it is appropriate in those instances, I see no reason why it isn't appropriate in this case. Terminology should be consistent throughout an article in order to enhance readability. Whether "mother" or "woman" is preferable isn't really in dispute here — either are acceptable — but, the precedent seems to be toward defaulting to "woman," and I see no cause for switching, especially only in one case. It's sort of the same thing with B.C./A.D. vs. B.C.E./C.E. and British/Canadian spelling vs. American spelling. Unless there's a completely valid reason to defer to a particular system in an article (as in, the article is about a British actor, book, etc., so we defer to British/Canadian spelling), then, generally, we stick with whatever convention got there first. -Severa (!!!) 08:10, 23 May 2007 (UTC)

The article been worded better improves the text and changing the word from woman to mother in this case is suitable, unlike in the other cases woman pops up in the page.--McNoddy 08:47, 23 May 2007 (UTC)

The text in question has remained unchanged for a year. When there is an established terminology convention on an article, it isn't appropriate to simply make changes which do not adhere to that convention, especially if there is no real cause for making those changes. It introduces inconsistency and inconsistency is not some to aim for when trying to write The Perfect Article. Your explanation that this wording would be "more suitable" is too vague to justify changing established terminology in a single case. How would it be more suitable? It might be helpful for you to explain your thoughts in greater detail. -Severa (!!!) 09:01, 23 May 2007 (UTC)

I've explained it pretty much the way I see it, there is no bigger explanation than what I have already told you, short and sweet. That is your opinion and your entitled to it, try thinking outside the box.--McNoddy 10:45, 23 May 2007 (UTC)

With all due respect "thinking outside the box" does not generally include accepting that a phrase is "more suitable" with no further explanation. Why do you find it more suitable? And be aware, as the content has stood for over a year, it is de facto the consensus phrasing, and the onus is on you to persuade or convince others that your preferred change is preferable - if you cannot do so, you are editing against consensus. I have restored the previous verbiage, as you have as yet not convinced anyone your change improves the article in any way. KillerChihuahua?!? 11:43, 23 May 2007 (UTC)

Not everyone see's eye to eye and with all due respect back at you, the term mother is used for women who are pregnant it's suitable and more descriptive of the situation that there in. The way it's worded is pretty bland (lacking in special interest, individuality)--McNoddy 13:57, 23 May 2007 (UTC)

A "mother" is defined as "A woman who conceives, gives birth to, or raises and nurtures a child." Therefore, either usage is correct, "woman" or "mother." I find it problematic that there have been concerted efforts by some at Wikipedia to stamp out all uses of the word "mother" in connection with a woman who carries a fetus or embryo. This strikes be as an NPOV problem. Likewise, there have been concerted efforts at Wikipedia to stamp out all uses of the word "human" in connection with a fetus or embryo. So, I'd just like to say that I agree with McNoddy. The word "mother" can be used sometimes, and the word "woman" can be used sometimes, but it is a POV problem to demand that the word "mother" never be used.
By the way, what is the male parent of an embryo or fetus supposed to be called?Ferrylodge 14:45, 23 May 2007 (UTC)
The question is not "would mother be an accurate term" but "is mother a prefereable term" to use in this place in the article? Further, in some useages, mother is reserved for one who has given birth - a pregnant woman is not a mother, but an expectant mother - which does address accuracy. There being several objections to the change, and at least one objection to the accuracy, there is not consensus for making this change. Finally, your claims that there is a concerted effort on another article is 1) nonsense 2) accusatory and 3) completely irrelevant to this article. KillerChihuahua?!? 15:42, 23 May 2007 (UTC)
It is nonsensical what has occurred at other articles, and I agree that my saying so is accusatory. As for relevance, we disagree.Ferrylodge 15:47, 23 May 2007 (UTC)
Also, you are rewriting the English language when you say that, "a pregnant woman is not a mother." The word "expectant" is an adjective. The word "mother" is a noun. If I see a "red balloon" that does not mean that I do not see a balloon. If I see an expectant mother, that does not mean that I do not see a mother.Ferrylodge 15:59, 23 May 2007 (UTC)

The term "woman" is not inaccurate by any means. However, a specialized usage of the word "mother", one that isn't the typical use, has to be employed for "mother" to be used accurately. There is also controversy surrounding the term "mother", while all parties can agree (or compromise) with "woman". The word has stood in the article, and I find no compelling reason to change it. After a woman has a miscarriage, who still calls her a "mother"? -Andrew c 15:42, 23 May 2007 (UTC)

After a wife dies, who still calls the widower a husband?Ferrylodge 15:45, 23 May 2007 (UTC)

McNoddy clarified why he thinks the term "mother" is more appropriate, as, in his assessment, the current wording lacks "individuality." Others note concerns over the accuracy of the word "mother" as applied to this case. Is there a term which satisfies both concerns, or a descriptive term which "woman" could be appended with so it doesn't seem as generic, or overly broad (al least, that's how I interpret McNoddy's comment)? I don't know if it's possible, but, I say brainstorming is worth a try. Any ideas? -Severa (!!!) 19:08, 23 May 2007 (UTC)

Sev, while your attempts to compromise are laudable, I'm not sure that it is appropriate, necessary, or desireable. Knowing that I'll repeat some of what has already been said, here are my thoughts:
  1. I disagree that the term Mother is appropriate. Dicdefs aside, I (and probably most others) consider a Mother to be "...a woman with a child". A pregnant woman has the potential to become a mother, but a miscarriage, almost by definition, ends that potential (at least in that specific case).
  2. As previously mentioned, when an article is well-written and has been as stable as this, I'm very, very reluctant to make changes, even minor ones, until I've seen much more significant proof that a change is necessary.
Would the proposed change help, in any way, to raise this article from "B" to "GA" class? I think not, and therefore, I oppose. Doc Tropics 20:28, 23 May 2007 (UTC)
What is the male parent of an embryo or fetus supposed to be called?Ferrylodge 22:17, 23 May 2007 (UTC)
If "dicdefs" are put aside, must we also put aside dozens of state and federal laws, such as this one? Is it not obvious that a uniform refusal by Wikipedia to use the term "mother" in this context is a POV problem?Ferrylodge 22:22, 23 May 2007 (UTC)
Not at all a POV problem. If you've understood the responses, you'll understand that those who disagree with you regard the current version as technically accurate. Also, because WP is international, we don't generally refer to "state and federal laws" (which country's laws would we use?) at all, unless they are relevant to a specific legal point. POV is simply not the issue. Doc Tropics 22:33, 23 May 2007 (UTC)
I agree that the current version is technically accurate. It would also be technically accurate to replace the term "woman" with the term "adult female organism" wherever it occurs in this article. However, that would be foolish. Since you would like to dismiss English-language dictionaries and English-language laws, I suppose there is really no objective resource that I can use to convince you that exorcising the word "mother" from articles about pregnant women is a POV violation.Ferrylodge 22:56, 23 May 2007 (UTC)
Especially when you use inflammatory and inaccurate phrasing such as "exorcising" - it would be far more accurate to describe your posts as attempts to "exorcise" the term "woman" - since that is the current term, and you are seeking to change it. That you are failing to gain consensus for your desired change does not somehow turn the person wanting the change around into those happy with the current consensus phrasing. Dragging in dictionaries and laws which do not even enter into the issue fails to muddy the waters enough to see that you're simply not persuading anyone the change would be an improvement. KillerChihuahua?!? 23:04, 23 May 2007 (UTC)
Leaving the term "woman" five times out of six is hardly "exorcising" the word "woman" from the article.Ferrylodge 23:07, 23 May 2007 (UTC)

At this point I think that the points raised by McNoddy and Ferrylodge have been given all the attention that they need. Ferry's claims have been sufficiently refuted and there is a strong consensus against changing the text. Since there is nowhere productive for the discussion to go, I suggest we consider it "Closed" and move on. I know for a fact that at least 3 of us have better things to do than rehash unproductive arguments. Doc Tropics 23:45, 23 May 2007 (UTC)

Yes, and at least 2 of us have better things to do than reiterate the obvious.Ferrylodge 00:21, 24 May 2007 (UTC)
Perfect! We finally have common ground we can agree on : ) Doc Tropics 00:29, 24 May 2007 (UTC)

[edit] Half of pregnancies miscarried

The claim that "up to half of all pregnancies end in miscarriage." was inserted in this diff. Looking at the citation to the website of an insurance company, they seem to cite a March of Dimes factsheet and an NIH news release. The NIH news release says "...at least one-third of all embryos fail", which is what this article currently claimed - lower than half. The March of Dimes factsheet does say "As many as 50 percent of all pregnancies may end in miscarriage" and cites a study published in the New England Journal of Medicine (PMID 3393170). The study says, "The total rate of pregnancy loss after implantation, including clinically recognized spontaneous abortions, was 31 percent." Again, this is what this Wikipedia article already said - and is still lower than half.

I don't have access to the full text of the New England Journal of Medicine article, so I can only speculate where the MoD 50% claim came from. My best guess would be that is including embryos that are created but fail to ever implant - a category this Wikipedia article does not currently cover (although I have considered adding it - see #Before implantation - should this article address that?). So for now, at least, I am going to remove the claim that up to half of pregnancies end in miscarriage. I believe that it should only be re-added as part of a discussion on embryos that fail to implant. (If anyone is interested in writing such a discussion, they may find useful material at Early pregnancy factor#Infertility and early pregnancy loss.) LyrlTalk C 02:01, 3 July 2007 (UTC)

[edit] Needs section on risks to woman

The page speaks nothing of associate risks to the woman when miscarriage happens--such as infection if parts of the aborted fetus are not expelled or complications resulting from the D&C. Does anyone have any sources from which this info can be added?LCP 17:56, 18 September 2007 (UTC)

The "Forms and types" section does cover septic abortion, calls it "a grave risk to the life of the woman," and provides a wikilink to sepsis. The management section also mentions the benefit of watchful waiting avoiding "the side effects and complications possible from medications and surgery". These risks may need to be reworded and/or repositioned in the article to be more clear to readers, but they are spoken of. The vacuum aspiration article has a "Complications" section that is sourced, and the sepsis article seems to be decently sourced, also. LyrlTalk C 21:13, 18 September 2007 (UTC)

[edit] Causes

A study suggest that certain sport activities may increase the risk for a misscarriage (Study: M Madsen, T Jørgensen, ML Jensen, M Juhl, J Olsen, PK Andersen, A-M Nybo Andersen:Leisure time physical exercise during pregnancy and the risk of miscarriage: a study within the Danish National Birth Cohort IN BJOG: An International Journal of Obstetrics and Gynaecology (OnlineEarly Articles). doi:10.1111/j.1471-0528.2007.01496.x). Shouldn't this be included in the article? cu Cyrus Grisham 09:55, 27 September 2007 (UTC)

We should also include that eating chocolate is correlated with a lower risk of miscarriage. But like the exercise study, the chocolate studies were retrospective and susceptible to bias - a cause-and-effect relationship has not been firmly established. I've thought about adding a "correlations" section (below the "causes" section) for things like exercise and chocolate that are suspected to be related to miscarriage, but not proven. It's not something I've gotten around to, though, and I'd be more than happy to see someone else put something together. LyrlTalk C 22:47, 27 September 2007 (UTC)
I really like this suggestion. It accomplishes three things. It serves the reader by giving her all of the available information. It lets the reader know which information is most reliable. It reduces editorial bias, by which some editors would altogether exclude information that, although likely, is not eminently certain.LCP 16:52, 14 November 2007 (UTC)

Hi everyone, I thought it was important to add that progesterone supplements are not effective in preventing miscarriage once conception's occurred. Added a reference to a 1996 British Medical Journal study that said as much.Scrapple 17:02, 12 November 2007 (UTC)

I suspect that progesterone supplements are way overprescribed: many doctors don't seem to be able to get past the CD21 testing for progesterone, which assumes ovulation on day 14 and will falsely identify as "deficient" any woman who happens to ovulation earlier than CD13 or later than CD15 (both very common occurrences). Were a study to be designed that correctly tested for progesterone deficiency in the 6-8 days past ovulation window, I believe it would have different results than the BMJ study. Lacking such a study, however, I agree the BMJ article is an important addition. LyrlTalk C 01:39, 14 November 2007 (UTC)
Apart from perhaps variations in when a women ovulates, also need consider the cycle length on the cycle testing actually undertaken. So even if ovulation does occur 14days prior to menstruation and normal cycle length of 28days, if test undertaken on a cycle that just happens to run at 30days, then progesterone result is meaningless. Always need hold off advising on a progesterone blood test result until can find out when the impending period actually occured (then can start question assumption of "ovulation on day 14" - but in practice with ultrasound scans not available and basal body temperature too fiddly, I agree this is generally not considered) David Ruben Talk 03:14, 14 November 2007 (UTC)
Some women have good luck with OPKs. Basal temperatures from everything I've seen in the charting message boards I frequent are quite reliable, however a significant number of women who have allergies that cause mouth-breathing, or who have trouble staying awake enough to hold the thermometer correctly will get erratic oral temperatures. A few women have thermal shifts small enough even the normal day-to-day variations in oral temps will make the shift difficult to see. Vaginal temping is an excellent solution in all these cases, but of course many women are not willing to try that. Aside from my personal affinity for charting systems, David's approach seems both very simple and very accurate. LyrlTalk C 12:21, 14 November 2007 (UTC)

[edit] Caffeine

Copied with permission from my talk page. LyrlTalk C 12:40, 26 January 2008 (UTC)

I noticed that you - de facto - removed caffeine as a considered factor in the current understanding in the genesis of miscarriages. I do not like to go into an edit war, but here is my point:

Li's recent study (it may not be the last word) (as referenced in the NYT article, ref # 19) is the among the best we currently have and should be taken very seriously. You eliminated its point by just leaving it as a subject in "correlations", a section that obviously suggests that is just a unrelated linkage and that other factors are behind it (how do you know this?). The statement that half the patients were recruited after fetal death is not supported by the reference at all. Dr. Westhoff's personal opinion in the reference does not invalidate the study.

Li demonstrated not only that 200 mg are linked to double the miscarriage rate, but that there is a dose-response association. Why would you like to censor Li's findings? It may well be, ultimately, that there are other factors involved, but would it not simply be prudent to take this information seriously (adherening to the nil nocere concept) and not withhold it from the readers? Ekem (talk) 01:03, 24 January 2008 (UTC)

I agree that Li's recent study is among the best we currently have and should be taken very seriously. I disagree that acknowledging the partially retrospective nature (and therefore potential bias) of Li's study equates to withholding information from readers.
From the New York Times article: "At the time of the interview... 102 had already miscarried... Later, 70 more women miscarried." Technically, 59% of the miscarriages had occurred before the patients were recruited.
Li did not demonstrate a dose-response association. The miscarriage rates of women with zero caffeine intake and caffeine intake of less than 200mg/day were not different enough to be statistically significant.
The New York Times article states the study group had "an overall miscarriage rate of 16 percent... a typical rate." But 16% is not typical of prospective studies. The only prospective studies I have been able to find (PMID 10362823 PMID 12620443) both found 25% miscarriage rates by the sixth week LMP. A further number (around 8%) miscarry after the sixth week, for a total rate of around 33%. So by recruiting women who were (on average) already 10 weeks pregnant, Li's study missed a huge number of very early miscarriages, about half of the total miscarriages that occurred. This could affect his results in two significant ways: First, caffeine intake may show the same relationship to very early pregnancy loss as to later pregnancy loss, meaning it is even more harmful that Li's study suggests. Second, caffeine intake may show an inverse relationship to very early pregnancy loss compared to later pregnancy loss, so "saved" very early pregnancies could cancel out the "increased" miscarriage rate later on.
Is there precedent for a drug affecting very early pregnancy loss differently than clinical pregnancy loss? Yes, tobacco smoke. From this prospective study: "the group of women whose husbands smoked >=20 cigarettes/day had the highest prevalence of early pregnancy loss in the first conception (nonsmoking: 22 percent; <20 cigarettes/day: 20 percent; and >=20 cigarettes/day: 29 percent), [and] the lowest prevalence of clinical spontaneous abortion (nonsmoking: 8 percent; <20 cigarettes/day: 10 percent; and >=20 cigarettes/day: 4 percent)."
So, again, Li's study is one of the best available and should be taken seriously. But because it was not a prospective study, I believe the potential for bias is too high to present his results as established fact rather than the strong suggestion that they are. I'm not attached to the current formatting, though, if others have suggestions for reorganization. LyrlTalk C 01:12, 25 January 2008 (UTC)


This is a complicated issue and it appears to me that the discussion is currently made without even having the primary source available, at least I have not been able to verify that the article has appeared in the January issue of the American Journal of Ob Gyn as the NYT indicated, - I have seen several press releases, a more comprehensive perhaps here: [6]. Where have you found the article itself to be in a position to critique its methodology?
Wikipedia is an encyclopedia and as such should provide verifiable information but not take personal interpretations in the scientific fray: when you place “caffeine” in the “correlation” you are making a judgment and saying this is an example of presumably spurious association. Li’s study is one of many that would caution a reader to come to that conclusion. Li' study is just lowering the bar, so the question should be how much caffeine may still be safe in pregnancy?
I do not understand your position that the study is invalid because women were studied posthoc; that is how most epidemiologic studies are conducted, just think of all the studies looking at links with cancer,
It appears to me from the data so far released that patients with > 200 mg caffeine had about a 100% increase in miscarriage rates, those with less caffeine exposure a 40 % increase, and those with no exposure were the zero controls: isn't there a dose - response?
It is my simple suggestion to place "caffeine" back into the discussion of putative causative agents, and include a reference to Li’s data which have been already discussed in the general media. I have no objection to the attachment of a qualifier attached if that appears appropriate and is referenced. Ekem (talk) 04:57, 26 January 2008 (UTC)
The New York Times article states the study "will be published on Monday": I'm assuming that's January 28th. I have critiqued the information provided by the New York Times article, on the assumption that the New York Times is correctly reporting relevant information. Should the NYT article turn out to have misrepresented the study in the areas I am concerned about, I will certainly withdraw my assessment.
I have added nausea and vomiting of pregnancy as well as exercise to the correlations section - I hope these will increase the credibility of the factors listed in that section. I certainly do not want to imply that these associations are spurious.
If an epidemiological study on cancer omitted half the patient population who died of that cancer, I think the results of the study could be questioned. Because such a large portion of miscarriages happen very early in pregnancy, unfortunately retrospective studies of miscarriage (unlike those of most other conditions) miss a significant amount of valid information.
From this Medscape article: the aHR of miscarriage for caffeine use less than 200 mg/day was 1.42, which was not statistically significant. The study was small enough that a 40% change in risk is likely to be the result of random variation. The study on exercise I've added to the article did show a statistically significant dose-response relationship, showed a much higher risk of miscarriage (up to triple the risk of non-exercisers) and the authors of that article still cautioned that their results were subject to bias because of retrospective data collection and should not be used to tell pregnant women to not exercise. I think my response to the caffeine study was biased by having read the exercise study first (here); seeing the similarities in data collection methods, my tendency is to treat their results with equal weights. LyrlTalk C 13:42, 26 January 2008 (UTC)


As you predicted, the study came out today: [7], unfortunately all I get there is the abstract. It indicates that the study was done in a prospective manner, and that increasing doses of caffeine increased the risk of miscarriage (dose - response), but we may want to look at the full article.
The inclusion of other "factors" in the "correlation" section makes it better as "caffeine" now is not singled out as the only item. It should be clear that a "correlation" in this context is a connection under serious investigation and of concern, not some spurious event. Ekem (talk) 21:58, 28 January 2008 (UTC)

[edit] Environmental Toxins?

What exactly does the article mean when it mentions environmental toxins, and how are they a risk? --24.56.163.227 (talk) 04:36, 7 March 2008 (UTC)

[edit] Terminology and timeline

Even I as a GP doctor get confused by timelines and what gets defined as what & when, so I wonder if a table might help the terminology section. Note there are different definitions worldwide for "Stillbirth" (vs the term "Perinatal mortality").

Gestational age from LMP (in weeks and 2 more than Developmental age)
Situation of fetus & pregnancy 2 6 11 20 23† 37 40
(EDD)		 42
Prenatal development stage Embryo Fetus
Viability ? Not viable Viable
If vaginal bleeding is observed Threatened abortion Antepartum haemorrhage
Onset of spontaneous delivery Early
pregnancy
loss		 Clinical spontaneous abortion
(aka "Miscarriage")		 Premature labour Term labour Overdue
... and delivered alive Premature birth Delivery
... but then dies afterwards Neonatal death
If died before delivery Clinical spontaneous abortion Stillbirth‡
† Age of viability was 28 weeks before availability of modern medical intervention.
‡ Definition of stillbirth varies by country. Australia 20 weeks, UK 24 weeks, US has no standard definitio and Canada uses "Fetal death" for all stages.


With the potential to confuse on this, I thought I would open for comment first, rather than just boldly adding to the article :-) David Ruben Talk 04:06, 30 March 2008 (UTC)

I think in the U.S. as early as 20 weeks is considered premature birth: from March of Dimes: "A pregnancy that ends between 20 weeks and 37 weeks is considered preterm." Ditto for the vaginal bleeding column. Is there some way to make that overlap in the table fuzzy?
Also, the viability line is not sharp it is is depicted in the diagram; there are many variables influence the death and disability risks of an individual preemie aside from gestational age at the time of birth. A few preemies as early as 21 and 22 weeks have survived, while the death rate for 24 and 25 weekers is still rather high. I don't know that viability is something that should be included in the table.
Otherwise, I really like the table. LyrlTalk C 23:50, 31 March 2008 (UTC)
(Gulp re US 20 weeks) - Thanks for points, it is not of course a diagram but a table which has hard cell boundaries, so no "fuzzy" boundaries unless I convert this (once agreed) into a picture. The viability issue is the primary medical factor in understanding the table (at least from UK position). With the fall in this from 28 to 24weeks, the previous UK abortion law on "routine" abortions upto 28 weeks became anacronistic, given that it was apparent that fetus far younger could survive (allbeit with high morbidity rates). In 1992 the UK law changed, limiting most abortions to 24 weeks and defined still birth as interuterine death from 24 weeks. Also this drop had a knock-on effect on the issuing of the UK "Mat-B1" form which is the official certificate issued by doctors/midwives and used by woman to then notify their employers of their rights to maternity, with this being issuable from 20 rather than 24 weeks (issued before viability so that necessary paperwork can be done in time and a reasonable notice period given to employers).
I entirely agree that a very few survivals have now occured before 24 weeks, but in generally that is still exceptional and so there is a split in management between under 24weeks, which is still gynaecology (ie manage the woman) and after 24weeks which is obstetrics (manage a baby and a mother). Hence in vaginal bleeding, prior to 24weeks is seen as a threatened miscarriage and if contractions start and continue then outcome will be a non-surviving fetus, and if a catestrophic bleed starts then all measures just on sorting out the women. Whereas after 24weeks the term is antepartum haemorrhage, literally meaning before birth bleeding, and as this implies if managed well will be something that preceeds a successful emergency cesarian delivery (will well baby and what is then a mother). So if I see a woman who senses reduced movements of her baby at say 19 weeks, there is no point in my referring to labour ward for a midwife to help deliver a fetus (it is not going to happen), however if the same reduced movements felt at 26 weeks then I would direct her straight to the labour ward for assessment, and if concerns raised then emergency caesarian.
Of course 15 years ago, the cut off was probably 26 weeks, if not 28, as to what pragmatically could be achieved. But realistically a fetus at 20 weeks is not going to survive and be an independantly surviving preterm baby, and this in UK would not be seen as pre-term delivery but a lost pregnancy of a miscarriage. Again I agree survival rates have improved markedly in the last 10-20 years.
Recent Irish consensus paper: Vavasseur C, Foran A, Murphy JF (2007). "Consensus statements on the borderlands of neonatal viability: from uncertainty to grey areas". Ir Med J 100 (8): 561-4. PMID 17955714. “"All would provide intensive care at 26 weeks and most would not at 23 weeks. The grey area is 24 and 25 weeks gestation. This group of infants constitute 2 per 1000 births."” 
Sobering (none of this is pleasant) 1995 US paper PMID 8648459, and then look at a 2006 paper:Kaempf JW, Tomlinson M, Arduza C, et al (2006). "Medical staff guidelines for periviability pregnancy counseling and medical treatment of extremely premature infants". Pediatrics 117 (1): 22-9. doi:10.1542/peds.2004-2547. PMID 16396856.  - see current survival table wherein survival 50% (value other papers suggests neonatologists consider the full rescussitation point) is still around 24-25 weeks which reflects decision whether to offer caesarian (generally not for fetal reasons until after 25 weeks) and this table of neonatologists rescussitation advice wherein level 3 is their neutral poistion whether they would or would not recommend rescussitation.
Finally this year Morgan MA, Goldenberg RL, Schulkin J (2008). "Obstetrician-gynecologists' practices regarding preterm birth at the limit of viability". J. Matern. Fetal. Neonatal. Med. 21 (2): 115-21. doi:10.1080/14767050701866971. PMID 18240080.  also concludes viability 24 weeks.
Anyway the purpose of teh table to to try and give an overview of theatended miscarriage vs APH, miscarriage expulsion vs onset labour etc, so yes will try create version with changing cut offs varying on circumstances and country. :-) David Ruben Talk 01:48, 1 April 2008 (UTC)
First stab at creating table image with "fuzzier margins for viability":David Ruben Talk 02:26, 1 April 2008 (UTC)

Wow, that's lovely! I'm really impressed with how you put all that information together. I look forward to seeing it in the article. LyrlTalk C 23:57, 1 April 2008 (UTC)
Above now lost some silly extraneous words in left-hand column (I had "premature" and "term" inserted when they only belonged in relevant place to teh right), abbreviated 2nd footnote a little to get it to fit.
Only real shame over picture vs table is that can't have those nice wikilinks for teh various terms - oh, well. I'll insert into the article now. David Ruben Talk 01:12, 3 April 2008 (UTC)
There should be nothing in the "Not viable" and "....delivered alive" cell. ✏✎✍✌✉✈✇✆✃✄Ⓠ‽ (talk) 17:49, 8 June 2008 (UTC)