Ecological design

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Ecological_design

Ecological design or ecodesign is an approach to designing products and services that gives special consideration to the environmental impacts of a product over its entire lifecycle. Sim Van der Ryn and Stuart Cowan define it as "any form of design that minimizes environmentally destructive impacts by integrating itself with living processes." Ecological design can also be defined as the process of integrating environmental considerations into design and development with the aim of reducing environmental impacts of products through their life cycle.

The idea helps connect scattered efforts to address environmental issues in architecture, agriculture, engineering, and ecological restoration, among others. The term was first used by John Button in 1998. Ecological design was originally conceptualized as the “adding in “of environmental factor to the design process, but later turned to the details of eco-design practice, such as product system or individual product or industry as a whole. With the inclusion of life cycle modeling techniques, ecological design was related to the new interdisciplinary subject of industrial ecology.

Overview

Stainless steel table with FSC Teca wood - Brazil ecodesign

As the whole product's life cycle should be regarded in an integrated perspective, representatives from advanced product design, production, marketing, purchasing, and project management should work together on the Ecodesign of a further developed or new product. Together, they have the best chance to predict the holistic effects of changes of the product and their environmental impact. Considerations of ecological design during product development is a proactive approach to eliminate environmental pollution due to product waste.

An eco-design product may have a cradle-to-cradle life cycle ensuring zero waste is created in the whole process. By mimicking life cycles in nature, eco-design can serve as a concept to achieve a truly circular economy.

Environmental aspects which ought to be analysed for every stage of the life cycle are:

• Consumption of resources (energy, materials, water or land area)
• Emissions to air, water, and the ground (our Earth) as being relevant for the environment and human health, including noise emissions

Waste (hazardous waste and other waste defined in environmental legislation) is only an intermediate step and the final emissions to the environment (e.g. methane and leaching from landfills) are inventoried. All consumables, materials and parts used in the life cycle phases are accounted for, and all indirect environmental aspects linked to their production.

The environmental aspects of the phases of the life cycle are evaluated according to their environmental impact on the basis of a number of parameters, such as extent of environmental impact, potential for improvement, or potential of change.

According to this ranking the recommended changes are carried out and reviewed after a certain time.

As the impact of design and the design process has evolved, designers have become more aware of their responsibilities. The design of a product unrelated to its sociological, psychological, or ecological surroundings is no longer possible or acceptable in modern society.

With respect to these concepts, online platforms dealing in only Ecodesign products are emerging, with the additional sustainable purpose of eliminating all unnecessary distribution steps between the designer and the final customer.

Another area of ecological design is through designing with urban ecology in mind, similar to conservation biology, but designers take the natural world into account when designing landscapes, buildings. or anything that impacts interactions with wildlife. A such example in architecture is that of green roofs, offices, where these are spaces that nature can interact with the man made environment but also where humans benefit from these design technologies. Another area is with landscape architecture in the creation of natural gardens, and natural landscapes, these allow for natural wildlife to thrive in urban centres.

Ecological design issues and the role of designers

The rise and conceptualization of ecological design

Since the Industrial Revolution, design fields have been criticized for employing unsustainable practices. The architect-designer Victor Papanek (1923-1998) suggested that industrial design has murdered by creating new species of permanent garbage and by choosing materials and processes that pollute the air. Papanek states that the designer-planner shares responsibility for nearly all of our products and tools, and hence, nearly all of our environmental mistakes. To address these issues, R. Buckminster Fuller (1895-1983) demonstrated how design could play a central role in identifying and addressing major world problems. Fuller was concerned with the Earth's finite energy resources and natural resources, and how to integrate machine tools into efficient systems of industrial production. He promoted the principle of "ephemeralization", a term he coined himself to do "more with less" and increase technological efficiency. This concept is key in ecological design that works towards sustainability. In 1986, the design theorist Clive Dilnot argued that design must once again become a means of ordering the world rather than merely of shaping products.

Despite rising ecological awareness in the 20th century, unsustainable design practices continued. The1992 conference "The Agenda 21: The Earth Summit Strategy to Save Our Planet” put forward a proposition that the world is on a path of energy production and consumption that cannot be sustained. The report drew attention to individuals and groups around the world who have a set of principles to develop strategies for change among many aspects of society, including design. More broadly, the conference emphasized that designers must address human issues. These problems included six items: quality of life, efficient use of natural resources, protecting the global commons, managing human settlements, the use of chemicals and the management of human industrial waste, and fostering sustainable economic growth on a global scale.

Though Western society has only recently espoused ecological design principles, indigenous peoples have long coexisted with the environment. Scholars have discussed the importance of acknowledging and learning from Indigenous peoples and cultures to move towards a more sustainable society. Indigenous knowledge is valuable in ecological design as well as other ecological realms such as restoration ecology.

Sustainable development issues

These concepts of design tie into the concept of sustainable development. The three pillars addressed in sustainable development are: ecological integrity, social equity, and economic security. Gould and Lewis argue in their book Green Gentrification that urban redevelopment and projects have neglected the social equity pillar, resulting in development that focuses on profit and deepens social inequality. One result of this is green or environmental gentrification. This process is often the result of good intentions to clean up an area and provide green amenities, but without setting protections in place for existing residents to ensure they are not forced out by increased property values and influxes of new wealthier residents.

Unhoused persons are one particularly vulnerable affected population of environmental gentrification. Government environmental planning agendas related to green spaces may lead to the displacement and exclusion of unhoused individuals, under a guise of pro-environmental ethics. One example of this type of design is hostile architecture in urban parks. Park benches designed with metal arched bars to prevent a person from laying on the bench restricts who benefits from green space and ecological design.

Life Cycle Analysis

An electric wire reel reused as a center table in a Rio de Janeiro decoration fair. The reuse of materials is a sustainable practice that is rapidly growing among designers in Brazil.

Life Cycle Analysis (LCA) is a tool used to understand the how a product impacts the environment at each stage of its life cycle, from raw input to the end of the products' life cycle. Life Cycle Cost (LCC) is an economic metric that "identifies the minimum cost for each life cycle stage which would be presented in the aspects of material, procedures, usage, end-of-life and transportation." LCA and LCC can be used to identify particular aspects of a product that is particularly environmentally damaging & reduce those impacts. For example, LCA might reveal that the fabrication stage of a product's life cycle is particularly harmful for the environment and switching to a different material can drive emissions down. However, switching material may increase environmental effects later in a products life time; LCA takes into account the whole life cycle of a product and can alert designers to the many impacts of a product, which is why LCA is important.

Some of the factors that LCA takes into account are the costs and emissions of:

• Transportation
• Materials
• Production
• Usage
• End-of-life

End-of-life, or disposal, is an important aspect of LCA as waste management is a global issue, with trash found everywhere around the world from the ocean to within organisms. A framework was developed to assess sustainability of waste sites titled EcoSWaD, Ecological Sustainability of Waste Disposal Sites. The model focuses on five major concerns: (1) location suitability, (2) operational sustainability, (3) environmental sustainability, (4) socioeconomic sustainability, and (5) site capacity sustainability. This framework was developed in 2021, as such most established waste disposal sites do not take these factors into consideration. Waste facilities such as dumps and incinerators are disproportionately placed in areas with low education and income levels, burdening these vulnerable populations with pollution and exposure to hazardous materials. For example, legislation in the United States, such as the Cerrell Report, has encouraged these types of classist and racist processes for siting incinerators. Internationally, there has been a global 'race to the bottom' in which polluting industries move to areas with fewer restrictions and regulations on emissions, usually in developing countries, disproportionately exposing vulnerable and impoverished populations to environmental threats. These factors make LCA and sustainable waste sites important on a global scale.   

Urban Ecological Design

Related to ecological urbanism, Urban Ecological Design integrates aesthetic, social, and ecological concerns into an urban design framework that seeks to increase ecological functioning, sustainably generate & consume resources, and create resilient built environments & the infrastructure to maintain them. Urban ecological design is inherently interdisciplinary: it integrates multiple academic and professional fields including environmental studies, sociology, justice studies, urban ecology, landscape ecology, urban planning, architecture, and landscape architecture. Urban ecological design aims to solve issues related to multiple large-scale trends including the growth of urban areas, climate change, and biodiversity loss. Urban ecological design has been described as a "process model" contrasted to a normative approach that outlines principles of design. Urban ecological design blends a multitude of frameworks & approaches to create solutions to these issues by improving Urban resilience, sustainable use & management of resources, and integrating ecological processes into the urban landscape.

Applications in design

EcoMaterials, such as the use of local raw materials, are less costly and reduce the environmental costs of shipping, fuel consumption, and CO₂ emissions generated from transportation. Certified green building materials, such as wood from sustainably managed forest plantations, with accreditations from companies such as the Forest Stewardship Council (FSC), or the Pan-European Forest Certification Council (PEFCC), can be used.

Several other types of components and materials can be used in sustainable objects and buildings. Recyclable and recycled materials are commonly used in construction, but it is important that they don't generate any waste during manufacture or after their life cycle ends. Reclaimed materials such as timber at a construction site or junkyard can be given a second life by reusing them as support beams in a new building or as furniture. Stones from an excavation can be used in a retaining wall. The reuse of these items means that less energy is consumed in making new products and a new natural aesthetic quality is achieved.

Architecture

Stoltz Bluff Eco-Retreat: an off-grid home on Vancouver Island, Canada

Off-grid homes only use clean electric power. They are completely separated and disconnected from the conventional electricity grid and receive their power supply by harnessing active or passive energy systems. Off-grid homes are also not served by other publicly or privately managed utilities, such as water and gas in addition to electricity.

Art

Increased applications of ecological design have gone along with the rise of environmental art. Recycling has been used in art since the early part of the 20th century, when cubist artist Pablo Picasso (1881–1973) and Georges Braque (1882–1963) created collages from newsprints, packaging and other found materials. Contemporary artists have also embraced sustainability, both in materials and artistic content. One modern artist who embraces the reuse of materials is Bob Johnson, creator of River Cubes. Johnson promotes "artful trash management" by creating sculptures from garbage and scraps found in rivers. Garbage is collected, then compressed into a cube that represents the place and people it came from.

Clothing

There are some clothing companies that are using several ecological design methods to change the future of the textile industry into a more environmentally friendly one. Some approaches include recycling used clothing to minimize the use of raw resources, using biodegradable textile materials to reduce the lasting impact on the environment, and using plant dyes instead of poisonous chemicals to improve the appearance and impact of fabric.

Decorating

The same principle can be used inside the home, where found objects are now displayed with pride and collecting certain objects and materials to furnish a home is now admired rather than looked down upon. Take for example the electric wire reel reused as a center table.

There is a huge demand in Western countries to decorate homes in a "green" style. A lot of effort is placed into recycled product design and the creation of a natural look. This ideal is also a part of developing countries, although their use of recycled and natural products is often based in necessity and wanting to get maximum use out of materials. The focus on self-regulation and personal lifestyle changes (including decorating as well as clothing and other consumer choices) has shifted questions of social responsibility away from government and corporations and onto the individual.

Biophilic design is a concept used within the building industry to increase occupant connectivity to the natural environment through the use of direct nature, indirect nature, and space and place conditions.

Active system

These systems use the principle of harnessing the power generated from renewable and inexhaustible sources of energy, for example; solar, wind, thermal, biomass, and geothermal energy.

Solar power is a widely known and used renewable energy source. An increase in technology has allowed solar power to be used in a wide variety of applications. Two types of solar panels generate heat into electricity. Thermal solar panels reduce or eliminate the consumption of gas and diesel, and reduce CO₂ emissions. Photovoltaic panels convert solar radiation into an electric current which can power any appliance. This is a more complex technology and is generally more expensive to manufacture than thermal panels.

Biomass is the energy source created from organic materials generated through a forced or spontaneous biological process.

Geothermal energy is obtained by harnessing heat from the ground. This type of energy can be used to heat and cool homes. It eliminates dependence on external energy and generates minimum waste. It is also hidden from view as it is placed underground, making it more aesthetically pleasing and easier to incorporate in a design.

Wind turbines are a useful application for areas without immediate conventional power sources, e.g., rural areas with schools and hospitals that need more power. Wind turbines can provide up to 30% of the energy consumed by a household but they are subject to regulations and technical specifications, such as the maximum distance at which the facility is located from the place of consumption and the power required and permitted for each property.

Water recycling systems such as rainwater tanks that harvest water for multiple purposes. Reusing grey water generated by households are a useful way of not wasting drinking water.

Passive systems

Buildings that integrate passive energy systems (bioclimatic buildings) are heated using non-mechanical methods, thereby optimizing natural resources.

Passive daylighting involves the positioning and location of a building to allow for and make use of sunlight throughout the whole year. By using the sun's rays, thermal mass is stored in the building materials such as concrete and can generate enough heat for a room.

Green roofs are roofs that are partially or completely covered with plants or other vegetation. Green roofs are passive systems in that they create insulation that helps regulate the building's temperature. They also retain water, providing a water recycling system, and can provide soundproofing.

History

• 1971 Ian McHarg, in his book "Design with Nature", popularized a system of analyzing the layers of a site in order to compile a complete understanding of the qualitative attributes of a place. McHarg gave every qualitative aspect of the site a layer, such as the history, hydrology, topography, vegetation, etc. This system became the foundation of today's Geographic Information Systems (GIS), a ubiquitous tool used in the practice of ecological landscape design.
• 1978 Permaculture. Bill Mollison and David Holmgren coin the phrase for a system of designing regenerative human ecosystems. (Founded in the work of Fukuoka, Yeoman, Smith, etc..
• 1994 David Orr, in his book "Earth in Mind: On Education, Environment, and the Human Prospect", compiled a series of essays on "ecolgocial design intelligence" and its power to create healthy, durable, resilient, just, and prosperous communities.
• 1994 Canadian biologists John Todd and Nancy Jack Todd, in their book "From Eco-Cities to Living Machines" describe the precepts of ecological design.
• 2000 Ecosa Institute begins offering an Ecological Design Certificate, teaching designers to design with nature.
• 2004 Fritjof Capra, in his book "The Hidden Connections: A Science for Sustainable Living", wrote this primer on the science of living systems and considers the application of new thinking by life scientists to our understanding of social organization.
• 2004 K. Ausebel compiled compelling personal stories of the world's most innovative ecological designers in "Nature's Operating Instructions."

Ecodesign research

Ecodesign research focuses primarily on barriers to implementation, ecodesign tools and methods, and the intersection of ecodesign with other research disciplines. Several review articles provide an overview of the evolution and current state of ecodesign research.

On-Line Isotope Mass Separator

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/On-Line_Isotope_Mass_Separator 

 

ISOLDE Facility Logo

 

ISOLDE experimental hall.

The ISOLDE Radioactive Ion Beam Facility, is an on-line isotope separator facility located at the heart of the CERN accelerator complex on the Franco-Swiss border. The name of the facility is an acronym for Isotope Separator On Line DEvice. Created in 1964, the ISOLDE facility started delivering radioactive ion beams to users in 1967. Originally located at the SynchroCyclotron accelerator (CERN's first ever particle accelerator), the facility has been upgraded several times most notably in 1992 when the whole facility was moved to be connected to CERN's ProtonSynchroton Booster (PSB). Entering its 6th decade of existence, ISOLDE is currently the oldest facility still in operation at CERN. From the first pioneering isotope separation on-line (ISOL) beams to the latest technical advances allowing for the production of the most exotic species, ISOLDE benefits a wide range of physics communities with applications covering nuclear, atomic, molecular and solid-state physics, but also biophysics and astrophysics, as well as high-precision experiments looking for physics beyond the Standard Model. The facility is operated by the ISOLDE Collaboration, comprising CERN and fifteen (mostly) European countries. As of 2019, more than 800 experimentalists around the world (including all continents) are coming to ISOLDE to perform typically 45 different experiments per year.

Radioactive nuclei are produced at ISOLDE by shooting a high-energy (1.4GeV) beam of protons delivered by CERN's PSBooster accelerator on a 20 cm thick target. Several target materials are used depending on the desired final isotopes that are requested by the experimentalists. The interaction of the proton beam with the target material produces radioactive species through spallation, fragmentation and fission reactions. They are subsequently extracted from the bulk of the target material through thermal diffusion processes by heating the target to about 2000 degrees. The cocktail of produced isotopes is ultimately filtered using one of ISOLDE's two magnetic dipole mass separators to yield the desired isobar of interest. The time required for the extraction process to occur is dictated by the nature of the desired isotope and/or that of the target material and places a lower limit on the half-life of isotopes which can be produced by this method, and is typically of the order of a few milliseconds. Once extracted, the isotopes are directed either to one of several low-energy nuclear physics experiments or an isotope-harvesting area. An upgrade of the pre-existing REX post-accelerator, the latest addition to the ISOLDE facility is the HIE-ISOLDE superconducting linac which allows the re-acceleration of the radioisotopes to higher energies.

Background

The number of protons in a nucleus determine what element it belongs to: to have a neutral atom, the same number of electrons circulate around the atomic nucleus and these define the chemical properties of the element. However, a specific element can occur with different ‘nuclei’, each having the same number of protons but a different number of neutrons. These variations of the element are called its isotopes. For example, three isotopes of the element carbon are called carbon-12, carbon-13 and carbon-14; which have 6, 7, 8 neutrons respectively. The numbers added after the element name are the mass number of the isotope i.e. the sum of the number of protons and neutrons in the nucleus.

Table of nuclides

Each isotope of an element has different stability depending on their numbers of protons and neutrons. The word nuclide is used to refer to the isotopes with respect to their stability and nuclear energy state. Stable nuclides can be found in nature but unstable (i.e. radioactive) ones cannot because they spontaneously decay into more stable nuclides. Scientists use accelerators and nuclear reactors to produce and examine radioactive nuclides. The neutron-to-proton ratio has a strong impact on the properties of the isotope in question. Most notably, as this ratio strongly departs from unity the isotopes usually become ever increasingly short-lived. The time required to lose half of a population of a given nuclide through radioactive decays, the so-called half-life, is a measure of how stable an isotope is. 

Similar to the periodic table of elements for atoms, nuclides are usually visually represented on a table (the so-called Segré chart or chart of nuclides) where the proton number is represented on the y-axis while the x-axis represents the neutron number. 

History

Excavation of underground experimental area for ISOLDE

In 1950, two Danish physicists Otto Kofoed-Hansen and Karl-Ove Nielsen discovered a new technique for producing radioisotopes which enabled producing isotopes with shorter half-lives than earlier methods. Ten years later, in Vienna, at a symposium about separating radioisotopes, plans for an ‘on-line’ isotope separator were published. Using these plans, CERN's Nuclear Chemistry Group (NCG) built a prototype on-line mass separator coupled to target and ion source, which was bombarded by a proton beam delivered by CERN's the Synchro-Cyclotron. The test was a success and showed that the Synchro-Cyclotron was an appropriate machine for on-line rare isotope production. In 1964, a proposal for an isotope separator on-line project was accepted by the CERN Director-General and the ISOLDE project began.

The "Finance Committee" for the project set up with five members, then extended to 12. As the term "Finance Committee" had other connotations, it was decided 'until a better name was found' to call the project ISOLDE and the committee the ISOLDE Committee. In May 1966, the Synchro-Cyclotron shut down for some major modifications. One of these modifications was the construction of a new tunnel to send proton beams to a future underground hall that would be dedicated to ISOLDE. In 1965, as the underground hall at CERN was being excavated, the isotope separator for ISOLDE was being constructed in Aarhus. Separator construction made good progress in 1966 and the underground hall was finished in 1967. On 16 October 1967, the first experiment carried out and successfully.

Shortly after the ISOLDE experimental program started, some major improvements for SC were planned. In 1972 the SC shut down to upgrade its beam intensity by changing its radiofrequency system. The SC improvement program increased the primary proton beam intensity by about a factor of 100. To be able to handle this high-intensity ISOLDE facility also needed some modifications. After necessary modifications, the new ISOLDE facility also known as ISOLDE 2 was launched in 1974. Its new target design combined with the increased beam intensity from the SC led to significant enhancements in the number of nuclides produced. However, after some time the external beam current from the SC started to be a limiting factor. The collaboration discussed the possibility of moving the facility to an accelerator that could reach higher current values but decided on building another separator with ultra-modern design, for the facility. The new high-resolution separator, ISOLDE 3, was in full use by the end of the 80s. In 1990 a new ion source named Resonance Ionization Laser Ion Source (RILIS) was installed at the facility to selectively and efficiently produce radioactive beams.

Industrial robots used in ISOLDE facility

The Synchro-Cyclotron was decommissioned in 1990, after having been in operation for more than three decades. As a consequence, the collaboration decided to relocate the ISOLDE facility to the Proton Synchrotron, and place the targets in an external beam from its 1 GeV booster. The construction of the new ISOLDE experimental hall started about three months prior to the decommissioning of the Synchro-Cyclotron. With the relocation also came several upgrades. The most notable being the installation of two new magnetic dipole mass separators. One general-purpose separator with only one magnet and the other one is a high-resolution separator with two magnets. The latter one is a reconstructed version of the ISOLDE 3. The first experiment at the new facility, known as ISOLDE PSB, was performed on 26 June 1992. In May 1995, two industrial robots were installed in the facility to handle the targets and ion sources units without human intervention.

To diversify the scientific activities of the facility, a post-accelerator system called REX-ISOLDE (Radioactive beam EXperiments at ISOLDE) was inaugurated at the facility in 2001. With this new addition, nuclear reaction experiments which require a high-energy radioactive ion beam could now be performed at ISOLDE.

The facility building was extended in 2005 to allow more experiments to be set up. ISCOOL, an ion cooler and buncher, increasing the beam quality for experiments was installed at the facility in 2007. Furthermore, HIE-ISOLDE (High Intensity and Energy Upgrade), a project for upgrading beam intensity and energy, was approved in 2009 and has been completed in several phases. In late 2013 the construction of a new facility for medical research called CERN MEDICIS (MEDICal Isotopes Collected from ISOLDE) started. The facility is designed to work with proton beams that have already passed a first target. Of the incident beams, only 10% are actually stopped in the targets and achieve their objective, while the remaining 90% are not used.

In 2013, during the Long Shutdown 1, three ISOLDE buildings were demolished. They've been built again as a new single building with a new control room, a data storage room, three laser laboratories, a biology and materials laboratory, and a room for visitors. Another building extension for the MEDICIS project and several others equipped with electrical, cooling and ventilation systems to be used for the HIE-ISOLDE project in the future were also built. In addition, the robots which were installed for the handling of radioactive targets have been replaced with more modern robots. In 2015, for the first time, a radioactive isotope beam could be accelerated to an energy level of 4.3 MeV per nucleon in the ISOLDE facility thanks to the HIE-ISOLDE upgrades. In late 2017, the CERN-MEDICIS facility produced its first radioisotopes.

Facility and concept

A model of ISOLDE facility (2017)

Before ISOLDE, the radioactive nuclides were transported from the production area to the laboratory for examination. In ISOLDE, from the production to the measurements all the processes are connected, or in other words, they're "on-line". Radioactive nuclides are produced by bombarding a target with protons from a particle accelerator. Then they are ionized using surface, plasma or laser ion sources before being separated according to their masses by using magnetic dipole mass separators. After producing the beam of the preferred isotope, the beam can be cooled and/or bunched to reduce the emittance and energy spreads of the beam. Then the beam is directed to either low-energy experiments or a post-accelerator to increase its energy.

At THE ISOLDE facility, the main beam for reactions comes from the Proton Synchrotron. This incoming proton beam has an energy value of 1.4 GeV and its average intensity is up to 2 μA. The facility has two separators. One of them called the general purpose separator (GPS) and which is made with an H-type magnet with a bending radius of 1.5 m and a bending angle of 70°. Its resolution is approximately 800. The other separator is called the high resolution separator (HRS) is made from two C-type dipole magnets. Their bending radii are 1m and bending angles are 90° and 60°. The overall resolution of these two magnets can reach values higher than 7000.

The class A laboratories, buildings for the HIE-ISOLDE and MEDICIS projects, and building 508 which serves as a home for THE ISOLDE control rooms as well as other operations can be seen on the sketch. The 1.4 GeV proton beam from the PS Booster, coming from the right on the sketch, is being directed to one of the separators. The general purpose separator sends beams to an electronic switchyard which allows scientists to conduct up to three simultaneous experiments. The high resolution separator with two magnets and beam-correcting elements, can be used for experiments that require higher mass resolution values. One branch from the GPS switchyard and HRS are connected to a common central beamline which is used to provide beam to various experimental setups dedicated to nuclear spectroscopy and nuclear orientation, laser spectroscopy, high-precision mass spectrometry, solid-state and surface studies.

The traditional ion source units at ISOLDE are based on surface or plasma ionization techniques. In addition to those techniques a laser based ion source called RILIS, which allows an element sensitive selection of isotopes, is also being used for some elements. To be able to deliver beams with higher quality and increased sensitivity an ion cooler and buncher called ISCOOL, is being used in the HRS separator. All in all, the ISOLDE facility provides 1300 isotopes from 75 elements in the periodic table.

The project CERN-MEDICIS, which is a part of the ISOLDE facility, is running to supply radioactive isotopes for medical applications. The experiments at ISOLDE facility use about half of the protons in the beams from PS Booster. The beams preserve 90% of their intensities after hitting a standard target in the facility. CERN-MEDICIS project uses the remaining protons on a target that is placed behind the HRS target to produce radioisotopes for medical purposes. The irradiated target is then being carried to MEDICIS building by using an automated conveyor to separate and collect the isotopes of interest.

Accelerating them to higher energy levels is a good technique to be able to examine radioactive isotopes further. For this purpose, a post-accelerator called REX-ISOLDE, which accelerates the newly produced radioisotopes up to 3 MeV, is being used at ISOLDE facility. The accelerated isotopes are being directed to the target setup of a nuclear spectroscopy experiment, which includes charged-particle detectors and the MINIBALL gamma ray detector. Originally intended to accelerate light isotopes, REX-ISOLDE project has passed this goal and provided post-accelerated beams of a wider mass range, namely from ⁶He up to ²²⁴Ra. REX-ISOLDE has delivered accelerated beams of more than 100 isotopes of more than 30 elements since its commissioning.

To be able to satisfy the ever-increasing needs of higher quality, intensity, and energy of the production beam is very important for facilities such as ISOLDE. As the latest response to satisfy these needs, HIE-ISOLDE upgrade project has been started. Due to its phased planning, the upgrade project will be carried out with the least impact on the experiments continuing in the facility. The project includes an energy increase for the REX-ISOLDE up to 10 MeV as well as resonator and cooler upgrades, enhancement of the input beam from PS Booster, improvements on targets, ion sources, and mass separators. As of 2018 most of the energy upgrades, including increasing REX-ISOLDE energy to 10MeV, completed and phase two is concluded. Upgrades about intensity are planned to be done in phase three. As a state-of-the-art project, HIE-ISOLDE is expected to expand the research opportunities in ISOLDE facility to the next level. When completed, the upgraded facility will be able to host advanced experiments in fields like nuclear physics, nuclear astrophysics.

Solid-state physics laboratory

Attached to ISOLDE is in building 508 one of the largest solid-state physics laboratory for perturbed angular correlation that receive its major funding from BMBF. It uses about 20-25% of ISOLDE's beam time. Its major focus is the study of functional materials, such as metals, semiconductors, insulators and bio-molecules. The main use of exotic PAC-isotopes, such as ^111mCd, ^199mHg, ^204mPb as well as transition metal isotopes are important for materials research. Because many isotopes have half-lives that are in the range of minutes and hours, experiments need to be performed on-site. Additional methods are tracer diffusion, online-Mössbauer spectroscopy (⁵⁷Mn) and photoluminescence with radioactive nuclei.

Results and discoveries

Below is the list of some physics activities done at ISOLDE facility.

• Extension of the table of nuclides by discovering new isotopes
• High precision measurements of nuclear masses
• Discovery of shape staggering in light Hg isotopes
• Production of isomeric beams
• Discovery of beta-delayed multi particle emission
• Studies on nuclear resonance systems beyond the dripline
• Proofs of existence of nuclear halo structure
• Synthesis of waiting-point nuclei
• Atomic spectroscopy of francium
• Studies on beta-neutrino correlations
• First observations of short-lived pear-shaped atomic nuclei
• Measurement of the mass and charge radii of exotic calcium nuclei
• Discovery of new magic numbers and disappearance of some well established shell closures

Miscarriage

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Miscarriage 

Miscarriage
Other names	spontaneous abortion, early pregnancy loss
An ultrasound showing a gestational sac containing a yolk sac but no embryo
Specialty	Obstetrics and Gynaecology, Neonatology, Pediatrics
Symptoms	Vaginal bleeding with or without pain
Complications	Infection, bleeding, sadness, anxiety, guilt
Usual onset	Before 20 weeks of pregnancy
Causes	Chromosomal abnormalities, uterine abnormalities
Risk factors	Being an older parent, previous miscarriage, exposure to tobacco smoke, obesity, diabetes, autoimmune diseases, drug or alcohol use
Diagnostic method	Physical examination, human chorionic gonadotropin, ultrasound
Differential diagnosis	Ectopic pregnancy, implantation bleeding.
Prevention	Prenatal care
Treatment	Expectant management, vacuum aspiration, emotional support
Medication	misoprostol
Frequency	10–50% of pregnancies

Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Some use the cutoff of 20 weeks of gestation, after which fetal death is known as a stillbirth. The most common symptom of a miscarriage is vaginal bleeding with or without pain. Sadness, anxiety, and guilt may occur afterwards. Tissue and clot-like material may leave the uterus and pass through and out of the vagina. Recurrent miscarriage may also be considered a form of infertility.

Risk factors for miscarriage include being an older parent, previous miscarriage, exposure to tobacco smoke, obesity, diabetes, thyroid problems, and drug or alcohol use. About 80% of miscarriages occur in the first 12 weeks of pregnancy (the first trimester). The underlying cause in about half of cases involves chromosomal abnormalities. Diagnosis of a miscarriage may involve checking to see if the cervix is open or closed, testing blood levels of human chorionic gonadotropin (hCG), and an ultrasound. Other conditions that can produce similar symptoms include an ectopic pregnancy and implantation bleeding.

Prevention is occasionally possible with good prenatal care. Avoiding drugs, alcohol, infectious diseases, and radiation may decrease the risk of miscarriage. No specific treatment is usually needed during the first 7 to 14 days. Most miscarriages will complete without additional interventions. Occasionally the medication misoprostol or a procedure such as vacuum aspiration is used to remove the remaining tissue. Women who have a blood type of rhesus negative (Rh negative) may require Rho(D) immune globulin. Pain medication may be beneficial. Emotional support may help with processing the loss.

Miscarriage is the most common complication of early pregnancy. Among women who know they are pregnant, the miscarriage rate is roughly 10% to 20%, while rates among all fertilisation is around 30% to 50%. In those under the age of 35 the risk is about 10% while it is about 45% in those over the age of 40. Risk begins to increase around the age of 30. About 5% of women have two miscarriages in a row. Some recommend not using the term "abortion" in discussions with those experiencing a miscarriage in an effort to decrease distress. In Britain, the term "miscarriage" has replaced any use of the term "spontaneous abortion" in relation to pregnancy loss and in response to complaints of insensitivity towards women who had suffered such loss. An additional benefit of this change is reducing confusion among medical laymen, who may not realize that the term "spontaneous abortion" refers to a naturally-occurring medical phenomenon, and not the intentional termination of pregnancy.

Signs and symptoms

Signs of a miscarriage include vaginal spotting, abdominal pain, cramping, and fluid, blood clots, and tissue passing from the vagina. Bleeding can be a symptom of miscarriage, but many women also have bleeding in early pregnancy and do not miscarry. Bleeding during the first half of pregnancy may be referred to as a threatened miscarriage. Of those who seek treatment for bleeding during pregnancy, about half will miscarry. Miscarriage may be detected during an ultrasound exam, or through serial human chorionic gonadotropin (HCG) testing.

Risk factors

Further information: List of miscarriage risks

Miscarriage may occur for many reasons, not all of which can be identified. Risk factors are those things that increase the likelihood of having a miscarriage but do not necessarily cause a miscarriage. Up to 70 conditions, infections, medical procedures, lifestyle factors, occupational exposures, chemical exposure, and shift work are associated with increased risk for miscarriage. Some of these risks include endocrine, genetic, uterine, or hormonal abnormalities, reproductive tract infections, and tissue rejection caused by an autoimmune disorder.

Trimesters

First trimester

Chromosomal abnormalities found in first trimester miscarriages

Description	Proportion of total
Normal	45–55%
Autosomal trisomy	22–32%
Monosomy X (45, X)	5–20%
Triploidy	6–8%
Structural abnormality of the chromosome	2%
Double or triple trisomy	0.7–2.0%
Translocation	Unknown

Most clinically apparent miscarriages (two-thirds to three-quarters in various studies) occur during the first trimester. About 30% to 40% of all fertilized eggs miscarry, often before the pregnancy is known. The embryo typically dies before the pregnancy is expelled; bleeding into the decidua basalis and tissue necrosis causes uterine contractions to expel the pregnancy. Early miscarriages can be due to a developmental abnormality of the placenta or other embryonic tissues. In some instances an embryo does not form but other tissues do. This has been called a "blighted ovum".

Successful implantation of the zygote into the uterus is most likely eight to ten days after fertilization. If the zygote has not implanted by day ten, implantation becomes increasingly unlikely in subsequent days.

A chemical pregnancy is a pregnancy that was detected by testing but ends in miscarriage before or around the time of the next expected period.

Chromosomal abnormalities are found in more than half of embryos miscarried in the first 13 weeks. Half of embryonic miscarriages (25% of all miscarriages) have an aneuploidy (abnormal number of chromosomes). Common chromosome abnormalities found in miscarriages include an autosomal trisomy (22–32%), monosomy X (5–20%), triploidy (6–8%), tetraploidy (2–4%), or other structural chromosomal abnormalities (2%). Genetic problems are more likely to occur with older parents; this may account for the higher rates observed in older women.

Luteal phase progesterone deficiency may or may not be a contributing factor to miscarriage.

Second and third trimesters

Second trimester losses may be due to maternal factors such as uterine malformation, growths in the uterus (fibroids), or cervical problems. These conditions also may contribute to premature birth. Unlike first-trimester miscarriages, second-trimester miscarriages are less likely to be caused by a genetic abnormality; chromosomal aberrations are found in a third of cases. Infection during the third trimester can cause a miscarriage.

Age

Further information: Advanced maternal age

The age of the pregnant woman is a significant risk factor. Miscarriage rates increase steadily with age, with more substantial increases after age 35. In those under the age of 35 the risk is about 10% while it is about 45% in those over the age of 40. Risk begins to increase around the age of 30. Paternal age is associated with increased risk.

Obesity, eating disorders and caffeine

Not only is obesity associated with miscarriage; it can result in sub-fertility and other adverse pregnancy outcomes. Recurrent miscarriage is also related to obesity. Women with bulimia nervosa and anorexia nervosa may have a greater risk for miscarriage. Nutrient deficiencies have not been found to impact miscarriage rates but hyperemesis gravidarum sometimes precedes a miscarriage.

Caffeine consumption also has been correlated to miscarriage rates, at least at higher levels of intake. However, such higher rates are statistically significant only in certain circumstances.

Vitamin supplementation has generally not shown to be effective in preventing miscarriage. Chinese traditional medicine has not been found to prevent miscarriage.

Endocrine disorders

Disorders of the thyroid may affect pregnancy outcomes. Related to this, iodine deficiency is strongly associated with an increased risk of miscarriage. The risk of miscarriage is increased in those with poorly controlled insulin-dependent diabetes mellitus. Women with well-controlled diabetes have the same risk of miscarriage as those without diabetes.

Food poisoning

Ingesting food that has been contaminated with listeriosis, toxoplasmosis, and salmonella is associated with an increased risk of miscarriage.

Amniocentesis and chorionic villus sampling

Amniocentesis and chorionic villus sampling (CVS) are procedures conducted to assess the fetus. A sample of amniotic fluid is obtained by the insertion of a needle through the abdomen and into the uterus. Chorionic villus sampling is a similar procedure with a sample of tissue removed rather than fluid. These procedures are not associated with pregnancy loss during the second trimester but they are associated with miscarriages and birth defects in the first trimester. Miscarriage caused by invasive prenatal diagnosis (chorionic villus sampling (CVS) and amniocentesis) is rare (about 1%).

Surgery

The effects of surgery on pregnancy are not well-known including the effects of bariatric surgery. Abdominal and pelvic surgery are not risk factors for miscarriage. Ovarian tumours and cysts that are removed have not been found to increase the risk of miscarriage. The exception to this is the removal of the corpus luteum from the ovary. This can cause fluctuations in the hormones necessary to maintain the pregnancy.

Medications

There is no significant association between antidepressant medication exposure and spontaneous abortion. The risk of miscarriage is not likely decreased by discontinuing SSRIs prior to pregnancy. Some available data suggest that there is a small increased risk of miscarriage for women taking any antidepressant, though this risk becomes less statistically significant when excluding studies of poor quality.

Medicines that increase the risk of miscarriage include:

• retinoids
• nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
• misoprostol
• methotrexate
• statins

Immunizations

Immunizations have not been found to cause miscarriage. Live vaccinations, like the MMR vaccine, can theoretically cause damage to the fetus as the live virus can cross the placenta and potentially increase the risk for miscarriage. Therefore, the Center for Disease Control (CDC) recommends against pregnant women receiving live vaccinations. However, there is no clear evidence that has shown live vaccinations to increase the risk for miscarriage or fetal abnormalities.

Some live vaccinations include: MMR, varicella, certain types of the influenza vaccine, and rotavirus.

Treatments for cancer

Ionizing radiation levels given to a woman during cancer treatment cause miscarriage. Exposure can also impact fertility. The use of chemotherapeutic drugs used to treat childhood cancer increases the risk of future miscarriage.

Pre-existing diseases

Several pre-existing diseases in pregnancy can potentially increase the risk of miscarriage, including diabetes, polycystic ovary syndrome (PCOS), hypothyroidism, certain infectious diseases, and autoimmune diseases. PCOS may increase the risk of miscarriage. Two studies suggested treatment with the drug metformin significantly lowers the rate of miscarriage in women with PCOS, but the quality of these studies has been questioned. Metformin treatment in pregnancy has not been shown to be safe. In 2007 the Royal College of Obstetricians and Gynaecologists also recommended against use of the drug to prevent miscarriage. Thrombophilias or defects in coagulation and bleeding were once thought to be a risk in miscarriage but have been subsequently questioned. Severe cases of hypothyroidism increase the risk of miscarriage. The effect of milder cases of hypothyroidism on miscarriage rates has not been established. A condition called luteal phase defect (LPD) is a failure of the uterine lining to be fully prepared for pregnancy. This can keep a fertilized egg from implanting or result in miscarriage.

Mycoplasma genitalium infection is associated with increased risk of preterm birth and miscarriage.

Infections can increase the risk of a miscarriage: rubella (German measles), cytomegalovirus, bacterial vaginosis, HIV, chlamydia, gonorrhoea, syphilis, and malaria.

Immune status

Autoimmunity is a possible cause of recurrent or late-term miscarriages. In the case of an autoimmune-induced miscarriage, the woman's body attacks the growing fetus or prevents normal pregnancy progression. Autoimmune disease may cause abnormalities in embryos, which in turn may lead to miscarriage. As an example, Celiac disease increases the risk of miscarriage by an odds ratio of approximately 1.4. A disruption in normal immune function can lead to the formation of antiphospholipid antibody syndrome. This will affect the ability to continue the pregnancy, and if a woman has repeated miscarriages, she can be tested for it. Approximately 15% of recurrent miscarriages are related to immunologic factors. The presence of anti-thyroid autoantibodies is associated with an increased risk with an odds ratio of 3.73 and 95% confidence interval 1.8–7.6. Having lupus also increases the risk for miscarriage.

Anatomical defects and trauma

Fifteen per cent of women who have experienced three or more recurring miscarriages have some anatomical defect that prevents the pregnancy from being carried for the entire term. The structure of the uterus affects the ability to carry a child to term. Anatomical differences are common and can be congenital.

In some women, cervical incompetence or cervical insufficiency occurs with the inability of the cervix to stay closed during the entire pregnancy. It does not cause first trimester miscarriages. In the second trimester, it is associated with an increased risk of miscarriage. It is identified after a premature birth has occurred at about 16–18 weeks into the pregnancy. During the second trimester, major trauma can result in a miscarriage.

Smoking

See also: Smoking and pregnancy

Tobacco (cigarette) smokers have an increased risk of miscarriage. There is an increased risk regardless of which parent smokes, though the risk is higher when the gestational mother smokes.

Morning sickness

Nausea and vomiting of pregnancy (NVP, or morning sickness) is associated with a decreased risk. Several possible causes have been suggested for morning sickness but there is still no agreement. NVP may represent a defense mechanism which discourages the mother's ingestion of foods that are harmful to the fetus; according to this model, a lower frequency of miscarriage would be an expected consequence of the different food choices made by women experiencing NVP.

Chemicals and occupational exposure

Chemical and occupational exposures may have some effect in pregnancy outcomes. A cause and effect relationship almost can never be established. Those chemicals that are implicated in increasing the risk for miscarriage are DDT, lead, formaldehyde, arsenic, benzene and ethylene oxide. Video display terminals and ultrasound have not been found to have an effect on the rates of miscarriage. In dental offices where nitrous oxide is used with the absence of anesthetic gas scavenging equipment, there is a greater risk of miscarriage. For women who work with cytotoxic antineoplastic chemotherapeutic agents there is a small increased risk of miscarriage. No increased risk for cosmetologists has been found.

Other

Alcohol increases the risk of miscarriage. Cocaine use increases the rate of miscarriage. Some infections have been associated with miscarriage. These include Ureaplasma urealyticum, Mycoplasma hominis, group B streptococci, HIV-1, and syphilis. Infections of Chlamydia trachomatis, Camphylobacter fetus, and Toxoplasma gondii have not been found to be linked to miscarriage. Subclinical infections of the lining of the womb, commonly known as chronic endometritis are also associated with poor pregnancy outcomes, compared to women with treated chronic endometritis or no chronic endometritis.

Diagnosis

In the case of blood loss, pain, or both, transvaginal ultrasound is performed. If a viable intrauterine pregnancy is not found with ultrasound, blood tests (serial βHCG tests) can be performed to rule out ectopic pregnancy, which is a life-threatening situation.

If hypotension, tachycardia, and anemia are discovered, exclusion of an ectopic pregnancy is important.^[91]

A miscarriage may be confirmed by an obstetric ultrasound and by the examination of the passed tissue. When looking for microscopic pathologic symptoms, one looks for the products of conception. Microscopically, these include villi, trophoblast, fetal parts, and background gestational changes in the endometrium. When chromosomal abnormalities are found in more than one miscarriage, genetic testing of both parents may be done.

Ultrasound criteria

A review article in The New England Journal of Medicine based on a consensus meeting of the Society of Radiologists in Ultrasound in America (SRU) has suggested that miscarriage should be diagnosed only if any of the following criteria are met upon ultrasonography visualization:

Miscarriage diagnosed	Miscarriage suspected
Crown-rump length of at least 7 mm and no heartbeat.	Crown–rump length of less than 7 mm and no heartbeat.
Mean gestational sac diameter of at least 25 mm and no embryo.	Mean gestational sac diameter of 16–24 mm and no embryo.
Absence of embryo with heartbeat at least 2 weeks after an ultrasound scan that showed a gestational sac without a yolk sac.	Absence of embryo with heartbeat 7–13 days after an ultrasound scan that showed a gestational sac without a yolk sac.
Absence of embryo with heartbeat at least 11 days after an ultrasound scan that showed a gestational sac with a yolk sac.	Absence of embryo with heartbeat 7–10 days after a scan that showed a gestational sac with a yolk sac.
	Absence of embryo at least 6 weeks after last menstrual period.
	Amniotic sac seen adjacent to yolk sac, and with no visible embryo.
	Yolk sac of more than 7 mm.
	Small gestational sac compared to embryo size (less than 5 mm difference between mean sac diameter and crown-rump length).

Classification

A threatened miscarriage is any bleeding during the first half of pregnancy. At investigation it may be found that the fetus remains viable and the pregnancy continues without further problems.

An anembryonic pregnancy (also called an "empty sac" or "blighted ovum") is a condition where the gestational sac develops normally, while the embryonic part of the pregnancy is either absent or stops growing very early. This accounts for approximately half of miscarriages. All other miscarriages are classified as embryonic miscarriages, meaning that there is an embryo present in the gestational sac. Half of embryonic miscarriages have aneuploidy (an abnormal number of chromosomes).

An inevitable miscarriage occurs when the cervix has already dilated, but the fetus has yet to be expelled. This usually will progress to a complete miscarriage. The fetus may or may not have cardiac activity.

Transvaginal ultrasonography after an episode of heavy bleeding in an intrauterine pregnancy that had been confirmed by previous ultrasonography. There is some widening between the uterine walls, but no sign of any gestational sac, thus, in this case, being diagnostic of a complete miscarriage.

A complete miscarriage is when all products of conception have been expelled; these may include the trophoblast, chorionic villi, gestational sac, yolk sac, and fetal pole (embryo); or later in pregnancy the fetus, umbilical cord, placenta, amniotic fluid, and amniotic membrane. The presence of a pregnancy test that is still positive, as well as an empty uterus upon transvaginal ultrasonography, does, however, fulfil the definition of pregnancy of unknown location. Therefore, there may be a need for follow-up pregnancy tests to ensure that there is no remaining pregnancy, including ectopic pregnancy.

Transvaginal ultrasonography, with some products of conception in the cervix (to the left in the image) and remnants of a gestational sac by the fundus (to the right in the image), indicating an incomplete miscarriage

An incomplete miscarriage occurs when some products of conception have been passed, but some remains inside the uterus. However, an increased distance between the uterine walls on transvaginal ultrasonography may also simply be an increased endometrial thickness and/or a polyp. The use of a Doppler ultrasound may be better in confirming the presence of significant retained products of conception in the uterine cavity. In cases of uncertainty, ectopic pregnancy must be excluded using techniques like serial beta-hCG measurements.

A 13-week fetus without cardiac activity located in the uterus (delayed or missed miscarriage)

A missed miscarriage is when the embryo or fetus has died, but a miscarriage has not yet occurred. It is also referred to as delayed miscarriage, silent miscarriage, or missed abortion.

A septic miscarriage occurs when the tissue from a missed or incomplete miscarriage becomes infected, which carries the risk of spreading infection (septicaemia) and can be fatal.

Recurrent miscarriage ("recurrent pregnancy loss" (RPL) or "habitual abortion") is the occurrence of multiple consecutive miscarriages; the exact number used to diagnose recurrent miscarriage varies. If the proportion of pregnancies ending in miscarriage is 15% and assuming that miscarriages are independent events, then the probability of two consecutive miscarriages is 2.25% and the probability of three consecutive miscarriages is 0.34%. The occurrence of recurrent pregnancy loss is 1%. A large majority (85%) of those who have had two miscarriages will conceive and carry normally afterward.

The physical symptoms of a miscarriage vary according to the length of pregnancy, though most miscarriages cause pain or cramping. The size of blood clots and pregnancy tissue that are passed become larger with longer gestations. After 13 weeks' gestation, there is a higher risk of placenta retention.

Prevention

Prevention of a miscarriage can sometimes be accomplished by decreasing risk factors. This may include good prenatal care, avoiding drugs and alcohol, preventing infectious diseases, and avoiding x-rays. Identifying the cause of the miscarriage may help prevent future pregnancy loss, especially in cases of recurrent miscarriage. Often there is little a person can do to prevent a miscarriage. Vitamin supplementation before or during pregnancy has not been found to affect the risk of miscarriage. Progesterone has been shown to prevent miscarriage in women with 1) vaginal bleeding early in their current pregnancy and 2) a previous history of miscarriage.

Non-modifiable risk factors

Preventing a miscarriage in subsequent pregnancies may be enhanced with assessments of:

• Immune status
• Chemical and occupational exposures
• Anatomical defects
• Pre-existing or acquired disease in pregnancy
  • Polycystic ovary syndrome
• Previous exposure to chemotherapy and radiation
• Medications
• Surgical history
• Endocrine disorders
• Genetic abnormalities

Modifiable risk factors

Maintaining a healthy weight and good prenatal care can reduce the risk of miscarriage.^[32] Some risk factors can be minimized by avoiding the following:

• Smoking
• Cocaine use
• Alcohol
• Poor nutrition
• Occupational exposure to agents that can cause miscarriage
• Medications associated with miscarriage
• Drug abuse

Management

Women who miscarry early in their pregnancy usually do not require any subsequent medical treatment but they can benefit from support and counseling. Most early miscarriages will complete on their own; in other cases, medication treatment or aspiration of the products of conception can be used to remove remaining tissue. While bed rest has been advocated to prevent miscarriage, this has not been found to be of benefit. Those who are experiencing or who have experienced a miscarriage benefit from the use of careful medical language. Significant distress can often be managed by the ability of the clinician to clearly explain terms without suggesting that the woman or couple are somehow to blame.

Evidence to support Rho(D) immune globulin after a spontaneous miscarriage is unclear. In the UK, Rho(D) immune globulin is recommended in Rh-negative women after 12 weeks gestational age and before 12 weeks gestational age in those who need surgery or medication to complete the miscarriage.

Methods

No treatment is necessary for a diagnosis of complete miscarriage (so long as ectopic pregnancy is ruled out). In cases of an incomplete miscarriage, empty sac, or missed abortion there are three treatment options: watchful waiting, medical management, and surgical treatment. With no treatment (watchful waiting), most miscarriages (65–80%) will pass naturally within two to six weeks. This treatment avoids the possible side effects and complications of medications and surgery, but increases the risk of mild bleeding, need for unplanned surgical treatment, and incomplete miscarriage. Medical treatment usually consists of using misoprostol (a prostaglandin) alone or in combination with mifepristone pre-treatment. These medications help the uterus to contract and expel the remaining tissue out of the body. This works within a few days in 95% of cases. Vacuum aspiration or sharp curettage can be used, with vacuum aspiration being lower-risk and more common.

Delayed and incomplete miscarriage

In delayed or incomplete miscarriage, treatment depends on the amount of tissue remaining in the uterus. Treatment can include surgical removal of the tissue with vacuum aspiration or misoprostol. Studies looking at the methods of anaesthesia for surgical management of incomplete miscarriage have not shown that any adaptation from normal practice is beneficial.

Induced miscarriage

Further information: Self-induced abortion

An induced abortion may be performed by a qualified healthcare provider for women who cannot continue the pregnancy. Self-induced abortion performed by a woman or non-medical personnel can be dangerous and is still a cause of maternal mortality in some countries. In some locales it is illegal or carries heavy social stigma. However, in the United States, many choose to self-induce or self-manage their abortion and have done so safely.

Sex

Some organizations recommend delaying sex after a miscarriage until the bleeding has stopped to decrease the risk of infection. However, there is not sufficient evidence for the routine use of antibiotic to try to avoid infection in incomplete abortion. Others recommend delaying attempts at pregnancy until one period has occurred to make it easier to determine the dates of a subsequent pregnancy. There is no evidence that getting pregnant in that first cycle affects outcomes and an early subsequent pregnancy may actually improve outcomes.

Support

Organizations exist that provide information and counselling to help those who have had a miscarriage. Family and friends often conduct a memorial or burial service. Hospitals also can provide support and help memorialize the event. Depending on locale others desire to have a private ceremony.^[123] Providing appropriate support with frequent discussions and sympathetic counselling are part of evaluation and treatment. Those who experience unexplained miscarriage can be treated with emotional support.

Miscarriage leave

Miscarriage leave is leave of absence in relation to miscarriage. The following countries offer paid or unpaid leave to women who have had a miscarriage.

• The Philippines – 60 days' fully paid leave for miscarriages (before 20 weeks of gestation) or emergency termination of the pregnancy (on the 20th week or after) The husband of the mother gets seven days' fully paid leave up to the 4th pregnancy.
• India – six weeks' leave
• New Zealand – three days' bereavement leave for both parents
• Mauritius – two weeks' leave
• Indonesia – six weeks' leave
• Taiwan – five days, one week or four weeks, depending on how advanced the pregnancy was

Outcomes

Psychological and emotional effects

A cemetery for miscarried fetuses, stillborn babies, and babies who have died soon after birth

 

See also: Miscarriage and grief and Miscarriage and mental illness

Every woman's personal experience of miscarriage is different, and women who have more than one miscarriage may react differently to each event.

In Western cultures since the 1980s, medical providers assume that experiencing a miscarriage "is a major loss for all pregnant women". A miscarriage can result in anxiety, depression or stress for those involved. It can have an effect on the whole family. Many of those experiencing a miscarriage go through a grieving process. "Prenatal attachment" often exists that can be seen as parental sensitivity, love and preoccupation directed toward the unborn child. Serious emotional impact is usually experienced immediately after the miscarriage. Some may go through the same loss when an ectopic pregnancy is terminated. In some, the realization of the loss can take weeks. Providing family support to those experiencing the loss can be challenging because some find comfort in talking about the miscarriage while others may find the event painful to discuss. The father can have the same sense of loss. Expressing feelings of grief and loss can sometimes be harder for men. Some women are able to begin planning their next pregnancy after a few weeks of having the miscarriage. For others, planning another pregnancy can be difficult. Some facilities acknowledge the loss. Parents can name and hold their infant. They may be given mementos such as photos and footprints. Some conduct a funeral or memorial service. They may express the loss by planting a tree.

Some health organizations recommend that sexual activity be delayed after the miscarriage. The menstrual cycle should resume after about three to four months. Women report that they were dissatisfied with the care they received from physicians and nurses.

Subsequent pregnancies

Some parents want to try to have a baby very soon after the miscarriage. The decision of trying to become pregnant again can be difficult. Reasons exist that may prompt parents to consider another pregnancy. For older mothers, there may be some sense of urgency. Other parents are optimistic that future pregnancies are likely to be successful. Many are hesitant and want to know about the risk of having another or more miscarriages. Some clinicians recommend that the women have one menstrual cycle before attempting another pregnancy. This is because the date of conception may be hard to determine. Also, the first menstrual cycle after a miscarriage can be much longer or shorter than expected. Parents may be advised to wait even longer if they have experienced late miscarriage or molar pregnancy, or are undergoing tests. Some parents wait for six months based upon recommendations from their health care provider.

The risks of having another miscarriage vary according to the cause. The risk of having another miscarriage after a molar pregnancy is very low. The risk of another miscarriage is highest after the third miscarriage. Pre-conception care is available in some locales.

Later cardiovascular disease

There is a significant association between miscarriage and later development of coronary artery disease, but not of cerebrovascular disease.

Epidemiology

Among women who know they are pregnant, the miscarriage rate is roughly 10% to 20%, while rates among all fertilized zygotes are around 30% to 50%. A 2012 review found the risk of miscarriage between 5 and 20 weeks from 11% to 22%. Up to the 13th week of pregnancy, the risk of miscarriage each week was around 2%, dropping to 1% in week 14 and reducing slowly between 14 and 20 weeks.

The precise rate is not known because a large number of miscarriages occur before pregnancies become established and before the woman is aware she is pregnant. Additionally, those with bleeding in early pregnancy may seek medical care more often than those not experiencing bleeding. Although some studies attempt to account for this by recruiting women who are planning pregnancies and testing for very early pregnancy, they still are not representative of the wider population.

The prevalence of miscarriage increases with the age of both parents. In a Danish register-based study where the prevalence of miscarriage was 11%, the prevalence rose from 9% at 22 years of age to 84% by 48 years of age. Another, later study in 2013 found that when either parent was over the age of 40, the rate of known miscarriages doubled.

In 2010, 50,000 inpatient admissions for miscarriage occurred in the UK.

Terminology

Most affected women and family members refer to miscarriage as the loss of a baby, rather than an embryo or fetus, and healthcare providers are expected to respect and use the language that the person chooses. Clinical terms can suggest blame, increase distress, and even cause anger. Terms that are known to cause distress in those experiencing miscarriage include:

• abortion (including spontaneous abortion) rather than miscarriage,
• habitual aborter rather than a woman experiencing recurrent pregnancy loss,
• products of conception rather than baby,
• blighted ovum rather than early pregnancy loss or delayed miscarriage,
• cervical incompetence rather than cervical weakness, and
• evacuation of retained products of conception (ERPC) rather than surgical management of miscarriage.

Pregnancy loss is a broad term that is used for miscarriage, ectopic and molar pregnancies. The term fetal death applies variably in different countries and contexts, sometimes incorporating weight, and gestational age from 16 weeks in Norway, 20 weeks in the US and Australia, 24 weeks in the UK to 26 weeks in Italy and Spain. A fetus that died before birth after this gestational age may be referred to as a stillbirth. Under UK law, all stillbirths should be registered, although this does not apply to miscarriages.

History

The medical terminology applied to experiences during early pregnancy has changed over time. Before the 1980s, health professionals used the phrase spontaneous abortion for a miscarriage and induced abortion for a termination of the pregnancy. In the late 1980s and 1990s, doctors became more conscious of their language in relation to early pregnancy loss. Some medical authors advocated change to use of miscarriage instead of spontaneous abortion because they argued this would be more respectful and help ease a distressing experience. The change was being recommended by some in the profession in Britain in the late 1990s. In 2005 the European Society for Human Reproduction and Embryology (ESHRE) published a paper aiming to facilitate a revision of nomenclature used to describe early pregnancy events.

Society and culture

Society's reactions to miscarriage have changed over time. In the early 20th century, the focus was on the mother's physical health and the difficulties and disabilities that miscarriage could produce. Other reactions, such as the expense of medical treatments and relief at ending an unwanted pregnancy, were also heard. In the 1940s and 1950s, people were more likely to express relief, not because the miscarriage ended an unwanted or mistimed pregnancy, but because people believed that miscarriages were primarily caused by birth defects, and miscarrying meant that the family would not raise a child with disabilities. The dominant attitude in the mid-century was that a miscarriage, although temporarily distressing, was a blessing in disguise for the family, and that another pregnancy and a healthier baby would soon follow, especially if women trusted physicians and reduced their anxieties. Media articles were illustrated with pictures of babies, and magazine articles about miscarriage ended by introducing the healthy baby—usually a boy—that had shortly followed it.

Beginning in the 1980s, miscarriage in the US was primarily framed in terms of the individual woman's personal emotional reaction, and especially her grief over a tragic outcome. The subject was portrayed in the media with images of an empty crib or an isolated, grieving woman, and stories about miscarriage were published in general-interest media outlets, not just women's magazines or health magazines. Family members were encouraged to grieve, to memorialize their losses through funerals and other rituals, and to think of themselves as being parents. This shift to recognizing these emotional responses was partly due to medical and political successes, which created an expectation that pregnancies are typically planned and safe, and to women's demands that their emotional reactions no longer be dismissed by the medical establishments. It also reinforces the pro-life movement's belief that human life begins at conception or early in pregnancy, and that motherhood is a desirable life goal. The modern one-size-fits-all model of grief does not fit every woman's experience, and an expectation to perform grief creates unnecessary burdens for some women. The reframing of miscarriage as a private emotional experience brought less awareness of miscarriage and a sense of silence around the subject, especially compared to the public discussion of miscarriage during campaigns for access to birth control during the early 20th century, or the public campaigns to prevent miscarriages, stillbirths, and infant deaths by reducing industrial pollution during the 1970s.

In places where induced abortion is illegal or carries social stigma, suspicion may surround miscarriage, complicating an already sensitive issue.

In the 1960s, the use of the word miscarriage in Britain (instead of spontaneous abortion) occurred after changes in legislation.

Developments in ultrasound technology (in the early 1980s) allowed them to identify earlier miscarriages.

According to French statutes, an infant born before the age of viability, determined to be 28 weeks, is not registered as a 'child'. If birth occurs after this, the infant is granted a certificate that allows women who have given birth to a stillborn child, to have a symbolic record of that child. This certificate can include a registered and given name to allow a funeral and acknowledgement of the event.

Other animals

Miscarriage occurs in all animals that experience pregnancy, though in such contexts it is more commonly referred to as a spontaneous abortion (the two terms are synonymous). There are a variety of known risk factors in non-human animals. For example, in sheep, miscarriage may be caused by crowding through doors, or being chased by dogs. In cows, spontaneous abortion may be caused by contagious disease, such as brucellosis or Campylobacter, but often can be controlled by vaccination. In many species of sharks and rays, stress induced miscarriage occurs frequently on capture.

Other diseases are also known to make animals susceptible to miscarriage. Spontaneous abortion occurs in pregnant prairie voles when their mate is removed and they are exposed to a new male, an example of the Bruce effect, although this effect is seen less in wild populations than in the laboratory. Female mice who had spontaneous abortions showed a sharp rise in the amount of time spent with unfamiliar males preceding the abortion than those who did not.