A miscarriage (also known as a spontaneous abortion by doctors) is the loss of a foetus before the twentieth week of pregnancy, but most occur in the first twelve weeks, often before a woman realises that she is pregnant. It usually starts with a slight vaginal bleed, then period-type cramps low in the abdomen. The bleeding becomes heavier, and eventually clots and tissue may pass. Up to 15 percent of diagnosed pregnancies, and possibly 50 percent of all pregnancies, fail to reach 20 weeks.

   In more than half the cases, the miscarriage occurs because there is no baby developing. What develops in the womb can be considered to be just placenta (afterbirth), without the presence of a foetus (a blighted ovum is the rather blunt technical term). There is obviously no point in continuing with this type of pregnancy, and the body rejects the growth as a miscarriage.

Abnormalities in the developing foetus (eg: heart malformations) or faults in chromosome matching at the moment of conception, may not be compatible with continuing life, and often result in later than average miscarriages.

The placenta is responsible for transferring all nutrition and oxygen from the mother to the foetus. If it fails to develop normally, or attach to the inside of the uterus properly, the foetus may die.

   Some women do not secrete sufficient hormones from their ovaries to sustain a pregnancy, and this can also result in a miscarriage.

   Pelvic inflammatory disease (a long term low grade infection of the organs in the pelvis) and infection of the fallopian tubes (salpingitis) may result in both difficulty in falling pregnant and a miscarriage. Many of these are the result of sexually transmitted diseases such as gonorrhoea.

   Malformations of the uterus and cervix are another, though rarer, cause. This problem may be surgically corrected to prevent the cervix from opening prematurely, or to remove fibrous growths (fibroids) that may be distorting the womb.

   Malfunctions of any of the major hormone producing glands in the body may prevent a pregnancy from progressing. Examples are under or over activity of the thyroid gland in the neck, disorders (eg: tumour) of the pituitary gland under the brain, and poorly controlled diabetes.

   Severe infections or other disease (eg: cancer) of any type in the mother, significant physical damage (eg: multiple injuries in an accident), extreme emotional stress, malabsorption of food (eg: coeliac disease) and autoimmune diseases (inappropriate rejection by the body of its own tissue) such as systemic lupus erythematosus are other possible causes.

   Numerous drugs taken in early pregnancy, both prescribed and illegal, may be responsible. No medication, even those available without prescription,  should be taken during pregnancy unless a doctor or pharmacist is consulted.

   Miscarriages are more common in smokers and heavy drinkers of alcohol.

   In most cases, there is no reason why a subsequent pregnancy should not be successful. It is only if a woman has two miscarriages in succession that doctors become concerned, and investigate the situation further.


Mouth pain (Stomatitis)

   Pain in the mouth may arise from the teeth, gums, tongue, salivary glands or the moist mucous membrane that lines the mouth.


   By far the most common cause is an ulcer of the mucous membrane. The saliva in the mouth contains a huge number of different viruses, bacteria and fungi that are constantly interacting with each other and the body’s immune system. Every individual’s proportions of these normally harmless germs is different, but those in the mouth of a husband and wife are almost identical.   The balance is one that suits each person, but if that balance is disturbed by an additional infection, emotional or physical stress, or an injury, the brew of germs may start to attack the lining of the mouth to cause an ulcer (see “Mouth ulcer” entry below).

   Bacterial (eg: Streptococcus, tuberculosis), viral (eg: Herpes) or fungal (eg: thrush) infections of the mouth may also cause mouth pain and ulcers.

   Dental disease is a very common cause. Damage to teeth or fillings, dental decay or infection, and an abscess of a tooth root may all cause significant pain. Tapping on the affected tooth with a metal object (eg: spoon handle) will often identify the affected tooth by causing a sudden worsening of the pain. In all cases, seeing a dentist as soon as possible will minimise both pain and permanent damage to the tooth.

   Injury to the mucous membrane lining the mouth may be caused by very hot foods or drinks, sharp objects (eg: bone in food) inadvertently placed in the mouth, poorly fitting false teeth, and by medical procedures such as irradiation for skin cancer on the face.

   Teething pains in children between six months and two years of age may cause considerable distress as the first teeth cut through the gums. The pain may be felt in the ear, and the child may pull at the ear as though there is an infection there, but this is a referred pain. The nerves from the teeth and gums run along the top and bottom jaws to a point just in front of the ear where they pass through a hole in the skull to the brain, and are thus able to pass pain sensations from the jaw to the ear.

   Infections or stones in the any of the six salivary glands (three on each side, under and behind the lower jaw) may cause severe pain that is made worse by eating.


   Deficiencies of essential vitamins and minerals such as vitamin B (in pernicious anaemia and beriberi), vitamin C (in scurvy) and iron may result in mouth pain.

   Erythema multiforme is an acute inflammation (redness) of the skin, which may be triggered by drugs, bacterial or viral infections, cold sores and other herpes infections, or it may appear for no apparent reason. Patients develop several types of rash simultaneously. Stevens-Johnson syndrome is a form of erythema multiforme that progresses to cause infection and ulceration of the eyes, mouth inflammation, fever and ulcers in the vagina, urethra (urine tube) and anus.

   Ulcerative colitis is a serious disease where the lining of the large intestine becomes ulcerated and bleeds. Sometimes the mouth is also involved. Pain, blood in the faeces and diarrhoea are the common symptoms of this disease.

   Lichen planus is an uncommon skin condition which causes small, shiny, flat topped growths that may grow and join together to form a plaque. It can occur anywhere on the body surface, including the insides of the mouth, nose, ears, vagina and anus.

Reiter syndrome causes conjunctivitis, inflammation of the urethra (urine tube), arthritis and painful ulceration of the gums. Its cause is unknown, but settles slowly without treatment, although recurrences are possible.

   Some medications, such as phenytoin (for epilepsy) and captopril (for blood pressure and heart disease), may cause mouth soreness.


   Cancer in the mouth is rare, but when it occurs, a painful lump, firm patch of mucous membrane or ulcer develops.

   Pemphigoid is a skin disease of elderly women, although men may sometimes be affected. Patients develop red, scaling, itchy patches, which after a few days break down into large, fluid-filled blisters on widespread areas of the body. These huge, soft bubbles develop on the arms and legs initially, but soon spread to the trunk, and may involve the mouth.

   Leukaemia is a cancer of the white cells in the blood, and it may present with a multiplicity of symptoms, including mouth ulcers and soreness, tiredness, fever, pale colour, belly pains and loss of appetite.

   Kidney failure and a build up of waste products in the body is a rare cause.

   Behçet syndrome is a seriously disabling condition characterised by recurrent mouth and gum ulcers, genital ulcers, eye inflammation, arthritis and brain damage.

Hand-Schueller-Christian syndrome is a rare condition that causes skull bone defects, diabetes insipidus (excessive passing of urine), protruding eyes and ear inflammation as well as sore gums.

    see also Gum pain; Mouth ulcer; Throat pain; Tongue pain.


Mouth pigmentation

   The inside of the mouth may become darker in colour, or have patches of dark pigmentation, for a number of reasons. Negroes may naturally have some patchy pigmentation inside their mouths.

   The adrenal glands sit on top of each kidney, and produce hormones (chemical messengers) that control the levels of vital elements in the body and regulate the breakdown of food. Addison's disease occurs when the adrenal glands do not produce sufficient quantities of these vital hormones. The common symptoms are weakness, lack of appetite, diarrhoea and vomiting, skin and mouth pigmentation, mental instability, low blood pressure, loss of body hair and absence of sweating. It is diagnosed by special laboratory tests that measure the body's response to stimulation of the gland.

   Haemochromatosis is a congenital (present since birth) inability of the body to correctly process iron. Excessive amounts of iron are stored in the liver, pancreas, kidneys, heart, testes and other tissues. It is far more common in males than females, and because it is a very slowly progressive condition, it usually causes no problems until the patient is in his 50s or 60s. The common symptoms are liver enlargement and reduced liver function, joint pains, heart enlargement, impaired heart function, diabetes, dark skin, mouth discolouration and impotence. The disease can be diagnosed by specific blood tests and liver biopsy.

   A melanoma is a cancer of the pigment cells in the skin. They normally occur on sun exposed areas of skin, but rarely may develop just inside the mouth.

   The Peutz-Jegher syndrome is characterised by pigmentation inside the mouth and on the lips and fingers. Polyps that develop in the intestine may bleed and cause a gut obstruction.

   Kaposi’s sarcoma is a rare tumour that causes raised purple patches on the skin and in the mouth. It is almost invariably a complication of AIDS.

     see also Skin pigmentation, excess.