MISCARRIAGE

A miscarriage is the ending of a pregnancy due to the premature delivery of the foetus before the 20th week of pregnancy, a point at which the foetus is not developed enough to survive outside the uterus on its own. A miscarriage is called a spontaneous abortion in medical terms, but after the 20th week of pregnancy it is called a premature delivery or, if the foetus is born dead, a stillbirth. Most miscarriages, however, occur within the first...

14 weeks of pregnancy.

About 15 percent of known pregnancies end in miscarriage, but it is impossible to know how many miscarriages occur during the first month of pregnancy, before many women may even realize they are pregnant. The only indication may be a slightly late menstrual period with a heavier than normal flow.

There are several different types of miscarriages. They include:

·         Threatened miscarriage. One of every five pregnant women experiences this when she bleeds vaginally during the first three months. Although it may indicate that a spontaneous abortion will eventually occur, it is often no more than a threat, and the pregnancy continues normally.

·         Inevitable miscarriage. When a pregnant woman begins to bleed and the cervix dilates, it is then only a matter of time before the contents of the uterus are expelled.

·         Missed miscarriage. In this situation, the foetus dies in the uterus but is not naturally expelled and the woman has no bleeding or pain to signify that the pregnancy is not progressing. The physician usually diagnoses the condition when the uterus stops enlarging.

·         Incomplete miscarriage. This occurs when only parts of the uterine contents are naturally expelled.

·         Complete miscarriage. This occurs when all the uterine contents have been naturally expelled.

It's often not clear why a miscarriage occurs, but in many cases it is believed that a foetus is aborted because it is not developing normally. This is thought to be a chance event and is usually not due to a defect in either parent. Several factors can contribute to abnormal foetal development, including:

·         abnormalities in the father's sperm or in the mother's egg

·         disease in the mother, such as rubella (German measles), severe heart or kidney disease, diabetes, or thyroid disease

·         abnormalities in the uterus

·         the mother's use of certain drugs

·         the mother's exposure to toxic substances or certain environmental pollutants

Although women often worry that severe emotional trauma or stress or simply falling can cause a miscarriage, this is rarely--if ever--the case. That's true for automobile accidents, too.

If a woman has an infectious condition that causes a miscarriage and she is never treated for it, then the chances of a subsequent miscarriage increase and her pregnancies will be high risk.

Miscarriage in women can be very frustrating especially when she doesn’t know as to why it happened to her. It has a deep impact on her and the associated people. The sudden end to her pregnancy is very difficult to deal with but it could help her if she can identify the exact reason of this happening to her lest it can help her to conceive successfully next time or she would always be in dilemma whether it was her fault or her partner’s fault.

One out of four pregnancies ends up in miscarriage and therefore this is better for every woman to understand the reasons of the miscarriage and for a successful pregnancy by taking appropriate treatments and measures. Below are some of the possible causes:

Chromosomal abnormalities

Chromosomes contain DNA which determines the genetic make up of the baby. A normal fetus should have 46 chromosomes (23 from the father’s sperm and 23 from the mother’s egg). But sometimes the fetus can get abnormal number of chromosomes from mother or father or both. In such a scenario, the pregnancy terminates in miscarriage. Such chromosomal abnormalities account for around two thirds of early miscarriages.

Placental abnormalities

The placenta supplies the fetus with mother’s blood and nutrition. If this organ doesn’t develop properly, the pregnancy fails and ends with miscarriage.

Thyroid gland malfunctioning

If the mother is suffering from overactive thyroid gland (hyperthyroidism) or underactive thyroid gland (hypothyroidism) and she is not undergoing treatment or her thyroid hormone levels are not normal, then it can lead to miscarriage.

 Womb abnormalities

Certain womb problems like scarring on the surface can also cause miscarriage. Presence of fibroids (non-cancerous growths) in the womb can also lead to miscarriage.

 Prolonged illness

If the pregnant woman is suffering from chronic health problems like diabetes, severe hypertension, kidney diseases and the likes, then that can cause miscarriage if proper care is not taken.

Intake of some medicines

Certain medicines can also cause miscarriage or put a pregnant woman at an increased risk of miscarriage. Some of these medicines include: misoprostol, retinoids, methotrexate and non-steroidal anti-inflammatory drugs. Therefore it is extremely important that a pregnant woman must never take medicines without prescription or consulting with her gynecologist.

 Infections

If pregnant woman contracts infections like rubella, malaria, cytomegalovirus, toxoplasmosis, HIV, sexually transmitted diseases like chlamydia, gonorrhea and syphilis, then it can lead to miscarriage.

Drug abuse

If a pregnant woman takes drugs particularly cocaine, she may lose her fetus through miscarriage. Pregnant women should refrain from smoking, drinking and even drinking excess coffee.

Previous history of miscarriages

A woman who has had 3-4 miscarriages recurrently has a very high level of an antibody called aPL. This condition is also called Hughes syndrome. This can lead to miscarriage.

 Weakened Cervix

If a woman has naturally weak cervix muscles or they have been weakened because of some injury, then it may lead to miscarriage.

Genetic

In around half of all the early miscarriages the baby does not develop normally right from the start and survive.

Hormonal

Women with irregular periods may have the difficulty in conceiving and when they do they are likely to miscarry the fetus.

Immunological/blood clotting

Problems in the blood vessels that supply the blood to the placenta can lead to miscarriage.

Anatomical

If the bottom of the uterus is weak then it may start to open in the later stages of the pregnancy as it becomes heavier then.

There may not be enough room for the baby to grow if the uterus has the irregular shape.

Fibroids

Harmless growths also known as fibroids cause miscarriage

Symptoms of miscarriage

Vaginal bleeding

One of the symptoms of a miscarriage is vaginal bleeding (from a few drops to a heavy flow).  The bleeding can start suddenly or follow a brownish discharge. A solid clot of material or tissue may pass from the vagina. If possible, this should be saved for the doctor, who may be able to examine it and confirm that a miscarriage has occurred. A miscarriage can either be complete, when the uterus expels all the tissue, or incomplete, when some tissue remains inside the uterus.

A pregnant woman who starts bleeding or experiences abdominal pain should contact the doctor immediately. Depending on the type of miscarriage, diagnosis may be made on the basis of the medical history, physical examination, analysis of any discharge, blood and urine tests (to detect the presence of infection or anaemia caused by haemorrhage), or ultrasound studies (to establish the presence or absence of a foetus.)

Abdominal pain with cramping similar to period pain or back pain

Uterine cramps (either dull and constant or sharp and intermittent) in the lower abdomen or back occur.

Lessening of pregnancy symptoms

Here, the pregnant woman will not feel some of the symptoms a pregnant woman is supposed to feel, i.e. vomiting, constant spittoon, loss of appetite, tiredness, etc.

Treatment

Dilatation and Curettage

After an inevitable, incomplete, or missed miscarriage, any remaining fetal or placental tissue must be removed by a surgical procedure known as dilatation and curettage, or D&C), in which the physician expands the cervix and gently scrapes out residual material from inside the uterus. Without this precaution, a woman is more susceptible to infections and heavy bleeding.

Tests or medical investigations

Medical tests are the good method to ensure that the next pregnancy would be a successful one as you can hope of identifying your problem area by undergoing the tests and then taking the right treatment to remove the problem and get well.