MISCARRIAGE

With modern antenatal care most pregnancies end happily. If a miscarriage does happen it is important to remember that this is often nature’s way of preventing the birth of a deformed child.

No one knows exactly how common miscarriages are since if one happens in the early weeks of pregnancy, the woman herself may be unaware that she was ever pregnant. It is estimated that between 10 and 25 per cent of pregnancies miscarry in the first three months (first trimester) and that an average of 30 per cent of women will miscarry during a pregnancy at some stage during their reproductive lives. An early miscarriage may be experienced like an unusually heavy period that is a few weeks late. It is often nature’s way of rejecting a fetus that is genetically abnormal or malformed.

CAUSES

A miscarriage in the first 28 days of pregnancy is often caused by a hormone imbalance. Instead of producing enough of the hormone that will maintain a pregnancy, the body goes through similar hormonal changes as it does during the menstrual cycle, resulting in what is called a partially suppressed period. The threatened miscarriage often starts at the time of the month at which the woman would normally have had her period. There may be some bleeding, either heavy or light, accompanied by backache or a heavy ache around the uterus (womb). Hormone deficiencies can also result in problems with the placenta, causing it not to develop adequately to sustain the pregnancy.

A miscarriage can also be caused by a cervix that is week . if the muscles of the cervix have been damaged in any way (either by previous surgery or a difficult previous childbirth) they are not able to support the pregnant uterus; the cervix is then described as ‘incompetent’.

Other miscarriage can be the result of genetic abnormalities. Research continues into why this can happen, but it is clear that it can relate to either the sperm or the ovum (egg).

SIGNS OF MISCARRIAGE

A miscarriage is likely to start with bleeding and/or pain, which will vary in its severity depending on the length of the pregnancy. The blood may become brighter red in colour, and contractions of the uterus may being to expel the pregnancy. This could take anything from under an hour to a number of hours, and the amount of pain experienced will vary from woman to woman.

A miscarriage due to an incompetent cervix will start with the amniotic sac (filled with amniotic fluid and containing the fetus) dropping downwards into the cervix. The sac then breaks, and the waters are lost through the vagina. After the loss of the waters a miscarriage will take place.

DANGERS

In most cases the body of the woman returns to normal after a miscarriage. But there can be dangers if the miscarriage has been incomplete, and not all the contents of the uterus have been expelled. A hemorrhage can follow and profuse bleeding of this kind can be very dangerous indeed. If heavy bleeding takes place either after a miscarriage or a medically – induced abortion a doctor should be seen immediately.

Infection can also occur after an incomplete miscarriage. The symptoms of this are a high temperature and pain in the lower abdomen. Treatment should be sought at once.

Afterwards the woman will have a curettage (scrape) to remove any residue left inside the uterus.

TREATMENT

Treatment for a miscarriage depends on the cause. It usually starts with bed rest and sedatives, and a normal pregnancy may well continue after a threatened miscarriage. If the miscarriage has already begun there is little a doctor can do to stop it.

As a result, most treatment for miscarriage is preventive, so can only be attempted for a woman who has a history of miscarriage when she next becomes pregnant. In some cases, if the cervix is known to be incompetent, it can have a stitch inserted around it to make it more secure. The stitch is removed a couple of weeks before the baby is due. A hormonal imbalance can be rectified.

WHAT TO DO FOR A THREATENED MISCARRIAGE

At the first signs (bleeding from the vagina and pain), the patient should go to bed and her doctor called. The doctor will be able to assess whether the pregnancy can be saved tranquilizers, painkillers or hormone injections may be given. The patient will be advises to rest at the time her next period would be due. Internal tampons should not be used and sexual intercourse avoided.

If a miscarriage is imminent the patient may be admitted to hospital. If it happens before the doctor arrives the products of the uterus (a large, liver-like clot) should be kept for the doctor to examine. This indicates whether or not the miscarriage has been complete.

EMOTIONAL PROBLEMS

More difficult to treat are the feelings of loss and grief that many women experience after a miscarriage. Women often blame themselves needlessly for what has happened, and have strong feelings of guilt. Any woman who has had a miscarriage will need the care and support of those around her, as well as reassurance that she was in no way responsible for the loss of her pregnancy. Some women may need to wait for several months before they feel emotionally able to cope with another pregnancy, even if the indications are that the next pregnancy is likely to be normal.

REPEATED MISCARRIAGES

If a woman miscarries at different times during three or more pregnancies this is described as recurrent miscarriage. Each miscarriage may have a different cause, so thorough tests are very important – for both the woman and the main concerned. This is because the health of the father’s sperm may be poor. Some women miscarry at the same point in each pregnancy. If this happens three or more times it is described as habitual miscarriage. This could be for a number of reasons depending on the time of miscarriage. This could be for a number of reasons depending on the time of miscarriage. Internal problems, like fibroids in the uterus, may be the cause, and these can be treated.

Many miscarriages may be caused by particular circumstances such as a single malformed ovum, which are unlikely to happen again. Doctors usually advise women to wait for three months or so before beginning another pregnancy, although sexual intercourse can start once internal recovery is complete, which may be a matter of weeks.

STARTING AGAIN

Once a woman has recovered from a miscarriage it may take time before she is ready to try again.

How soon another pregnancy should begin will depend on age, general health, and why the previous miscarriage happened. The doctor can advise how long it is best to wait. It is worth remembering that miscarriage is especially common in a firs pregnancy, and that a very high number of second and that a very high number of second pregnancies progress normally and result in the birth of a healthy child.