Miscarriage

What is Miscarriage?

Miscarriage, also known as spontaneous abortion, is the loss of an embryo or foetus before 28 weeks of gestation or when the foetus weighs less than 500 grams. It is a common occurrence, affecting approximately 10-20% of pregnancies.

Causes of Miscarriage

In about 60% of miscarriages, the cause remains unknown. However, several factors can contribute to miscarriage:

• Chromosomal abnormalities: These are the most common cause of miscarriage, accounting for about 50% of cases.
• Age: Miscarriage rates are higher for women over 35 years old and younger than 15 years old.
• Medical conditions: Chronic illnesses like diabetes, hypertension, and autoimmune diseases can increase the risk of miscarriage.
• Previous miscarriages: A history of miscarriages increases the chances of experiencing another one.
• Lifestyle factors: Smoking, alcohol consumption, and drug use can harm the developing embryo or foetus.

Types of Miscarriage

Miscarriages can be categorised based on their severity and progression:

• Threatened abortion: Vaginal bleeding occurs but the cervix remains closed. Half of these cases result in miscarriage, while the other half continue to term.
• Inevitable abortion: Heavier vaginal bleeding and abdominal cramps occur, along with an open cervix. The amniotic sac may also rupture.
• Complete abortion: The foetus and all uterine contents are naturally expelled. This type of miscarriage typically resolves on its own without medical intervention.
• Incomplete abortion: Only part of the foetus or uterine contents are expelled. This requires medical intervention to remove the remaining tissue and prevent complications.
• Missed abortion: The foetus has died but has not been expelled, often for several weeks or months. Diagnosis typically involves ultrasound.
• Septic abortion: Miscarriage accompanied by an infection, leading to fever, abdominal pain, and vaginal bleeding.

Identifying the Signs of Miscarriage

If you're pregnant and notice any of the following symptoms, it's crucial to seek medical attention immediately:

• Vaginal Bleeding: This can range from mild spotting to more significant bleeding.
• Abdominal Discomfort: Experiencing pain in the abdominal area.
• Discharge of Tissue: Any tissue expelled from the vagina should be promptly addressed.

Diagnostic Procedures for Miscarriage

To accurately diagnose a miscarriage, your healthcare provider will likely undertake the following:

• Review of Medical History: This includes an assessment of menstrual and pregnancy history, especially any previous abnormal pregnancies.
• Physical Examination: An internal examination may be performed to evaluate the condition of the cervix.
• Ultrasound Scanning: This helps in determining the fetus's size and developmental stage, particularly when the gestational age is uncertain.
• Hormone Blood Tests: These tests measure pregnancy-related hormone levels.

Effective Management and Treatment Strategies

The treatment for a miscarriage depends on several factors, including the fetus's condition and the severity of the symptoms:

• Mild Symptoms: If the foetus is healthy and symptoms are mild, rest at home may be sufficient.
• Severe Symptoms: In cases of intense vaginal bleeding, hospital admission for close monitoring may be necessary.
• Recurrent Miscarriages: For women who have had multiple miscarriages, additional investigations may be conducted to identify the underlying causes.
• Cervical Incompetence: In certain cases, a cervical stitch (cerclage) might be applied to prevent miscarriage during the second trimester.
• Hormonal Treatment: Hormonal imbalances may be addressed with medications like progesterone.
• Dilation and Curettage (D&C): This procedure is performed to remove uterine contents in cases of incomplete miscarriage or when miscarriage is inevitable.
• Medication: Specific drugs might be prescribed to ensure a complete miscarriage, particularly when some uterine contents are retained.

Potential Complications and How to Address Them

• Excessive Bleeding: This may lead to anaemia or more severe conditions like shock and even death.
• Infection Risks: Infections can occur due to prolonged bleeding or retention of pregnancy tissues.
• Surgical Risks: Dilation and curettage procedures carry a slight risk of uterine perforation.

Prevention and Aftercare Following a Miscarriage

• Early Prenatal Care: Starting prenatal care early, particularly if you have a history of cervical issues, is vital.
• Lifestyle Choices: Maintain a healthy lifestyle through exercise, adequate rest, and a balanced diet. Avoid alcohol, smoking, and unmanaged pre-existing health conditions.
• Mental Health: Pay attention to your emotional well-being.
• Birth Control: Consider using birth control methods two weeks post-miscarriage.
• Dietary Considerations: Eat healthily and consider supplements like folic acid before conception.

Immediate Actions to Take

If you experience any unusual symptoms during pregnancy, such as vaginal bleeding, abdominal pain, or tissue discharge, it's imperative to visit your doctor immediately to mitigate the risk of complications like hemorrhage.