Miscarriage is a relatively common experience.It is estimated that up to 50 percent of all pregnancies end in a miscarriage. The emotional toll from a miscarriage can be tremendous and many women often blame themselves unnecessarily. Most miscarriages occur because the fetus is not developing normally.
What is a miscarriage?
The medical term for miscarriage is spontaneous abortion, but this condition is not an abortion as most people commonly refer to. A miscarriage is the spontaneous loss of a fetus before the 20th week of pregnancy. Miscarriages are less likely to occur after 20 weeks gestation. These are termed late miscarriages.
What causes miscarriage?
Despite years of clinical research we do not fully understand what causes miscarriages. Most miscarriages that occur in the first trimester (first three months of pregnancy) are caused by chromosomal abnormalities (genes) in the baby. Most chromosomal problems occur by chance and are not related to the mother’s or father’s health.
There is no proof that stress or physical or sexual activity causes miscarriage, but other factors are associated with miscarriages and include the following:
• Hormone problems
• Lifestyle factors like smoking, drinking alcohol or using illegal drugs
• Infection
• Exposure to environmental and workplace hazards such as high levels of radiation or toxic agents
• Uterine abnormalities
• Disorders of the immune system, including lupus
• Congenital heart disease
• Diabetes that is not controlled
• Thyroid disease
• Weight. Being underweight or being overweight has been linked with an increased risk of miscarriage.
In addition, women may be at increased risk for miscarriage as they get older (especially over the age of 40).
What Are the Symptoms of a Miscarriage?
Some women in the very first weeks of pregnancy might have a miscarriage and are not aware of it, but the symptoms include the following:
• Bleeding which progresses from light to heavy
• Fluid or tissue passing from your vagina
• Severe cramps
• Abdominal pain
• Back pain
If you experience these symptoms you should inform your obstetrician or healthcare provider. It should be pointed out that most women who experience vaginal spotting or bleeding in the first trimester go on to have successful pregnancies.
Diagnosis
Your doctor will carry out a complete history and clincial examination. Further tests and investigations might be needed. An ultrasound scan of the uterus is often required.
Treatment
Once a diagnosis of miscarriage is made several treatment options are available. Admission to hospital might not be required. If the miscarriage is complete, and the uterus is empty, then no further treatment is usually required. Occasionally, the uterus is not completely emptied, so a dilation and curettage (D&C) procedure is performed. As an alternative to a D&C, certain medications can be given to cause the uterus to expel its contents. This option may be more ideal for someone who wants to avoid surgery and whose condition is otherwise stable.
Complications
Some women who miscarry develop a uterine infection, also called a septic miscarriage. Signs and symptoms of this infection include:
• High fever
• Chills
• Lower abdominal tenderness
• Foul-smelling vaginal discharge
These patients will require hospitalization and should be managed by an experienced gynaecologist.
Follow up
All women who had a miscarriage should be reviewed. The patient will need counselling and further gynaecological care. The vast majority of women who had a miscarraige go on to have a successful pregnancy following a miscarriage. There are few indicators to predict an early miscarriage, but individuals who had a miscarriage should see their obstetrician prior to planning a subsequent pregnancy, or very early in the following pregnancy.
Conclusion
Miscarriage is a very common occurrence, but that does not make it any easier for the woman who experiences it. Most miscarriages occur because the fetus is not developing normally. These abnormalities are rarely understood, so it is often difficult to determine what causes them. The vast majority of women who have a miscarriage go on to have successful pregnancies in the future.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
