INTRODUCTION
A woman is said to have a miscarriage when the developing embryo or fetus dies before the 24th week of pregnancy. It is usually characterized by vaginal bleeding, the passage of fetal tissues [clot], and lower abdominal pains in some cases.
About 90 % of miscarriages will occur in the first 12 weeks of pregnancy. Miscarriage rates are about 15 – 30 % among women with higher rates among those older than 40 years.
SYMPTOMS
A woman having a miscarriage will notice she is bleeding per vagina. This is usually the first sign. She may also notice the passage of brownish discharge. In some cases, the bleeding resolves spontaneously and the pregnancy continues to develop. However, in some women progression of the miscarriage leads to abdominal pains, the passage of fleshy tissue and increased bleeding.
CAUSES
About 90 % of cases of miscarriage are caused by chromosomal abnormalities, usually caused by faulty or damaged eggs or sperm that go ahead and get fertilized. At fertilization there are over 50 million sperm cells that seek to fertilize the ovulated egg; as many as 50% of these sperms could be damaged and any of them could go ahead and fertilize the egg. Also, about 20 or more follicles start the journey for ovulation but only one gets released. There is no way of telling that the released egg is genetically okay.
Advanced age of a woman could cause miscarriage because the eggs are ‘ageing’; smoking, drinking alcohol; medical conditions like diabetes mellitus, thyroid diseases, infectious diseases, presence of fibroids; some medications such as Ibuprofen ‘Brustan’; exposure to X rays and chemotherapy [drugs for cancer treatment] could all cause miscarriages.
PREVENTION
Rates of miscarriage could be reduced by avoiding the known modifiable factors. These include: Maintaining a healthy weight; eating nutritious meals, abstaining from drinking alcohol or smoking cigarettes; avoiding recreational drugs such as cocaine, marijuana.
DIAGNOSIS
If you notice you’re bleeding, you need to visit your health care provider. After asking you some questions and examining the cervix [neck of the womb] to find out if it is open, he may send you for a pregnancy test if you have not done one and an ultrasound scan. An Ultrasound scan is important to make sure you’re not having an ectopic pregnancy [discussed next].
An ultrasound will also help distinguish the different types of miscarriages.
TYPES OF MISCARRIAGE
THREATENED MISCARRIAGE
The client has painless vaginal bleeding, but the embryo is alive and the cervix is closed. Reassure the client and counsel on the reduction of activities.
Treatment: Bed rest; progesterone support.
INEVITABLE MISCARRIAGE
The client has painful vaginal bleeding. The embryo may be alive but the cervix is opening. Miscarriage will usually progress to full miscarriage.
Treatment: Counseling; Evacuation via Misoprostol or Manual Vacuum Aspiration. Antibiotics are given to reduce the risk of infection.
INCOMPLETE MISCARRIAGE
The client has painful vaginal bleeding, with the passage of blood clots and some parts of the fetus/embryo. Cervix is open. An ultrasound scan will show some parts of the fetus remaining in the uterus. Miscarriage may progress to complete.
Treatment: Counseling; Evacuation via Misoprostol or Manual Vacuum Aspiration. Antibiotics are given to reduce the risk of infection.
COMPLETE MISCARRIAGE
The Client bled initially with the passage of clot and tissues but this has stopped. The cervix has closed and there are no more pains. An ultrasound scan shows an empty uterus.
Treatment: Counseling; some persons recommend the use of antibiotics to reduce rates of infection.
ANEMBRYONIC PREGNANCY [BLIGHTED OVUM]
The client usually has slight bleeding. The cervix is closed. An ultrasound scan shows an empty sac with no embryo.
Treatment: Counseling; Evacuation via Misoprostol or Manual Vacuum Aspiration. Antibiotics are given to reduce the risk of infection.
MISSED ABORTION
The client may only notice she is no longer having pregnancy symptoms or some slight spotting. Cervix is closed. An ultrasound scan shows the embryo/fetus is no longer alive.
Treatment: Counseling; Evacuation via Misoprostol or Manual Vacuum Aspiration. Antibiotics are given to reduce the risk of infection.
SEPTIC MISCARRIAGE
The client has had a miscarriage and the remaining products get infected over time. The patient usually has a fever with offensive vaginal discharge and abdominal pains. An ultrasound scan shows parts of the fetus remaining in the uterus.
Treatment: Counseling; antibiotic administration; Evacuation via Manual Vacuum Aspiration. The client may need a blood transfusion if blood levels are low.
WHEN TO SEE A DOCTOR
Having a miscarriage is a difficult time for most couples. Many grieve in silence and may not want to talk about the experience they have had. If you have had a miscarriage you could discuss with your healthcare giver to employ the services of a psychologist or psychotherapist to discuss your feelings.
Couples who have a miscarriage can heal faster by:
- Turning to your spouse for support. Sharing your feelings can be a great way to help you heal from grief.
- Discuss with your doctor and find out what went wrong and how to prevent it if possible.
- You can talk to your spiritual leader for some spiritual help. This is usually very helpful.
TRYING FOR THE NEXT PREGNANCY
Your doctor may counsel you to wait for about 3 months before attempting to get pregnant after a miscarriage; however, recent findings show it may be fine trying again after one normal menstrual cycle. Your doctors will advise you to take folic acid during the waiting period.
