Miscarriage
The possibility of miscarriage raises a prickle of uncertainty in the minds of many women during the early months of pregnancy. Medically called spontaneous abortion, miscarriage is the loss of the foetus and all or part of the placenta during the first 20 weeks of pregnancy, before the foetus is sufficiently mature to survive. After 20 weeks it’s called ‘pre-term birth’.
Miscarriage is very common. Around 15 per cent of all diagnosed pregnancies miscarry. Many more (possibly up to 50 per cent) miscarry before the pregnancy is diagnosed or even suspected, when a woman who is trying to conceive has a slightly late and perhaps heavier than usual period. There may be no evidence of early pregnancy failure if conception fails before the next period is due.
What causes miscarriage?
Many things cause miscarriage, the most common being foetal chromosomal abnormality. It is estimated that about seven out of ten miscarriages in the first three months are due to defects in the foetus that would make survival impossible. Other possible causes include immune system disorders, temporary or permanent conditions of the uterus that it incapable of retaining a pre hormonal disorders and, less commonly, maternal illness in the early months. Researchers have tried to find links be: miscarriage and psychological stated no definite connections have been found.
When is miscarriage most likely to happen?
The risk of miscarriage is highest immediately after implantation, and diminishes as the pregnancy advances. Once you’ve passed the 12-week mark and the foetus is alive and well, the risk is small. A miscarriage after three months is more; to be due to abnormalities in the uterus or cervix.
Bleeding or bloodstained discharge from the vagina is usually the earliest sign. Any bleeding, even slight, after a pregnancy has been diagnosed is called threatened abortion. About one-third of all pre women will have some bleeding during the first twelve weeks: less than half these will miscarry.
The blood loss of threatened miscarriage is often painless and is unrelated to activity. If it is slight and dark it usually settles down in a day or so and the pregnancy continues without further mishap. Babies born to mothers who have ‘threatened’ have no more abnormalities than those born to mothers who’ve had no bleeding.
Generally no treatment is recommended for threatened miscarriage, except to avoid intercourse and strenuous activity until bleeding stops. It’s unlikely that bed test is of any benefit, but most women prefer to take things very easily until the threat has passed.
If the bleeding becomes heavier and is accompanied by cramps, it usually means that the placenta has begun to separate from the uterus and that the pregnancy is doomed. This is an inevitable abortion. Often the pregnancy will be completely discharged from the uterus as a lump of soft, liver-like tissue consisting of the placenta lid membranes. After 10 weeks there may be a recognizable foetus. If the bleeding settles quickly and the pregnancy has been entirely expelled, a complete spontaneous portion has occurred. The uterus contracts to normal size, the cervix closes and no treatment is usually necessary.
All or part of the doomed conception may remain in the uterus, preventing it from contracting properly. This is an incomplete
abortion. In such cases profuse and dangerous bleeding can continue.
Occasionally the foetus dies but remains in the uterus, with little or no bleeding or pain. This is missed abortion, which can be difficult to diagnose because the uterus remains enlarged, though other symptoms of pregnancy usually disappear. If suspected, missed abortion can usually be diagnosed by falling levels of pregnancy hormone in the blood, and even more certainly by ultrasound examination. When missed abortion is confirmed, emptying the uterus by curettage is usually recommended.
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