Miscarriage – January 1st, 2005
Dr.A.ILLANCHERAN, GYNAEGOLOGIST. SINGAPORE
Among the many problems that affect women in early pregnancy, miscarriage is the most serious one. Especially if it occurs during the very first pregnancy, these young women are affected badly. Due to ignorance and superstitious believes, many wrong ideas exist on the concept of ‘miscarriage’. This article intends to bring the facts as to why and how miscarriage takes place from a medical point of view
Miscarriage is not something unusual. Medical experts say 35 to 40% women undergo miscarriage during their pregnancies. There are three stages in pregnancy and they are called first, second and third trimester. Miscarriages are more prone during the first two trimesters. First trimester miscarriage is the most common. The main reason is due to defects in the chromosomes. These defects occur during the conception period itself and hence this kind of miscarriage is inevitable. Deficiencies in hormone levels too, can lead to miscarriage. This can be reduced by giving hormone injections. Many other times the reason for miscarriage is unknown.
Generally, in the first trimester, if there is bleeding with pain, chances for miscarriages are high. After careful diagnosis, it can be classified into four types.
If the cervix is closed and the foetus is found healthy by ultrasound, it is known as threatened abortion. Complete rest and hormonal injections in this case may help prevent miscarriage. If these precautions are followed, the chance of completing the pregnancy is high. During this period, intercourse should be avoided. As stated earlier, if there are defects in the chromosomes, no amount of treatment can over come this.
This kind of miscarriage begins with the signs of the threatened miscarriage.If the bleeding continues, then foetal growth stops too. This is called inevitable miscarriage. During examination, if the cervix is found to be opened then it confirms the miscarriage to be inevitable. This kind of foetus cannot be saved. Only a D&C (dilatation and curettage) can stop the bleeding.
In some cases, after a while, the bleeding stops. In some cases, the symptoms of pregnancy stops all of a sudden. During the examination, it could be found that either there is no growth in the foetus or the heart beat has stopped (through ultrasound) or there would be no sign of a foetus at all (blighted ovum). If still there is doubt, another examination could be done. If the missed abortion is confirmed,then the uterus should be emptied.If the dead foetus stays for a long time inside the uterus, it can lead to clotting defects. Due to this, there will be lot of bleeding and it can pose a threat to life.
Among with bleeding certain parts of the foetus get expelled. To expel the rest of the foetus, the uterus contracts. This can cause intense pain. To stop the bleeding, the uterus should be cleaned completely.
MISCARRIAGE DURING THE LATER STAGE:
If miscarriage takes place in the second trimester, the main reason is an anatomical defect in the uterus. In cases with cervical incompetence,the cervix opens without any pain and the foetus is expelled. This happens usually around 14-16 weeks of pregnancy. If this condition is detected successfully during the first pregnancy, in the following pregnancies,the cervix can be closed with a special tape, after about twelve weeks of pregnancy. If this is detected and operated successfully there are high chances to complete the pregnancy.
The above facts should clear some of the misconceptions about miscarriages.Also one should understand that miscarriage is not something that recurrs. In fact, the chance of a successful pregnancy the next time is higher than having another miscarriage. There is another misconception about pregnancy that, carrying heavy goods, climbing up the stairs, and commuting in public transport can lead to miscarriage. This is no truth in any of these beliefs.First trimester miscarriage cannot be avoided or saved by doing or not doing anything. It is best to leave it to mother nature and to be optimistic without worrying too much.