Understanding miscarriages

A MISCARRIAGE is the spontaneous loss of a pregnancy before the 28th week. Up to one fifth of all pregnancies end in miscarriage, maybe even more, but the bulk of these happen so early that a woman doesn’t even know she is pregnant.

Most miscarriages occur because the foetus isn’t developing normally and in most cases no actual cause can be found.

The bulk of miscarriages occur before the 12th week of pregnancy. If you are pregnant, you know you are having a miscarriage if you get;

◆ Vaginal spotting or bleeding ◆ Pain or cramping in your abdomen or lower back ◆ Fluid or tissue passing from your vagina

It is worth remembering, however, that most women who experience vaginal bleeding in the first few months go on to have successful pregnancies.

So what causes miscarriages, well, the problem could be with the mother, the foetus, or both. Most miscarriages occur because the foetus isn’t developing normally. Problems with the baby’s genes or chromosomes are typically the result of errors that occur by chance as the embryo divides and grows — not problems inherited from the parents.

Examples of abnormalities include:

◆ Blighted ovum. Blighted ovum occurs when no embryo forms. ◆ Intrauterine foetal demise. In this situation the embryo is present but has stopped developing and died before any symptoms of pregnancy loss have occurred. ◆ Molar pregnancy. A molar pregnancy is a noncancerous (benign) tumour that develops in the uterus. A molar pregnancy occurs when there is an extra set of paternal chromosomes in a fertilized egg. This is a rare cause of pregnancy loss.

In a few cases, a mother’s health condition might lead to miscarriage. Examples include diabetes, infections, hormonal problems, thyroid disease and problems with the uterus or cervix. Exercise, having sex and working (provided you are not exposed to harmful chemicals) will not cause a miscarriage.

Various factors increase the risk of miscarriage, including: ◆ Age. Women older than age 35 have a higher risk of miscarriage than do younger women. Some research also suggests that women who become pregnant by older men are at slightly higher risk of miscarriage. ◆ Previous miscarriages. Women who have had two or more consecutive miscarriages are at higher risk of miscarriage. ◆ Chronic conditions. Women who have a chronic condition, such as uncontrolled diabetes, have a higher risk of miscarriage. ◆ Uterine or cervical problems. Certain uterine abnormalities or weak cervical tissues (incompetent cervix) might increase the risk of miscarriage.

◆ Smoking, alcohol and illicit drugs. Women who smoke during pregnancy have a greater risk of miscarriage. Heavy alcohol use and illicit drug use also increase the risk of miscarriage. ◆ Weight. Being underweight or being overweight has been linked with an increased risk of miscarriage. ◆ Invasive prenatal tests. Some invasive prenatal genetic tests, such as chorionic villus sampling and amniocentesis, carry a slight risk of miscarriage.

Some women who miscarry develop a uterine infection, also called a septic miscarriage. Signs and symptoms of this infection include fever, chills, lower abdominal tenderness and foul smelling vaginal discharge. This is more common after backyard induced miscarriages.

When you are having a miscarriage, your doctor will do an exam and tests to make sure it is indeed a miscarriage and in which category it falls. Miscarriages are classified as threatened, inevitable, missed, incomplete and complete depending on whether the foetus is alive or not and whether the cervix is open or not.

A miscarriage cannot be treated as such. When it is only threatening, so called threatened miscarriage, your doctor will advise strict bed rest. You might be asked to avoid exercise and sex as well. Although these steps haven’t been proved to reduce the risk of miscarriage, they might improve your comfort. If you still go on to have a miscarriage, a procedure known as dilatation is curettage (D and C) is sometimes done to clean the inside of the uterus.

Physical recovery from miscarriage in most cases will take only a few hours to a couple of days. Expect your period to return within four to six weeks. You can start using any type of contraception immediately after a miscarriage. However, avoid having sex or putting anything in your vagina — such as a tampon — for two weeks after a miscarriage.

Often, there is nothing you can do to prevent a miscarriage. Simply focus on taking good care of yourself and your baby. Seek regular prenatal care, and avoid known risk factors — such as smoking and drinking alcohol. If you have a chronic condition, work with your doctor to keep it under control.