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12 December 2011

All you need to know about miscarriage

A happy outcome of pregnancy is normally taken for granted by couples who have just conceived. But there are many things that might complicate a pregnancy. One of the most common adverse outcomes in early pregnancy is miscarriage. Losing a baby can be a heartbreaking experience for any expectant couple. More than the physical pain, the emotional pain can be devastating, involving feelings of anger, guilt, depression, hopelessness and loneliness. Unfortunately, miscarriage is much more common than most people think. It is therefore important to know certain facts about the condition in order to help patients cope with the consequences.

A miscarriage can occur at any time of a woman’s gestation period; it is when the loss of a pregnancy occurs spontaneously before the embryo or the foetus is developed enough to survive. This is also known as spontaneous abortion in medical terminology.

An average of about eight to 20 percent of clinically-recognised pregnancies, with less than 20 weeks of gestation, end in miscarriage and more than 80 percent of these losses happen before 12 weeks of gestation. As the gestation age increases, the incidence of pregnancy loss decreases. Sometimes the pregnancy loss occurs so early in the pregnancy, even before the woman is aware that she is pregnant, that she may not even realise that she has had a miscarriage and may just mistake it for heavy menstruation.

The signs and symptoms of spontaneous abortion generally include abdominal pain with bleeding and expulsion of fleshy mass from the birth canal. If the expulsion is complete, no intervention is required. But sometimes there might still be some tissue remaining inside the womb, which needs to be removed. This is done either with the help of

medication (oral or vaginal) or via a surgical procedure called evacuation. Sometimes the embryo or the foetus is dead inside the womb and demonstrates reluctance in being expelled; in this case, the pregnancy needs to be aborted—either through medicinal or surgical means.

Most of these pregnancy losses are because of chromosomal defects in the foetus, which, unfortunately, cannot be prevented. But there are some preventable causes of miscarriage, most of which comprise of maternal diseases such as diabetes and thyroid problems, uterine abnormalities and infections. Advancing age, smoking, drinking and a history of miscarriage are also some known risk factors for potential pregnancy losses. The general beliefs that working, washing, riding or travelling causes miscarriage, however, do not have any valid ground.

Although most miscarriages cannot be prevented, precautions should be taken to increase the chances of having a healthy pregnancy. It is important to maintain good health with proper diet and exercise before pregnancy. Drinking, drugs and alcohol should be avoided at all costs. It helps to visit a doctor before conceiving, for counseling and advice. And of course, regular antenatal check-ups are necessary after conception as well. Folic acid supplements should be taken before pregnancy to secure the foetus against neural tube defects occurring from folic acid deficiency. If the pregnancy is otherwise normal, exercise, work and sexual contact do not increase the risk of having a miscarriage. And with patients with a history of recurrent miscarriages, a thorough workup is required to identify any underlying complexities.

After a miscarriage, a woman should not hurry on to the next pregnancy. There is no definite time period that she would have to wait before trying to conceive again but at least three months is advisable to improve the chances of having a healthier pregnancy. She should give herself time to heal both physically and emotionally before attempting another pregnancy. Most couples who have experienced a miscarriage are naturally anxious about it happening again. Fortunately, at least 85 percent of women who have had one loss will go on to have a successful pregnancy the next time, 75 percent after two losses and still 57 percent after three or more miscarriages.

Miscarriage is a fairly common complication of early pregnancy and most of the time unpreventable. Even after repeated miscarriages there is still a good chance of achieving a successful pregnancy. A visit to a doctor before or during pregnancy is highly recommended, however, so risk factors can be identified and dealt with early on.

Dr Singh is an Associate Professor of Obstetrics and Gynaecology at the Patan Academy of Health Sciences

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All you need to know about miscarriage

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