MISCARRIAGE

Human society still tends to dismiss Miscarriage complacently. It is a subject which is rarely discussed. A foetus for most persons is a non-person and miscarriage is a non-event. But, to the would-be parents, the developing foetus is a baby with an identity, especially if they have seen it in the ultrasound screen and heard its heart throbbing.



It is followed by an incomprehensible sense of loss and hopelessness, of bereavement tinged with pain with anger, isolation and depression.

Miscarriage / Abortion is the termination of pregnancy before the foetus is capable of extrauterine life, generally considered to be before 24 weeks of gestation.



Usually miscarriage occurs between 6-12 weeks of pregnancy but second trimester miscarriage also takes place up to 24 weeks.



The most common cause of miscarriage is Abnormalities of foetus causing 50 to 80% of all miscarriages. Defective implantation site, abnormal embryo, maternal viral infections, chromosomal aberrations, cytotoxic drugs and agents taken by the mother cause this malformation of foetus. In case of recurrent miscarriage due to genetic defects, we suggest a karyotype, study of the chromosomes, of the foetal tissue. In about 5% of the couples that we screen, we find chromosomal abnormality in one of the parents explaining the cause of recurrent miscarriage. If the karyotype is normal then the patient can be reassured that the earlier miscarriage was a chance genetic event and the couple could be comforted to plan another baby.



Other causes of miscarriage are:

1.
Physical problems as distortion of the uterine cavity-The common types of uterine anomalies include: a septate uterus (in which a wall divides the uterine cavity), a unicornate uterus (in which the uterus has only one horn) and a bicornate uterus (in which the uterus has two horns as the two did not fuse normally during their development). This kind of abnormal uterus cannot grow normally to hold and retain pregnancy and then this is consequently expelled.
Presence of fibroids, as such, does not mar a pregnancy unless the fibroid is very close to the lining of the uterus.
2.
Hormone imbalance-The hormone Progesterone supports the pregnancy and helps in the implantation of the embryo in the uterus. If this is deficient, then the embryo lodging in the uterine lining gets weaker and may cause miscarriage.
3.
Endocrine or hormonal disorder as diabetes and hyper or hypo thyroidism.
4.
Severe heart, liver and kidney disease
5.
Any infection
6.
Abnormal antibodies in the blood that cause formation of blood clots. This mostly causes recurrent miscarriage by affecting the flow of blood to the placenta, thereby affecting its normal functioning. The result is the deprivation of the foetus of essential oxygen and nutrients, leading to its untimely death!
7.
An illness in which the woman produces antibodies against her own body tissues.

It is an accepted fact that around 15% of known pregnancies result in miscarriage. The rate for women under 35 years is around 6% and this further rises to 25% for those above 40 years. This occurs due to the increase in the chance of chromosomal abnormality with age.

Miscarriage is increasing amongst urban women. Age plays a very crucial role. Many women consider the 30s the happy-medium age for motherhood. A woman is more apt to be secure in her career and in relationship and so she opts for family planning at this juncture. This is one side of the coin. The other flip side is that there is a tremendous difference between a woman?s ability to get pregnant in her early versus her late 30s. As the age progresses the fertility of the woman goes into free fall. That is the reason why doctors caution women in their 30s not to wait too long particularly if they want more than one child. With age the ability to carry pregnancy decline and added to this is the routine rigmarole of stress and strain that a woman has to go through in this modern and dynamic lifestyle of ours.



The unhealthy food habits, intake of alcohol and smoking further aggravates the problem. Smoking is linked to low birth weight and increased risk of hospitalization during the first eight months of pregnancy. Having a partner who smokes, also increases the risk of miscarriage.



Even the environmental toxins expose a woman to greater risks of miscarriage.



Some common questions which we encounter from the patients are:
What are the signs that of having a miscarriage?
Spotting-finding spots of blood after urinating. Sometimes bleeding is the first sign of miscarriage. It is important to remember that spotting is common in early pregnancy and may or may not be a sign of a problem with the baby. However, 50% of the time, it is actually a symptom of a serious problem such as miscarriage or Ectopic pregnancy. The advice is to get I touch with your doctor immediately.

Is it necessary to undergo surgery after having a miscarriage?
Not always. Either the patient is conservatively managed under close monitoring involving regular scans or a D&C (dilatation & curettage) could be performed. The decision is taken based on clinical factors. By this process, the chance of infection is reduced and ensured that the patient does not continue to bleed.
What if more than one miscarriage is experienced?

If a woman has two or three miscarriages, it is called Recurrent Miscarriage. One needs to see the gynaecologist for this and investigations are recommended into physiology, hormones and immune system. If the reports are negative, then chances of next pregnancy being successful is 70%.



What are the chances of having a healthy baby after repeated abortions?
In case one has experienced recurrent miscarriage, one may feel hopeless regarding a positive pregnancy outcome. The real test lies in knowing the causes of this recurrent miscarriage. But knowledge of this problem is still limited, and no obvious cause is detected in up to 50% of couples with repeated pregnancy loss. This can be very frustrating. The encouraging news is that the spontaneous cure rate is very high; and successful treatment is available for treating certain uterine and endocrine causes.


Post miscarriage when can a couple try for another baby?

There are no hard-and-fast rules. The right time to try for children again normally varies from one couple to another. It is advisable to recover from the emotional turmoil before starting another pregnancy.



Some couples decide that they want to begin trying for a pregnancy right away, while others feel that it is too soon and need time to get over this loss.


As a doctor we advise to wait for the first period to start and then begin trying.