Spontaneous Abortion or Miscarriage
Abortion describes the loss of pregnancy before the foetus is viable which is medically defined as less than 20 weeks’ gestation or fetal size greater than 500 grams. Abortion can be either spontaneous or induced. Spontaneous abortion, often called a miscarriage, occurs without intervention from the woman or another person.
Some miscarriages have unexplained causes. However, the most common factors that may lead to a miscarriage are:
• chromosomal abnormalities
• maternal endocrine disorders (e.g. hypothyroidism, uncontrolled diabetes)
• reproductive system abnormalities (e.g. an incompetent cervix)
• maternal injury e.g. falls, bumps, etc.
• maternal infection
• drug abuse
• environmental factors such as poor water and sanitation, starvation, etc.
Spontaneous abortions are classified into several categories according to symptoms as follows;
1. Threatened abortions
This is usually when there is vaginal bleeding and, possibly, uterine cramping. Women suffering from a threatened abortion may or may not lose the fetus. However, careful monitoring and appropriate intervention are necessary. These include:
• Avoid sexual activity, tampons, and douches and strenuous exercise.
• Note and report bleeding to their healthcare practitioner.
• The doctor might prescribe bed rest for a period of time.
• Hormonal supplementation through drugs might also be prescribed.
2. Inevitable abortions
This occurs when amniotic membranes rupture and the cervix dilates. In this case, the miscarriage is considered inevitable. The woman will typically have cramping as the foetus is expelled without intervention. However, a dilation and curettage (D&C) may be performed if necessary. This is a brief surgical procedure in which the cervix is dilated and a special instrument is used to scrape and to remove tissue from the uterine lining.
3. Incomplete abortions
This occurs when some, but not all, of the products of the pregnancy, are expelled from the uterus. The retained products prevent the uterus from contracting completely, which results in bleeding from uterine blood vessels. The woman would experience severe cramping and profuse bleeding.
Treatment would include:
• Intravenous (IV) fluids and possibly blood products.
• A dilation and curettage (D&C) is performed to remove the retained products of the pregnancy.
• Medications such as oxytocin (Pitocin) or methylergonovine (Methergine) to contract the uterus and stop the bleeding.
4. Complete abortions
This is when all of the products of conception, including the foetus and placenta, are expelled from the uterus. The cervix closes and cramping and bleeding stop. Further intervention is typically not necessary. However, it is important to consult your doctor if there is any additional bleeding, pain, or symptoms of infection, such as fever or foul-smelling vaginal discharge.
5. Missed abortions
This occurs when the foetus expires during the first half of pregnancy but is retained in the uterus. If there are no obvious signs of infection present, you may carry the foetus until spontaneous expulsion occurs. This may take several weeks. However, a dilatation and curettage (D&C) may be performed. Consult your doctor immediately if you experience shortness of breath, chest pain, and bleeding from the nose and gums.
6. Recurrent (or habitual) spontaneous abortion
This refers to three or more consecutive spontaneous abortions or miscarriages. Several studies suggest that genetic defects and reproductive system abnormalities are the primary causes of recurrent abortions. In this case, you will be screened and examined for reproductive system abnormalities, such as recurrent premature dilation of the cervix, also known as incompetent cervix. In this case, a suturing procedure known as a cerclage may be performed to prevent the cervix from opening until delivery.
After a miscarriage
During the recovery time after a miscarriage:
• It is important to consult your doctor if you experience fever, foul-smelling vaginal discharge, significant bright red vaginal bleeding, and pelvic pain.
• Avoid sexual activity and the use of tampons.
• Seek psycho-social support from friends, professionals and family to help cope with the loss.
• Get enough rest for a few days before resuming your normal duties.
• You may be required to take iron supplements as a result of significant blood loss and/or antibiotics to treat or prevent infection.
• Eat foods such as liver, green leafy vegetables, dried foods, and eggs to aid in healing and increase your fluid intake as well.
