Miscarriage or spontaneous abortion is the loss of pregnancy (unplanned or death o the fetus) naturally before twenty weeks of pregnancy and is referred to as a miscarriage.
What is it?
Miscarriage or spontaneous abortion is the loss of pregnancy (unplanned or death o the fetus) naturally before twenty weeks of pregnancy and is referred to as a miscarriage. When you have a miscarriage, it can increase the risk of another spontaneous abortion in a future pregnancy. A key indicator for spontaneous abortion is a dilated cervix.
Risk factors due to the mother include being older than 35, having a history of spontaneous abortion, being overweight, smoking cigarettes, using cocaine, alcohol, high doses of caffeine, having infections, and poorly controlled chronic disorders such as diabetes, hypertension, & thyroid disorders.
Risk factors due to the father include being older than 35, structural abnormalities in sperm chromosomes, abnormal sperm shape, damage in the sperms’ DNA, excessive stress, smoking cigarettes, using cocaine, alcohol, high doses of caffeine, and infection,
Problems with the placenta (the organ that joins the mother’s blood supply to the baby’s), abnormal womb structure, weakened or injured cervix, problems with the immune system, chromosome abnormalities, molar pregnancy (abnormal tissue in the uterus in place of a fetus), ectopic pregnancy (embryo attaches outside the womb and is fatal to the fetus) and hormonal problems such as Polycystic ovary syndrome (PCOS) (when the ovaries are overly large causing a hormonal imbalance).
Caused by the baby: Genetic/chromosome problems (A fetus may receive the incorrect number of chromosomes, resulting in improper development)
- Pelvic abscess (life-threatening collection of infected fluid in the fallopian tube or ovary)
- Septic shock (a widespread infection that causes organ failure and dangerously low blood pressure)
- Hemorrhage (severe bleeding)
- Uterine perforation (accidental piercing of the uterus during a procedure
- Difficulty conceiving or recurrent miscarriages
- Pelvic pain
- Bleeding or brownish-colored discharge
- Burst of liquid (after the fetal membrane breaks)
- Passing clots (a thick mass of liquid stuck together, usually blood)
- Abdominal cramps
- Lower back pain
- Weight loss
Your doctor will perform examinations that typically include checking the vagina, uterus, cervix for abnormalities, assessing the fetal viability, getting an ultrasound check, and blood tests. Surgical procedures like D&E and Vacuum aspirations can be recommended to remove all fetal tissue. You might be prescribed medications to help ease pain, increase hormone levels, stop bleeding, and keep you healthy. You might be recommended to avoid strenuous activity, sexual intercourse, and best rest.
A miscarriage often can’t be prevented, but in some cases, you can reduce your chances by:
Exercise and eat healthy
Keep your body weight within healthy limits
Do not smoke (avoid secondhand smoke as well)
Do not drink alcohol or take other drugs
Limit or eliminate caffeine
Check with your doctor before taking any over-the-counter medicine
Avoid environmental risks such as radiation, infectious diseases, and X-rays
Protect your stomach
Avoid contact sports or activities that are at risk of injury
Classifications of Spontaneous abortion
- Threatened: is characterized by symptomatic or ‘threatened’ expulsion of the fetus. However, the cervix isn’t dilated, and the embryo or fetus remains viable. There is vaginal bleeding and slight abdominal cramping, and miscarriage is possible, but pregnancy can be saved sometimes.
- Inevitable : is characterized by an ‘inevitable’ expulsion of the fetus when the cervix is dilated, whether the embryo or fetus is viable or not. There is heavy vaginal bleeding, lower back pain, & cramping. Due to cervical dilation, a miscarriage will almost always occur. This typically occurs before the 16th week of pregnancy.
- Incomplete: is characterized when all of the pregnancy tissue isn’t removed from the uterus (some of the baby’s or placenta’s tissue leaves your body, while some remains in your uterus). There is constant and heavy vaginal bleeding, abdominal cramps, and the passing of blood clots or pieces of tissue. This typically occurs before the 16th week of pregnancy.
- Complete: is characterized by ‘complete’ removal of the fetus from the uterus. There is intense abdominal pain, vaginal bleeding until all the tissue is removed and the cervix is not dilated. This typically occurs before the 12th week of pregnancy.
- Missed: is characterized when the embryo dies, but the fetal tissues remain in the uterus for several weeks until it gets dispelled naturally or with induced abortion. Sometimes, there is a brownish vaginal discharge, and the cervix isn’t dilated. This typically occurs before the 12th week of pregnancy.
- Septic: is characterized when there is fetal tissue remaining after induced abortion and causes a miscarriage due to an infection in the uterus. It is often due to the procedure performed by an untrained person and using nonsterile equipment. There is fever, chills, vaginal discharge that smells bad, continuous vaginal bleeding, abdominal cramping, and pelvic pain.
- Recurrent or Habitual: is when there are three or more consecutive miscarriages during the first trimester. Repeated miscarriages need to be medically evaluated for chronic problems such as hormonal dysregulation and infection. Recurrent miscarriage is when a woman has two or more consecutive pregnancy losses. 1% of women who have one miscarriage experience a second one. However, increases to 20% for the second, 25% for the third, and 30% after the third consecutive miscarriage.
- Hormonal / Endocrine disorders
- Anatomical (abnormal uterus or weakened cervix)
- Inherited thrombophilia (predisposition to develop blood clots)
- Genetic (chromosome abnormalities)
- Lifestyle (alcohol, smoking, drugs)
- Vaginal bleeding
- Pelvic pain
- Loss of morning sickness
- More frequent urination
Tests are usually done after a woman has experienced 2 or 3 abortions. Some tests to determine the cause include ultrasonography (using ultrasound to produce diagnostic images of the internal organs of the body or fetus) and blood tests.
Treatment for recurrent abortion may help a woman’s womb hold the fetus. Treatment depends on medical conditions, chromosomal abnormalities, uterine abnormalities, immune system issues, and more. Recurrent miscarriages can cause psychological stress, so it is essential to have a strong support system. For chromosomal causes, treatment can be in vitro fertilization (IVF). For anatomical causes, treatment can be minor surgery. For immunological and blood clotting causes, treatment can be blood-thinning medications. For hormonal abnormalities, treatment to balance hormones is recommended.
Postabortion Care (PAC)
It is a care service that treats women with complications of abortion following spontaneous abortion and unsafe abortion. PAC reduces maternal mortality & morbidity and includes both medical and preventive care. Essential elements of PAC include emergency treatment of incomplete abortion & potentially life-threatening complications and post-abortion family planning counseling & services.
After your procedure, your doctor will provide you with specific after-care instructions, but sometimes it isn’t enough to reduce undesirable side effects. Some methods to increase comfort include:
- Use heating pads to relieve cramps
- Stay hydrated, particularly if you’re vomiting or diarrhea
- Have a support system to help with emotional changes due to the hormone shift
- Rest for a day or two to recover at home
- Take medication to decrease cramps and pain
- Massage the area where you have cramps
- Wear a tight-fitting bra to reduce breast soreness
Every woman seeking PAC care should receive physical and emotional support. The woman must be aware of precisely what will happen before, during, and after the procedure, including pain relief, immediate & future side effects, and possible complications. If the patient is an adolescent, additional care and attention are required to prepare her for the whole process.
A diagnosis should assess injury or permanent damage to internal and external organs, permanent damage to the bladder or bowel that cause chronic problems, permanent infertility, possible death due to complications like infection and hemorrhage.
Healthcare providers need to be prepared to manage unsafe procedures including providing treatment for signs of inevitable, incomplete, and septic abortions. Manual Vacuum Aspiration (MVA) is a procedure that can safely and effectively treat women with incomplete abortion, either spontaneous or induced.
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