A B C D E F G H I J K L M N O P R S T U V W

SPONTANEOUS ABORTION - MISCARRIAGE

What is a Spontaneous Abortion ?

A miscarriage is the loss of a pregnancy before the baby is able to survive outside the womb. This is usually accepted as being about 24 weeks. Most miscarriages happen in the first 12 weeks. The egg is fertilized in the tube shortly after ovulation. It reaches the womb 3 or 4 days later. At this stage it is made of 8 to16 cells. For a few days it is nourished by the secretions from the cells which line the womb inside. The fertilised egg has to implant in the womb lining. Then it must develop a connection with the mother's blood through the developing afterbirth (placenta). This will nourish the embryo for the rest of the pregnancy. Many miscarriages happen without the woman even knowing that she has conceived. The period may come a few days late and be a little heavier. Most women know they are pregnant and the first sign of possible miscarriage is bleeding. There are different types of miscarriage. In the past doctors sometimes used the word abortion to mean the same as miscarriage. Abortion does not imply that the miscarriage was planned or deliberate. Threatened miscarriage is when the woman has bleeding, usually less than a period. She has little or no pain and does not feel ill. The cervix (neck of the womb) does not open, the bleeding may stop and the pregnancy then carries on normally. Inevitable miscarriage means that it is no longer possible for the pregnancy to continue: miscarriage is unavoidable. The bleeding gets worse and one may feel pains like bad period pains. This means the muscles of the womb are contracting to get rid of the blood and the pregnancy. If the womb succeeds in expelling everything, the bleeding stops and the pain stops. This is now called a complete miscarriage. If the bleeding and pain continue, the miscarriage is incomplete and admission to hospital is necessary. Sometimes a miscarriage can occur even when there is no bleeding or pain. This may be because either the embryo fails to develop (also called a blighted ovum) or begins to develop then dies early in the pregnancy. The woman stops feeling pregnant. Sometimes the diagnosis is only made when the woman has her first scan performed. Recurrent miscarriage is the term used when someone has had at least three consecutive miscarriages.

Why does a Spontaneous Abortion occur ?

Miscarriages are common. We know that at least half the eggs that are fertilized are lost this way. It may well be more. Half of all miscarriages happen so early that they are not recognized. Miscarriage is commoner in women over 40. The commonest reason for miscarriage is because there is something abnormal in the fertilized egg. The earlier the miscarriage, the more likely is this to be the case. There is no evidence that a lack of progesterone hormone causes miscarriage. Miscarriage is more common in women with diabetes and polycystic ovarian syndrome. Lupus may cause miscarriage, as may infections such as listeria. A couple may each have a minor abnormality in their genes of which they are not aware. If both pass on this gene the combination may be fatal for the embryo. A very high fever and some drugs may cause miscarriage. Miscarriages that occur after 12 weeks may be due to abnormalities in the womb. These include a fibroid projecting into the cavity of the womb and an abnormally shaped womb. An incompetent cervix and may lead to late miscarriage.

Treatment involved for a Spontaneous Abortion

When a woman has bleeding in early pregnancy she should consult her doctor. He may recommend referral to hospital. If this happens out of normal working hours and the bleeding is not heavy an appointment may safely wait until the next day. At the hospital a gentle internal examination will be done to check if the neck of the womb. This examination itself can not cause the pregnancy to miscarry. If the cervix is closed an ultrasound scan will be arranged to see if the pregnancy is developing normally. Many women who have a threatened miscarriage carry on to have a normal pregnancy. There is no evidence that resting in bed or taking time off work reduces the risk of miscarriage occuring. However, many women feel happier if they take some time off and rest at home. Treatment with drugs does not help in cases of threatened miscarriage. An incomplete miscarriage may need antibiotics if there are signs of infection. An operation to remove any tissue and blood clot left in the womb is usually performed. This called an evacuation of retained products (ERPOC). It is similar to a D & C and involves using a fine suction tube passed through the cervix to remove any blood and tissue from inside the womb. It is usually done under general anaesthetic but can be done under local anaesthetic and sedation. There is a small risk of perforating the wall of the womb. If this happens it may be necessary check that there is no internal bleeding by laparoscopy (a telescope passed through a small cut below the navel). If the bleeding is not excessive and the woman prefers not have an operation she may wish to wait and allow the womb to expel the remaining tissue naturally. If this approach is taken there is a risk of infection and heavier bleeding. An ERPOC is also usually recommended for early pregnancy failure. An alternative is to wait for a miscarriage to occur naturally or to use drugs called prostaglandins to make the womb contract and expell the pregnancy. A Rhesus-negative woman with a Rhesus-positive partner should have an injection called Anti D to prevent antibodies forming. Couples having recurrent miscarriages should have their chromosomes checked. Other blood tests will be done to look for problems with anti-phospholipid (lupus) antibodies. Antibodies are the molecules the body produces the fight infection. Sometimes these antibodies can be produced against the body's own tissues and these can also affect a developing pregnancy. If these tests are positive your doctor may recommend taking a low dose as aspirin in future pregnancies. You may have an ultrasound scan of the womb. The history will tell the doctor if the cervix is incompetent. In these cases a stitch may be put into the cervix during early pregnancy to prevent another miscarriage.

During treatment for a Spontaneous Abortion

It is important to report any fever to the doctor as infections need vigorous treatment. He should also know if bleeding suddenly gets a lot heavier or faintness develops. If these symptoms are present they suggest an incomplete abortion. Once the womb is empty the pain and the bleeding stop.

After Treatment

A threatened miscarriage that settles down is likely to be followed by a normal pregnancy. If bleeding starts again, the doctor may want to do some other tests on you. These will include checking the cervix, and in later pregnancy, the position of the afterbirth. If the pregnancy is lost a woman may be advised to wait two or three normal cycles before trying for another pregnancy. Individual circumstances can vary and it is best to ask the doctor about this. It is important that all involved recognise that the woman has lost a baby. Often this side of a miscarriage is overlooked. It is very normal to mourn and grieve for the baby even when it is lost very early. Ask for help if there is a feeling of despair and loneliness. After a single miscarriage there is no increase in the risk miscarriage in the next pregnancy. The risk of further miscarriage does increase the more miscarriages a woman has but even after three miscarriages in a row most women will have a normal pregnancy. When trying to conceive a woman should avoid smoking or alcohol, drugs without medical advice and exposure to x-rays. Additional folic acid supplements should be taken. This advice should be followed for three months before conception and through pregnancy.

If a Spontaneous Abortion is left untreated

Treatment makes little difference to the outcome of the threatened miscarriage. If an ERPOC is not done in incomplete miscarriage infection might lead to sterility. The bleeding might also be very severe, leading to anaemia.

Effects on the family of a Spontaneous Abortion

Having a miscarriage can be very distressing. It is not unusual to feel guilty or depressed. . Some woman may worry that something they did caused the miscarriage. This is almost never the case. Your family and friends should understand that much emotional and physical support is essential.