Monday, 2 November 2015

Understanding spontaneous miscarriage and what to do if you start bleeding

A miscarriage (medically known as a spontaneous abortion), refers to the loss of a pregnancy before 20 weeks of gestation or loss of a foetus less than 500g, without any external intervention.

If you have a spontaneous abortion, your doctor will classify it as either:

  • Threatened abortion  (if you're bleeding and have cramps in the lower abdomen) or
  • Inevitable abortion (if you are bleeding through your vagina and your cervix is open) or
  • Incomplete abortion (if some products of conception remain in the uterus or womb)or
  • Complete abortion (if all the products of conception are expelled from the body and the cervix is closed) or

                   Complete abortion with a small gestation sac in the left corner
  • Recurrent abortion  ( if you've had three or more miscarriages)
  • Missed abortion (the embryo dies without your knowledge, but remains in the uterus)

                                                         Missed abortion

  • Blighted ovum (a fertilized egg implants into the uterine wall, but foetal development never begins)
  • Ectopic miscarriage (egg implants in places other than the uterus, most often the fallopian tubes)

A spontaneous abortion is the opposite of an induced abortion. In spontaneous abortion, pregnancy loss is purely accidental, not induced by artificial means.

What Are the Symptoms of a Spontaneous abortion (Miscarriage)?

Symptoms of a miscarriage include:

  • Bleeding (per vaginam) which may progress from light to heavy bleeding.
  • Severe cramps/lower abdominal pain  (in threatened and inevitable abortions)
  • Fever
  • Weakness
  •  Back pain.

Miscarriages are caused by a variety of other factors, including:

  • Chromosomal abnormalities- a common cause of abortions in the first trimester. It's the body's way of ensuring your baby is free of genetic defects when born.
  •  Infections like malaria, urinary tract infections etc.
  • Exposure to environmental and workplace hazards, such as high levels of radiation or toxic agents
  • Hormonal problems
  • Uterine abnormalities like a uterus with two horns (bicornuate uterus)
  • Incompetent cervix (the cervix begins to widen and open too early, in the middle of pregnancy, without signs of pain or labour)
  • Lifestyle factors, such as smoking, drinking alcohol, or using illegal drugs
  • Disorders of the immune system, including lupus
  • Severe kidney disease
  • Congenital heart disease
  • Uncontrolled Diabetes 
  • Thyroid disease
  • Radiation
  • Certain medications, such methotrexate used to treat some cancers.
  • Severe malnutrition
In addition, women may be at increased risk for miscarriage as they age. Studies show that the risk of miscarriage is 12% to 15% for women in their 20s, and rises to about 25% for women at age 40. The increased incidence of chromosomal abnormalities contributes to the age-related risk of miscarriage.

How Is a Miscarriage Diagnosed and treated?

Your health care provider will perform a pelvic exam and an ultrasound test to make sure that a miscarriage really occurred. He/she will confirm if the foetus is viable (that is alive/dead) and if there are any products of conception left in your womb.

If the miscarriage is complete and also the uterus is empty, then no further treatment is generally required.

Occasionally, the uterus seriously isn’t completely emptied, so a dilation as well as curettage (D&C) procedure is performed. During this procedure, the cervix is dilated as well as any remaining foetal or even placental tissue is gently taken off the uterus. As another solution to a D&C, certain medications may be given to cause the body to expel the contents in the uterus.

This option may be more ideal in someone who would like to avoid surgery and whose condition is otherwise firm.

What does NOT result in miscarriage?

It must be emphasized that exercise, working, and sexual intercourse do not increase the risk of pregnancy loss in routine (uncomplicated) pregnancies. However, in the unusual circumstance where a female is felt by her physician being at higher risk involving spontaneous abortion, she can be advised to stop working and avoid having sexual intercourse.

Women with past historical past of premature delivery along with other specific obstetrical conditions might are categorized in this category.

What to do when you are bleeding from the vagina during pregnancy?

1. Call for help- your husband or a friend
2. Wear a clean pad (keep count of the number of pads used)
3. Report to the nearest health centre (not a chemist or pharmacy)
4. Explain clearly to the doctor how much blood you may have lost; number of pads used; if you saw clots or foetal parts.
5. Say EXACTLY how you feel - dizzy, weak. This could raise alarms that you've lost a lot of blood and require urgent medical attention and resuscitation.
6. Get post-abortion care and counselling in any health facility of your choice. You really need it.

Finally, a spontaneous abortion is NOT your fault and you don't have to blame yourself for factors you cannot control.

Stay healthy!

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