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Facts about miscarriage

Miscarriage is the body's way of ending a pregnancy that is not developing normally

HARSHA IS fighting back tears. She is holding on tightly to Mukesh's hand. He too is looking bewildered. At their routine third month check-up, their obstetrician has told them that the baby inside the uterus has not grown beyond two months. Harsha has had a missed abortion. Being told that you are undergoing a miscarriage (abortion) is distressing. Even more disturbing is the lingering feeling that you may have in some way caused it. To compound this needless guilt, misinformed relatives and friends give you a list of things you may have done that attempts to place the blame squarely on your shoulders.

It is important to realise that miscarriage is a natural process and cannot be caused by something you did or didn't do. About 20 per cent of women who conceive will lose their pregnancy in a miscarriage. There is no reason why you will not be able to have a baby the next time you try.

What is a miscarriage (abortion)?

A miscarriage is the spontaneous ending of a pregnancy before the fifth month (20th week) of pregnancy. The medical term for miscarriage is spontaneous abortion.

How does it occur?

It is often difficult to pinpoint the exact cause of a miscarriage. However, most miscarriages are caused by an abnormal number of chromosomes — either too many or too few. Often the baby (also called a foetus) does not develop at all, or the baby may develop abnormally. In such cases, miscarriage is the body's way of ending a pregnancy that is not developing normally.

There is no evidence that emotional stress or physical or sexual activity causes miscarriage in a normal pregnancy.

What are the symptoms?

Bleeding which can range from a few drops to a heavy flow. The bleeding may start with no warning or there may be a brownish discharge first.

Cramping pain in the lower abdomen.

A gush of fluid from the vagina without bleeding or pain. This may mean that the membranes have ruptured.

Some clot-like tissue may pass out of the vagina. Try to keep this material so that the doctor can examine it.

How is it diagnosed?

Your doctor may do a pelvic exam to check the size of your uterus and find that the size of the uterus does not correspond to the duration of pregnancy. An ultrasound scan will confirm an abortion.

Recurrent pregnancy loss

If a woman loses her pregnancies repeatedly, she and her husband need to undergo a few tests to find out the cause. An incompetent cervix sometimes causes miscarriage, usually after the fourth month. In this case, the cervix opens painlessly and the baby aborts spontaneously. This is a treatable cause.

What is the treatment?

Threatened abortion or miscarriage: In a threatened abortion or miscarriage, the baby's heartbeat can be seen on the ultrasound and there is a chance that the pregnancy will continue. In a threatened miscarriage there may be a small amount of painless bleeding from the vagina early in the pregnancy. Your obstetrician may advise rest for 1 to 2 days. The bed rest may stop the bleeding and the pregnancy may continue normally. Special precautions such as stopping exercise, staying off the feet as much as possible, and avoiding intercourse may be necessary for one or two weeks.

Over the years, medical research has clearly proved that there is no need for hormonal tablets or injections in case of a threatened abortion.

Incomplete abortion or miscarriage: The miscarriage is incomplete if only part of the contents of the uterus is expelled. A dilation and curettage (D&C) or suction procedure may be required to remove the remains of the foetus and placenta from the uterus.

Missed abortion or miscarriage: If a missed abortion (miscarriage) is diagnosed where the foetus has died and there is no bleeding, the doctor may perform a D&C or induce labour to remove the foetus and placenta.

In any pregnancy, it is important to know your blood group and Rh type. If you are Rh negative, the doctor may want to immunise you against problems that might occur in future pregnancies.

How soon can I start trying to get pregnant again?

Your obstetrician may advise you to avoid sexual intercourse for four weeks after a miscarriage. An interval of 3-6 months is usually recommended before you try to get pregnant again. Your obstetrician may advise what form of contraception is best for you. Apart from the physical reasons to avoid a pregnancy, it is also important to wait to get pregnant until you have dealt emotionally with the loss.

(The author is a Chennai-based obstetrician and gynaecologist with a special interest in women's health issues)

GITA ARJUN

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