Miscarriages [Spontaneous abortions]
The correct medical term for a miscarriage is "spontaneous abortion". This implies a spontaneous happening while a voluntary termination of pregnancy is referred to as a MTP [Medical Termination of Pregnancy]. This is defined as a spontaneous loss of pregnancy before the 20th week of gestation [pregnancy].
Miscarriage is far commoner than most people think. Studies show that up to 24% of known pregnancies may end in miscarriage.
In individual patients the cause of a miscarriage is not usually found. Research shows that about half of all miscarriages are due to an error in the genetic make-up of the pregnancy. Nature's response to this problem is spontaneous miscarriage. Almost always, a miscarriage is not due to anything the patient or her partner did or did not do. We do know that miscarriage is NOT something which the mother has caused to happen.
When you conceive and a baby is created, it takes half its genes from the sperm and half from the egg that ovulated that month. At the exact time of conception, the cross-over of these genes takes place. Sometimes, for no reason other than bad luck, some information is lost and the pregnancy is destined from that point not to be. It might be that this lost information is not needed for many weeks, and the pregnancy will continue as normal until that time. When the needed information is not there, it is then that the baby dies and you begin to miscarry. Sometimes when this happens, the miscarriage doesn't happen right away. This is called a 'missed' miscarriage and may not be picked up until some weeks later, following a slight loss or period-type pains.
Another cause might be that the baby did not implant, or bury itself, into the womb lining properly - once again, just due to bad luck.
These are the most common reasons that women miscarry. Not because of something you did or didn't do, but just because of chance. Not because you drank alcohol, exercised , or didn't take folic acid. Certainly not because you had sex or didn't rest enough. Whether you lay in bed from the day of your positive pregnancy test or were over active every day wouldn't have changed things. Most pregnancies that are destined to end in a miscarriage are destined to end that way from the day of conception and there is nothing that either you or your doctor could do to change that. Its nature's way of making sure that when you do have a baby, it has the best chance for all of its life. Miscarriage does not mean that you won't be able to get pregnant again.
A small group of patients have an abortion because of hormonal deficiencies and although there is no easy way to document who suffers from this the treatment is simple. All women who have had a previous abortion are put on natural progesterone [the hormone which helps to look afer pregnancy] till about the 12th - 16th week of pregnancy.
You will have one or more of the following
In the case of a missed abortion you may have some of the above but it may be that you may not have any symptom at all and it may be picked up on a routine ultrasound scan.
After a discussion of the
symptoms, and possibly an examination, some tests and investigations may be
If a miscarriage is complete then no further treatment is needed. The other types of miscarriage frequently require treatment, though in some cases it is appropriate to see first if nature takes its course. The decision on whether medical treatment is needed depends on the stage of pregnancy, the amount of bleeding, and each woman's personal choice.
For missed miscarriage or when there is significant bleeding, treatment with medicines or surgery may be needed to remove the remaining pregnancy tissue. Medicines are effective for miscarriage under seven weeks, or where there is a small amount of tissue remaining in the uterus. The medicine doctors prescribe is called misoprostol, and it makes the uterus contract so that the remainder of the pregnancy is expelled.
The most common treatment is a
D&C which is a procedure usually under
general anaesthesia where the cavity of the uterus is cleared of any remaing
pregnancy tissue. This is sometimes called an Evacuation with Check Curettage.