Pregnancy and miscarriages

I HOPE I find you well and in good spirits.

The change in weather has caused a wave of flues and colds in all age groups.

Fortunately they have largely been unrelated to Covid-19, but they are still causing much distress and disrupt the learners.

This winter will possibly see the trend continuing.

This week we shall look at a very sensitive issue, miscarriages, this is a relatively common occurrence in up to 20 percent of pregnancies.

Pregnancy is a blessing from God regardless of circumstances, it is nature’s way of perpetuation.

At times the formula has errors that may cause the pregnancy’s viability to be compromised, thus leading to a premature end.

The loss of this unborn child has serious psychological burden over and above the physical pain one may experience.

When fertilised the foetus starts to grow in the womb for the nine months.

At seven months the foetus is believed to be viable and if born pre-term can survive if given adequate care.

Prior to these seven months if a woman expels her pregnancy it is regarded as a miscarriage or abortion.

The term abortion distresses women since they associate it with criminal abortion.

Pregnancy is divided into three equal time frames called trimesters.

Simply; the first trimester involves the one cell dividing and differentiating into the various body parts as we know them.

The last two trimesters involve the growth of the foetus and weight gain.

A miscarriage may also be defined as expulsion of foetus or embryo weighing less than 500g.

Spontaneous miscarriages are difficult to ascertain, they go unnoticed and the woman imagines it’s a late period.

Causes vary and include:

– Genetic — 50 percent of clinically identifiable first trimester miscarriages are chromosomally abnormal.

The risk of chromosomal abnormality falls with advancing gestation.

-Incompetent cervix — The characteristic feature are recurrent rapidly progressive, relatively painless mid-trimester miscarriages preceded by rupture of membranes.

-Septum or abnormal division of the uterus or a double uterus (two uteri).

– Fibroids especially submucosal thus cause spontaneous miscarriages.

– If the uterus is held during an operation.

– Multiple pregnancy — the more foetus in the uterus, the greater the risk of spontaneous miscarriage, probably because of overdistention of the uterus.

-Maternity diseases associated with fever, for example pneumonia, malaria.

-Teratogenic drugs like smoking and alcohol intake.

– Irradiation — high doses like those used in cancer treatment.

-Immunological factors — conditions like systemic lupus erythematous is associated with a significant increase in recurrent miscarriages.

-Women with men with very high sperm counts and defective sperm.

– Thyroid disease associated with low activity and high activity of the thyroid.

-Trauma —  a hard knock during a motor vehicle collision can cause a miscarriage.

– Diabetes mellitus with unsatisfactory blood glucose.

– Severe heart disease.

– Severe kidney disease.

Miscarriages can be classified into threatening, inevitable, complete, and missed miscarriage.

Threatening miscarriages: a period of amenorrhoea (no period) followed by slight bleeding (sometimes a watery bloodstained vaginal discharge).

There is slight or no pain, the size of the pregnancy is in keeping with what is expected for stage of pregnancy.

The internal os of the cervix is not open or dilated.

Treatment is bed rest, abstain from coitus, sympathetic psychological support of the mother since she is usually afraid that the foetus may be abnormal.

An ultrasound can be done to confirm the diagnoses and reassure the patient.

Inevitable miscarriage signs and symptoms are more severe than threatening miscarriages; watery discharge, watery blood-stained vaginal discharge and painful uterine contractions.

The internal os of the cervix is dilated and will lead to expulsion of the uterine contents.

Histology (laboratory test) of the expelled foetus can be done to exclude chances of cancer.

Incomplete miscarriages usually give a history that she had delivered pregnancy products after a period of amenorrhoea.

The abdomen is smaller than expected for the stage of pregnancy, pregnancy test may be negative.

There is a risk of infection, which presents with a fever, foul discharge per vagina and pain on urination.

Complete miscarriages is assumed when foetus, placenta and membranes are seen by the nurse or doctor and usually occurs after 12 weeks (three months).

Missed miscarriage means the foetus died in utero before it reaches viability and labour does not commence.

Amenorrhoea (no period) interrupted by an episode of slight vaginal bleeding, the signs of pregnancy disappear, uterus is smaller than expected for age of pregnancy. Pregnancy test negative.

Ultrasound confirms absent foetal heart.

Such a miscarriage can be delivered by the doctor immediately, or an expectant approach can be taken where the foetus is expected to spontaneously abort in three weeks, if this is acceptable to the mother.

Recurrent miscarriage is defined as three or more consecutive miscarriages at less than 24 weeks of gestation. Causes may include;