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All your pregnancy questions answered

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].

• Types of abortion

1. Threatened abortion is said to be when the patient has vaginal bleeding but the cervix [mouth of the uterus] is still closed

2. Inevitable abortion is when there is vaginal bleeding and the cervix is open. At this stage there is not much that one could do to prevent the loss of the pregnancy

3. Incomplete abortion is when there is bleeding, the cervix has opened and there is a partial expulsion of the pregnancy from the uterus

4. Complete abortion is when the cervix has opened and the pregnancy is completely expelled from the uterus and the cavity of the uterus is now empty

5. Missed abortion is when the baby dies and the cervix is closed and there is no further growth of the baby. There may or may not be associated vaginal bleeding. This type of miscarriage usually causes a slight, dark-brown blood loss and the sudden end of normal pregnancy symptoms. It is sometimes called a blighted ovum.

6. Septic abortion is when any of the above stages of abortion has become complicated with infection

• How common is a spontaneous miscarriage?

Miscarriage is far commoner than most people think. Studies show that up to 24% of known pregnancies may end in miscarriage.

• What is the cause of a abortion?

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.

• What symptoms will you experience if you are having a spontaneous abortion?

You will have one or more of the following

1. Bleeding from the vagina.-The most common symptom is vaginal bleeding, which can range from light spotting to heavier than a period. Some bleeding is very common during pregnancy, and vaginal bleeding does not always signal a miscarriage has taken place, especially if the bleeding is light and only lasts a short time. Bleeding that is prolonged or heavy, like a period, is more likely to lead to miscarriage.

2. Cramping of the uterus-Often there is cramping, with period-type pains.

3. Passage of blood clots or tissue from the vagina-There may be blood clots, or other tissue that is not clearly identifiable. Sometimes a sac-like structure is seen.

4. Symptoms of pregnancy such as breast tenderness, nausea etc may decrease

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.

• Treatment for abortions

After a discussion of the symptoms, and possibly an examination, some tests and investigations may be needed:

Complete blood count [CBC]- This is to make sure the bleeding hasn't caused anaemia.

Blood group-Women who have a rhesus negative blood group may need to have an injection to prevent problems for subsequent pregnancies.

Blood pregnancy test- Sometimes, a sensitive blood test for the pregnancy hormone, beta HCG, is sometimes taken.

Ultrasound scan- This will show the uterus and any developing embryo. If all is well and the pregnancy is sufficiently advanced, a fetal heartbeat can be seen. If pregnancy is not very far on (less than six to seven weeks) it is sometimes not possible to tell if everything is normal, and another scan is needed in seven to 10 days time. If the first scan shows a fetus lagging behind the size it should be with no heart beat then it is called a missed abortion.

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.

You will usually be discharged from the hospital on the same day with a course of antibiotics to prevent infections.

Next: After a miscarriage