Health @ Hfgrotto

Spontaneous miscarriage is when a baby dies or is expelled from the womb before the twenty-fourth week. After the twenty-fourth week, this is called a stillbirth. About one-third of all pregnancies end in miscarriage in the first few weeks, but one quarter of these happen before a woman even knows or suspects she is pregnant, so she is unaware anything has happened.

Miscarriages are more likely the older you are and the more pregnancies you’ve had. They are most common in the first trimester and the usual symptom is bleeding, which happens in 95 percent of cases. If you notice bleeding at any time in your pregnancy, call your doctor.

Many early miscarriages are due to a seriously abnormal fetus failing to implant in the wall of the uterus, while 70 percent are due to chromosomal abnormalities. Causes linked to the mother include abnormalities in her uterus, such as large fibroids, and hormonal imbalances. Some miscarriages are also caused by bacterial and viral infections. Cervical incompetence accounts for only one percent of spontaneous miscarriages. Causes linked to the father include abnormal sperm, or incompatible blood type, which causes a mother to produce antibodies to her partner’s blood. These antibodies then attack and kill her fetus. Doctors divide spontaneous miscarriages into several categories:

Threatened miscarriage Miscarriage is possible but not inevitable. A mother suffers vaginal bleeding and sometimes pain. This happens in about 10 percent of all pregnancies and may be confused with the slight bleeding that can come at the time of the first missed period.

Inevitable miscarriage A woman has vaginal bleeding and pain because her uterus is contracting. Unfortunately, if her cervix also dilates, she will lose her baby.

Complete miscarriage The fetus and placenta are expelled from the uterus, sometimes without any symptoms. Ultrasound examination can confirm this.

Missed miscarriage The fetus and placenta die, but remain in the mother’s womb for some time, even months, before being expelled. The symptoms of pregnancy disappear, but there’s no other indication of fetal death until much later.

Incomplete miscarriage There’s a miscarriage, but some of the products of conception, such as the amniotic sac or the placenta, remain in place.

Recurrent miscarriage A woman suffers a miscarriage on three or more occasions. This may happen at the same stage of pregnancy or at different stages, and the reasons may be the same or differ each time.

Treatment If you’re bleeding in the second or third trimester, call the hospital and go there as soon as you can. If you bleed in the first trimester, call your doctor and stop any physical activities, such as strenuous exercise and sexual intercourse. If the bleeding and pain stop, you’re quite likely to go on to deliver a healthy baby.

If a miscarriage seems inevitable, there’s little that doctors can do to prevent it. Complete and incomplete miscarriages are very often treated in the hospital. After an incomplete miscarriage, the uterus will be cleaned out by a procedure called dilatation and curettage (D and C) under anesthetic. Painkillers are given, along with drugs to stop the bleeding. If a lot of blood is lost (at least a pint/500 ml), a transfusion may be needed.

There’s no urgency in treating a missed miscarriage, but if, after a time, a spontaneous miscarriage hasn’t taken place, a D and C procedure will be carried out. If a baby dies later in pregnancy, prostaglandin pessaries or an oxytocin injection are given to stimulate delivery.

After suffering a miscarriage because of cervical incompetence some women can be treated by stitching the cervix shut at the beginning of the next pregnancy, though this is not always successful.

Other possible reasons for recurrent miscarriage are genetic or hormonal disorders, which often can be pinpointed. Long-term infections, such as listeria, may sometimes cause repeated miscarriages, but these can be difficult to diagnose and treat. Other contributing factors can be poor nutrition; chronic disease, such as renal disease; tumors in the uterus (particularly fibroids) or abnormalities such as partial or complete septums (see column, right) that can usually be corrected by surgery; and immune disorders.

This last happens when a mother’s immune system identifies the fetus as foreign and attacks it-Rhesus blood incompatibility is one example of such a situation. Other immune problems can sometimes be treated by using medication, which acts to suppress the mother’s immune reaction. Alternatively, the fetus can sometimes be injected with antibodies, either via the umbilical cord or directly into the fetus itself if the cord is underdeveloped.