Pregnancy

What is Miscarriage?

MiscarriageMiscarriage is when a fertilised egg or foetus is being rejected by the maternal system. It is in other words the termination of a pregnancy. The term spontaneous abortion is also used instead of miscarriage.

Signs and Symptoms of a Miscarriage:
For most females, the signs include vaginal bleeding (with or without tissue). Some cases will be accompanied by pain of the abdomen. There are also certain cases where there are no noticeable symptoms.

Some females however, may also experience vaginal bleeding/spotting during pregnancy with no concerns at all. In any case it is important to consult your doctor in such an event for management of pregnancy.

Reasons for Miscarriages:
There are a various number of reasons for miscarriages; so many that sometimes it is difficult to pinpoint a particular reason. A few reasons are:

  • Chromosomal(genetic) or structural abnormalities of the foetus
  • Uterine fibroids
  • Uterine abnormalities
  • Maternal medical problems like diabetes, pressure and other diseases
  • Hormonal, Immunological, Haematological conditions
  • Unknown causes

What is an implantation haemorrhage?
The fertilized egg goes on to get buried in the inside lining of the womb called endometrium that has undergone hormonal changes (During pregnancy the lining is called “decidua”). When the fertilized ovum embeds in the uterine cavity some women will experience some amount of bleeding. This is called implantation haemorrhage or decidua haemorrhage, which some women can tell you has the last menstrual date. Some females who are expecting to get pregnant may notice some initial vaginal bleeding, and worry about having undergone a miscarriage. This is a normal symptom and is not to be worried about.

Classifications of Miscarriage:
In the first trimester itself, if the fertilized egg has an abnormal genetic constitution it will abort spontaneously. This may be indicated by vaginal bleeding or in early stages by no symptoms. Some women, who are not expecting a pregnancy, may even pass this stage without noticing it. This process is called natural selection. Normal foetuses will be born to this world and abnormal foetuses are aborted by nature.

Threatened Miscarriage
This is when there is mild bleeding through the vagina during pregnancy. There will be no abdominal pain. The doctor will observe that the uterine cervix is closed, and an Ultrasound will reveal the foetus has a heartbeat. It is advisable to avoid intercourse until bleeding settles. This condition needs to be monitored by the doctor. The doctor may prescribe some placebo such as folic acid and if bleeding increases the doctor will advise the mother to get hospitalised.

Inevitable Miscarriage
It is possible for threatened miscarriage to lead to abortion. Here the mother will have severe pain. The neck of the womb would be opened up and the spontaneous abortion of the foetus will occur. This cannot be stopped by any medical or surgical methods. In severe cases the female needs to be resuscitated, pain relieved and evacuation of the uterus by medical or surgical methods will be required.

Incomplete miscarriage
This stage shows symptoms of vaginal bleeding with tissue (clots). However pain and bleeding will be much less than a complete miscarriage, due to the foetus being only partially removed. This condition again needs complete evacuation of the uterus by medical / surgical methods.

Complete Miscarriage
This is a stage when the whole process of miscarriage has completed. After blood and tissue have been completely expelled from the body, bleeding will have stopped. The mother needs to be reassured and her psychological condition of mourning should be addressed and future pregnancies should be discussed and addressed.

Missed Miscarriage
This is also known as a Silent Miscarriage. In a pregnancy, sometimes the foetus dies inside the womb without any obvious reason. The pregnant woman will miss her periods and after there may be some vaginal bleeding, where some brownish coloured old blood will pass through the vagina. Pregnancy signs and symptoms such as breast tenderness, abdominal fullness, and baby’s movements will disappear. The size of the stomach may get smaller and the woman will feel less heaviness of the body as pregnancy hormones reduce gradually.

Ultrasound is the main mode of confirming the diagnosis. In early pregnancy, you will see only the sac and you may or may not see the yolk sac foetal pole, without foetal heart pulsation. As the foetus is dead, the foetus needs to be evacuated from the uterus with available medical or surgical methods that will be decided by the experts.

Mid Trimester miscarriages
In some females there is bleeding from the vagina after 12 weeks and up to 24 weeks. This is called mid trimester threatened miscarriage which will go through usual process of inevitable, incomplete and complete in some women.

The reasons for this condition may be due to cervical incompetence, that means the inability to hold the weight of the baby and neck of the womb opens up. This can be due to congenital weaknesses like short cervix or relaxed cervix, or even due to surgical damage to the internal area of the cervix.
When this is diagnosed by clinical ultrasonography or biochemical methods, your doctor will insert a stitch around the neck of the womb. It is a minor surgical procedure called cervical circlarge.
Vaginal infection can also be a cause for miscarriage. The membranes around the sac can get infected and weakened and rupture and start the abortion process. This condition can be treated by commonly used antibiotics.

Most common reasons for mid-trimester miscarriage can include;

  • Uterine fibroids, adynomiosis, which can be diagnosed by ultrasound
  • A haematological disorder called thrombophilia can affect a small number of women, and if this condition is diagnosed one may treat it with recommended medication
  • Foetal chromosomal or structural abnormalities

What to expect after a miscarriage?
It is heartbreaking to hear that you will not go on to deliver. Upon hearing this, a couple’s first reaction is usually disbelief. It is natural to mourn and cry and even experience feelings of guilt. You may even tend to find someone to blame. It is important to understand that there are things beyond our control. Exploring the reasons of why it happened with your doctor is important. Discuss what to avoid in a future pregnancy.

The doctor will advice you on how best to manage miscarriage. Post-miscarriage stage is a time to get through mourning with your partner/ friends & family. It is best not to get through it alone. It is natural and many other females go through it. Reaching out to a counsellor is often useful & it is important to consult your doctor if you are continuing to feel sad and depressed.

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