A Family Doctor's Tale - MISCARRIAGE

DOC I HAVE A MISCARRIAGE

Miscarriage or spontaneous abortion is defined as the premature expulsion of contents from a pregnant uterus.

About 10-15 per cent of all pregnancies ends in spontaneous abortion.

Spontaneous abortion is most likely to occur between the 6th and 10th week of pregnancy.

Causes of miscarriage:
1.Fetus development:
most common cause is the fetus is unable to develop a heart or brain to sustain living and hence dies on its own with fetus remnants being expelled from the womb

2.Hormonal
low progesterone secretion prevents the the placenta to attach securely to the wall of the womb and hence the the detached fetus is expelled from the womb

3.Iatrogenic:
attempts by pregnant mothers to induce an abortion by taking poisons, ergometrine, hormones, chinese medicines may sometimes be successful

4.Maternal factors:
In later pregnancies, maternal factors like acute illness, hypertension, endocrine disease like diabetes, uterine abnormalities may play a part in spontaneous abortion

Signs and Symptoms:

1.Threatened Abortion:

vaginal bleeding occurs during the first 28 weeks of pregnancy, starting from the uterus with uterine contractions and without dilatation of the cervical os.

2. Inevitable Abortion:

miscarriage is inevitable if uterine contractions are strong and the cervical os is open.

3.Complete Abortion:

This occurs when the products of conception are passed out through the vagina.

It is incomplete abortion if the miscarriage is partial.

4.Missed Abortion:

This happened when the dead embryo and placenta are not passed spontaneously.

If there is incomplete abortion there is a danger of septic abortion.

5.Septic Abortion:

There is fever, rapid heart beat, foul smelling vaginal discharge, tender uterus and leucocytosis  , all symptoms of septicemia.

The cause is usually E. coli or clostridium bacteria.

Habitual abortion :

This occurs when the uterus has cervical incompetance or is bicornuate


Investigations and diagnosis of abortion need to be confirmed by :

1. Vaginal examination

2.Ultrasound scan of the uterus

3. Blood human placenta lactogen and human choriongenic hormones should be helpful to determine the strength of the pregnancy

4.High vaginal swab is important to determine cause of infection

5.Dilation and curretage of missed abortion

Treatment of Miscarriage:

1. Threatened abortion :

Bed rest is very important


Avoid sexual intercourse

2. Incomplete Abortion:

Treatment of shock

Dilation and currettage of the uterus

3.Septic Abortion:

Appropriate antibiotics should be given

4.Missed Abortion:

Dilatation and currettage

5.Habitual Abortion:

a suture should be sewn around the cervical os to tighten the opening and prevent the embryo sac to slip through the os .