What is miscarriage? – Miscarriage refers to termination of pregnancy before the baby is able to survive outside the mother. The cut-off age for the diagnosis varies from region to region based on the medical expertise and equipment available to ensure survival of baby. In developed countries, the cutoff for miscarriage is as low as 20 to 22 weeks (5 months) while in developing countries, the cutoff is 28 weeks (7 months). This cutoff age is referred to as viability.

What is the difference between miscarriage and abortion?

Both terminologies basically mean the same thing. However, while miscarriage is usually more appealing for spontaneous abortion, abortion is generally used when miscarriage is induced. 

What are the types of miscarriages?

Miscarriage can be categorized into:

1. Threatened miscarriage: In this case, a pregnant woman (before viability) is bleeding (usually minimal) and experiencing lower abdominal pain / cramps. The cervix is closed and the pregnancy continues with no problem.
2. Missed miscarriage: This refers to a situation where a pregnancy (before viability) stops growing; the fetus dies but is retained in the uterus. It is referred to as missed miscarriage because the uterus holds on to the pregnancy without a live / growing fetus.
3. Inevitable miscarriage: A pregnant woman is bleeding, with lower abdominal pain and dilated cervix. The pregnancy is yet to be expelled but is on its way out and cannot be stopped.
4. Incomplete miscarriage: This refers to a situation where part of the pregnancy has been expelled and part remaining in the uterus.
5. Complete miscarriage: This refers to a situation where pregnancy is completely expelled by the uterus. The uterus is empty after the abortion process is completed.
6. Recurrent miscarriage: This refers to a woman having three or more consecutive miscarriages.

What are the causes of abortion?

Abortion may be caused by factors relating to either the mother or the embryo / fetus. These include:

1. Chromosomal abnormalities: This refers to genetic abnormality in the formation of the pregnancy, which may be from the egg or sperm or even both. These abnormalities make development in the fetus difficult. Thus, it may stop growing and die at certain age. This is responsible for the majority of miscarriages in the first trimester (first 13 weeks).
2. Infections: Infection of pregnancy is not common because of the natural barriers created to protect the pregnancy. However, sometimes, disruptions in the barrier allow infection to get to the pregnancy which may lead to miscarriage.
3. Abnormality of the uterus: Abnormally shaped uterus or uterus with fibroid may not allow the baby to implant properly and this may lead to its expulsion as its growth continues.
4. Mother’s age: Miscarriage tends to increase as the mother’s age increases, especially from the age of 35 years and above.
5. Cervical incompetence (Weak / short cervix): The cervix is like the door to the uterus. The weight of the pregnancy is constantly pushing against the cervix due to gravity. When the cervix is weak or too short, it easily gives way and the pregnancy drops out effortlessly.
6. Mother’s lifestyle: Smoking, illicit drug use, drinking of alcohol etc may affect the growth of the fetus and lead to miscarriage
7. Medical diseases in the mother: Diabetes, severe kidney disease, thyroid disease
8. Drugs: Certain drugs are not recommended to be taken early in pregnancy. When taken, they may cause severe disruption in growth of the baby that may lead to miscarriage.

What factors are not responsible for miscarriage?

It is common for pregnant women faced with miscarriage to attribute such to factors such as stress, sexual activity, exercise or use of birth control before getting pregnant. Most miscarriages have nothing to do with any of these factors. They happen mostly because of inherent problems either in the mother or in the developing baby.

What are the symptoms of miscarriage?

Symptoms of miscarriage include:

1. Lower abdominal pain in excess of menstrual cramps
2. Lower back pain which may range from mild to severe
3. Vaginal bleeding that progresses from light to heavy
4. Passage of fetal tissue / blood clot
5. Reduced pregnancy symptoms

How is miscarriage treated?

The treatment of miscarriage depends on the type. There may not be need for any treatment, as in the case of complete miscarriage. Evacuation may be necessary, as in the case of missed abortion or incomplete abortion. This may require drug treatment or surgical evacuation. Sometimes, what is required is watchful waiting, as in the case of threatened abortion.

What to expect after miscarriage?

After completion of miscarriage, there may be some spotting and mild lower abdominal discomfort. This should not last more than few days; and it should be reducing by the day. There is need to report to hospital if any of the following happens after treatment:

1. Severe lower abdominal pain
2. Heavy vaginal bleeding
3. Fever; with associated chills

Advice after miscarriage

Within the first two weeks after miscarriage, the vagina should be free of any object: no sexual intercourse, finger or sex toys and no tampons. This is because any of these items may introduce infection into the uterus through the vagina.

What are preventive measures against miscarriage?

It is difficult to prevent miscarriages because majority of them are caused by intrinsic problems with the pregnancy itself, which is genetically determined and beyond physical control. However, the chances of having subsequent miscarriages in the following conditions may be reduced by adequate medical care:

1. Diabetes mellitus: Adequate control through regular prenatal care before getting pregnant
2. Cervical incompetence: Cervical cerclage in subsequent pregnancy
3. Obesity: Weight loss is encouraged
4. Lifestyle: Avoid smoking, alcohol and other illicit drugs