Pregnancy and Related topics-Miscarriage

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Miscarriage is the spontaneous loss of products of conception at anytime till the twenty-fourth week of pregnancy. If it happens anytime after this time it is called stillbirth. It is a very traumatic and unhappy experience for the woman. There are several causes which may lead to miscarriage. Still, in a few instances, the exact cause may still be not known.

Week1 to week 8:Ectopic Pregnancy

If a fertilized egg gets lodged and starts to grow in the fallopian tube instead of the cavity of the womb it is called an ectopic pregnancy. The embryo can grow distending the fallopian tube up to eight weeks. But after this the tube ruptures and profuse bleeding occurs. Bleeding and severe pain are the signs and symptoms of an ectopic gestation. An ultra sonogram and laparoscopy can determine the exact spot where the embryo is located and the pregnancy has to be terminated by surgical removal. An ectopic pregnancy is a serious thing and ,if you ever experience abdominal pain and bleeding you have to immediately consult your obstetrician. If neglected, it may even prove fatal.

First 12 weeks: Blighted Ovum

In this condition a fertilized egg does not develop, as it should normally. Though the hormones of pregnancy are produced in adequate amounts, the embryo does not grow properly. It is expelled (Miscarried) within the first twelve weeks of conception.

First 16 weeks: Hormonal causes

There are a few hormonal causes, which may be responsible for a miscarriage.

1. In cases of polycystic ovaries there may be high levels of luteinizing hormones (LH). This can significantly increase the chances of miscarriage. Urine tests can determine the levels of LH and treatment can be instituted to suppress the secretion of LH.
2. Low levels of progesterone or HCG(Human Chorionic Gonadotrophin)can alsolead to miscarriage. These hormones are responsible for maintaining pregnancy. If these hormone levels can be maintained by administering injections during the later stages of pregnancy there are chances of preventing a miscarriage.

INCOMPETENT CERVIX

The cervix will remain closed until labor starts. If the cervix or the neck of the uterus is not strong enough to resist the weight of the fetus , it may give way and open up and a miscarriage may result. If a woman shows a tendency for miscarriage after the 14th week of pregnancy, and if it happens more than once, it is presumed that it is due to an incompetent cervix, if all other factors are eliminated by the obstetrician. In such a situation a small surgery is performed under epidural or local anaesthesia wherein a stitch is passed around the cervix to make it more competent to resist the weight of the growing fetus. It is left till the end of pregnancy and at the time of delivery, it is cut to deliver the baby.

HYDATIDIFORM MOLE

Sometimes a defective egg cell with no nucleus can get fertilized by the sperm, and start growing as in a normal pregnancy. This resembles a cluster of hydatid cysts, hence known as hydatidiform mole. Though the embryo is not present, the placenta continues to grow as if there was an embryo. The hormones of pregnancy are released. In between 8 and 16 weeks the mole is miscarried. There may be severe vaginal bleeding and severe morning sickness may also be present in this condition. If it is diagnosed earlier, a dilatation and curettage (D and C) can be performed. Pessaries can speed up the process of miscarriage. There is a chance of cancerous changes in a few percentage of women who suffer from this condition.

AFTER 16 WEEKS: FIBROIDS

Fibroids are one of the most common non-cancerous tumors of the uterine wall. Women with fibroids can go through perfectly normal pregnancies until a miscarriage occurs when the fetus gets bigger. The fibroid can be removed by a surgery termed as myomectomy.

ABNORMALLY SHAPED UTERUS

If the uterus is not normal in shape and is irregular there may not be enough space for the fetus to grow. Miscarriage can result between 14-28 weeks. The surgeon can improve the shape of the uterus by surgery. If the woman conceives after correction of the shape of the uterus by surgical means, bed rest and medications are advised.

SYMPTOMS OF MISCARRIAGE


Bleeding, backache and lower abdominal cramps are the signs and symptoms of miscarriage. There may be no morning sickness or breast tenderness. In some cases bleeding and spotting need not be a sign of miscarriage. The pregnancy may continue normally without disturbance in spite of some spotting or some bleeding in a few women. However, obstetric advice is mandatory.
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