Facts and myths about miscarriage

Mrs. Pear experienced a sharp pain in her lower abdomen. Just 18 weeks into her pregnancy, she knew this could not be labour pain. The pain became persistent and when blood clots came out of her private part, she knew she had lost the pregnancy again.

This was the third miscarriage in two years. She is not the only woman experiencing spontaneous abortion. Studies have it that about 10 to 20 per cent of known pregnancies end in miscarriage, and more than 80 per cent of these losses happen before 12 weeks.

However, doctors claim that most miscarriages occur because the foetus did not develop normally. But because these abnormalities are rarely understood, it is often difficult to determine what causes them.

On the symptoms of miscarriage, many medical experts listed the most common as vaginal spotting or bleeding. This is usually the first sign of miscarriage. However, studies claim that one in four pregnant women have some bleeding or spotting; indicating the discovery of spots of blood on their underpants or toilet tissue in early pregnancy. Most of these pregnancies do not end in miscarriage.

Other symptoms of miscarriage include pain or cramping in a woman’s abdomen or lower back; fluid or tissue passing from the vagina. A gynaecologist, Dr. Cyril Dim, opined that if one has both bleeding and pain, the chances of one’s pregnancy continuing could be lower.

He said, “It’s very important to be aware that vaginal bleeding, spotting, or pain in early pregnancy can also signal an ectopic or a molar pregnancy.”

Dim added that some miscarriages were first suspected during a routine prenatal visit, when the doctor could not hear the baby’s heartbeat or notice that one’s uterus was not growing as it should be.

According to him, often the embryo or foetus stops developing a few weeks before one has symptoms like bleeding or cramping.

Speaking on the causes of miscarriage, an obstetrician, Dr. Kinglsey Ekwuazi, said between 50 and 70 per cent of first-trimester miscarriages were thought to be random events caused by chromosomal abnormalities in the fertilised egg.

He said, “Most often, this means that the egg or sperm had the wrong number of chromosomes, and as a result, the fertilised egg could not develop normally. On other occasions, miscarriage is caused by problems that occur during the process of early development, which includes an egg that does not implant properly in the uterus or an embryo with structural defects that prevent it from developing.”

On his part, another gynaecologist, Dr. Shukurat Okesina, identified age as another cause of miscarriage.

“Any woman can miscarry, though older women are more likely to conceive a baby with a chromosomal abnormality and to miscarry as a result. In fact, 40-year-olds are about twice as likely to miscarry as 20-year-olds. A woman’s risk of miscarriage also rises with each child she bears. Women who have had two or more miscarriages in a row are more likely than other women to miscarry again,” she said.

Okesina further identified poorly controlled diabetes and certain inherited blood clotting disorders, autoimmune and hormonal disorders as some of the conditions that could increase the risk of miscarriage.

“A history of birth defects or genetic problems is another cause. If an individual or her family members have a genetic abnormality such that she has also been identified in a previous pregnancy, including given birth to a child with a birth defect, one is at a higher risk of miscarriage. Smoking, drinking, and drug use could also be a cause of miscarriage. Smoking, drinking alcohol and using drugs like cocaine during pregnancy can all increase one’s risk of miscarriage. Some studies show an association between high levels of caffeine consumption and an increased risk of miscarriage,” she said.

Similarly, Dim said some medications had been linked to increased risk of miscarriage, hence the need for a woman to always ask her doctor about the safety of any medications prescribed to her, even while trying to conceive.

Dim stated, “This goes for prescription and over-the-counter drugs, including nonsteroidal anti-inflammatory drugs like ibuprofen and aspirin.”

How is miscarriage diagnosed?

Okesina said if one was experiencing any of the above symptoms, one should consult one’s doctor immediately.

“He or she will evaluate the bleeding and then possibly measure one’s hCG (hormone) levels, check whether one’s cervix is open (it should be closed during pregnancy), perform an ultrasound to look for a healthy gestational sac and placenta, and listen for a foetal heartbeat. The results of these tests will help one’s health care provider to determine whether one has miscarried.

“In rare cases, miscarriages can be misdiagnosed. If one is bleeding and one’s practitioner cannot find a foetal heartbeat (which can sometimes be tricky even in a healthy pregnancy), he might diagnose a miscarriage when an embryo is still thriving. If one stops bleeding, however, and continue to have pregnancy symptoms, a second ultrasound — where the heartbeat is hopefully heard — could confirm that one’s baby is still thriving,” she said.

After miscarriage, an Ilorin, Kwara-State-based gynaecologist, Dr. Gboyega Inofomoh, said if a woman’s cervix started to dilate but she has no bleeding or pain, her practitioner could diagnose her with incompetent cervix and perform cerclage (stitching the cervix closed) to prevent a late miscarriage.

“If one has miscarried, chances are it was complete — or all the contents of the uterus (including not only a foetus, but the placenta and all the extra uterine lining) are expelled naturally, which can take up to two weeks. But sometimes, parts of the pregnancy remain in the uterus. For the body to recover and resume normal menstrual cycles, the uterus needs to be emptied. So, in some cases of incomplete miscarriages, health care providers will recommend pills or surgery to help one’s body clear out the uterus. She will also need to take some extra precautions after miscarriage, including avoiding inserting anything in the vagina for two weeks to prevent infection,” he said.

However, Inofomoh said most miscarriages could be prevented with a healthy lifestyle, which includes getting chronic conditions under control before conception; keeping one’s weight gain in a healthy range and taking a prenatal vitamin like folic acid and other B vitamins.

He added that research had shown that some women have trouble conceiving and/or sustaining a pregnancy because of a folic acid or vitamin B12 deficiency treatable with appropriate supplementation.

The medical doctor further stated that avoiding and treating infections such as sexually transmitted diseases, staying away from cigarettes and alcohol and taking only prescribed medications could help check miscarriages.

Besides, Okesina said, “If one has had two or three miscarriages, one’s doctor will probably run extensive tests to see if he can find a cause. Around half the time, he won’t be able to find a single reason why one has had multiple miscarriages. But sometimes, he may discover an untreated health problem, such as an autoimmune disease (where the mother’s immune system attacks the embryo), thyroid problem, misshapen uterus or one of a few very rare disorders that can make one’s body reject pregnancies.

“A woman together with her partner may be tested too for blood-clotting disorders. An ultrasound or CT scan may be performed on her uterus, one’s uterine cavity may be assessed with hysteroscopy, and the miscarried foetus itself can be tested for chromosomal abnormalities. If he does pinpoint one of these causes, he’ll be able to help reduce her chances of future miscarriages with treatments, including surgery to correct cervical or uterine issues and medications to manage hormonal imbalances.”

However, Okesina said the good news is that most women who have had a miscarriage (even more than one) eventually go on to have a healthy pregnancy, although one may need to manage future pregnancies differently.

According to the American Congress of Obstetrics and Gynaecology, even after four consecutive losses, around 65 per cent of women go on to carry their next pregnancy to term.

Okesina also noted that whether it’s one’s first or fifth, in the aftermath of a miscarriage, it’s important to take care of both one’s body and mind, adding ‘‘After a miscarriage, check in with your healthcare provider and allow yourself time to grieve. Then when you’re ready, find someone to talk to. Sharing your feelings openly with your partner may help too.”

On conceiving again after a miscarriage, Okesina said one may have to wait a bit.

She further explained that whether a woman miscarries spontaneously, with the help of medication, or have the tissue removed, she should generally get her period again in four to six weeks.

“Some practitioners say one can start trying to conceive again after this period, but others recommend that one waits until one has been through another menstrual cycle so that she has more time to recover physically and emotionally,” she said.