Kenya Society - There seems to be a surge in the number of women having miscarriages. In the past few months, a couple of friends have lost their babies and, naturally, they wanted to know whether the loss could have been avoided. This week, we will talk about this subject and answer the common questions that arise when it happens.
What is a miscarriage?

A miscarriage is the loss of a pregnancy or foetus. In medical terms, it is called a spontaneous abortion.

This refers to the spontaneous ending of a pregnancy before the foetus is old enough to survive outside the womb.

This is before the foetus weighs 500g or before it is 20-22 weeks old. Most miscarriages occur by the end of the first trimester, the 13th week.

Miscarriages are quite common; about a fifth of all pregnancies end this way.

In fact, the percentage is actually higher, but many miscarriages occur before one even knows she is pregnant, therefore she may never know she miscarried.

Since miscarriages, especially in the first trimester, are so common, one occurrence will not necessarily need further evaluation since they tend not to recur.

If one has two or more miscarriages, however, or miscarries in the second trimester, then a doctor will need to evaluate and advise/manage accordingly.

What causes miscarriage?

In many cases, it is not clear why it happens. Causes may include the following:

Chromosomal abnormalities -- if very severe, it means that the baby is not viable, therefore the pregnancy cannot proceed.

Chromosomal abnormalities are the main cause of miscarriage, especially in the first trimester, and it is important to note that usually these abnormalities are not related to the mother's or father's genes.

Infections

Abnormalities of the uterus such as those a woman is born with, and in a few cases of fibroids. It is worth noting that fibroids do not always cause miscarriage.

Hormonal abnormalities such as thyroid disease, polycystic ovary disease.

Chronic diseases such as diabetes and hypertension.

As you grow older, there is a higher risk of the foetus developing chromosome abnormalities, especially after the age of 35.

Auto-immune illnesses like lupus in which the woman's immunity fights her body tissues.

Smoking.

Exposure to toxins in the environment.

Obesity.

Symptoms

The main symptom is vaginal bleeding. Vaginal bleeding is not normal in pregnancy and you must see a doctor if you experience this. It may be just blood or blood with clots. In addition, you may have abdominal or lower back pain.

Diagnosis

Usually, the doctor will examine you and perform an ultrasound to confirm the abortion.

This determines whether it is a missed abortion (no foetus in the sac), complete or incomplete abortion which may have to be completed, or threatened abortion, where the foetus is still viable.

In this case, the doctor will give advice on how to ensure that the foetus survives. The ultrasound also shows whether the foetus' heart is beating normally or whether the baby and placenta have exited the body.

Treatment

Treatment will depend on whether it is a threatened abortion or not. In the case of a threatened abortion, the doctor may advise bed rest, carry out procedures to strengthen the cervix, and provide medicine, depending on the particular case.

In other miscarriages or abortions, the doctor may carry out a procedure called dilatation and curettage, where the uterus is cleaned up to ensure that nothing is left to cause infection.

In case of a missed abortion (blighted ovum), the doctor may either perform this procedure or allow the miscarriage to proceed naturally.

Prevention

Since many causes of miscarriage are chromosomal and unpreventable, prevention is difficult.

However, the other factors that could trigger miscarriage, such as obesity and infection, can be prevented.

The writer is a doctor and a public health specialist.

Frida Njogu Ndongwe

Daily Nation/23/11/2011