A miscarriage is always a very distressing experience and can have a profound psy-chological impact on a woman. It’s common to suffer feelings of remorse at losing the baby and to worry unduly about the reason for the miscarriage.

However, if you’ve recently gone through all this it may be some small comfort to know that you’re certainly not alone. In fact at least 20 per cent of all pregnancies end in miscarriage, and the figure may well be much higher than that. This is because many early miscarriages are confused with a slightly delayed period and are therefore either not noticed at all, or else not reported to the doctor. After a miscarriage, it’s also vital that the mother reassures herself with the know-ledge that the most difficult part of achie-ving motherhood is becoming pregnant, and having demonstrated this ability to conceive, the outlook for finally achieving a full-term pregnancy and having a healthy, bouncing baby is very good.

Miscarriage, or to use its medical name, is defined as the expulsion of a pregnancy or part of a pregnancy from the womb before the 28tit week of pregnancy (or in some countries before the 24th week). This length of pregnancy is chosen because it is considered that a baby is incapable of living an existence separate from the mother before that time.

Miscarriages occurring within the first three months of pregnancy are called miscarriages. These are by far the most common, with the majority taking place in the second month of pregnancy, and relatively few in the third month. Those in the middle three months are known as miscarriages. The reasons for losing the foetus lend to van-according to the trimester in which this loss occurs.

Regardless of timing, miscarriage may either be complete or incomplete.

This means that although the amount of bleeding may have been considerable some of the pregnancy still remains within the womb. Others have when the entire contents of the womb are expelled.

It is a fact that some women have a tendency to miscarry during the first three months of pregnancy. There is no known reason for this and doctors stress that there is no cause for alarm. Indeed, up to three first trimester miscarriages in succession are considered to be absolutely ‘normal’, and little will usually be done to investigate possible reasons until a woman has had her third miscarriage. On the other hand, any miscarriage in the second trimester is considered more significant and investigations may be started soon alter the miscarriage.

Threatened miscarriages

These usually start with bleeding from the vagina. The blood lost can vary from slight brown staining to heavy bleeding with blood clots. At this stage a threatened miscarriage is similar to a period and the bleeding is not severe enough to terminate the pregnancy. The outcome of a threatened miscarriage is unpredictable but in most cases, if the bleeding stops, pregnancy is likely to continue.

Bleeding may occur during (he first three months for reasons entirely unrelated to threatened miscarriage. A few women tend to bleed slightly at the time the first, second and third periods are missed. Bleeding may also be caused by cervical erosions, or vaginal infections. Unfortunately, there is no way the bleeding due to these causes can be distinguished from the bleeding due to a threatened miscarriage.

This is why it’s essential for a pregnant woman who has vaginal bleeding to report to her doctor. If the bleeding is very heavy she should go to bed and ask the doctor to visit her at home. It’s also important to save any blood clots or heavily stained pads or clothing so that he can check that none of the developing rembry° or placenta has been lost. (The doctor will examine you to ensure ~~the cervix is still closed, and that the size of the uterus corresponds to the dates of the pregnane)’ calculated from the last period. Provided that this is the case, he will usually advise bed rest until the bleeding has stopped.

When it has, he will check to make sure there is a continuing pregnancy, and, where facilities are available, will arrange for an ultrasound test on the womb. This will help to confirm that all is well.

If the size of the uterus doesn’t correspond to the date of the last period then the doctor is alerted to the following possibilities: either simply that the woman has got her dates wrong (this is extremely common – about 70 per cent of women who say they are sure about the date of their last period are in fact proved wrong!) and the baby is due either earlier or later than previously estimated; or, if the womb is smaller than expected, it’s possible that the foetus has died .

Apart from bed rest there is no specific treatment for a threatened miscarriage. I ndeed, even the value of bed rest is hotly debated among many doctors. Surveys have shown that women who continue to go about their normal daily duties (provided they avoid strenuous exercise and sexual intercourse) have just as much chance of continuing the pregnancy as those who are confined to bed in hospital. In the last analysis, doctors sav that only nature can decide the final outcome of a threatened miscarriage.

Injections of pregnancy hormones, such as rarely prevent miscarriages. They are now used only in a few unusual cases as some of them have been found to cause abnormalities in the baby, and they are generally aborted.

Inevitable miscarriage

A miscarriage tends to become inevitable when the bleeding is accompanied by tummy cramps similar to period pains, andor low backache in which the pain may be quite severe. This indicates that the womb is making miniature contractions, similar to labour contractions, in an effort to expel the pregnancy from the womb. The cervix becomes dilated and quite soon after the onset of the symptoms the miscarriage usually occurs, and may be complete or incomplete.

Sometimes the whole thing happens quite quickly with none of the warning symptoms of a threatened miscarriage. On other occasions the sequence of events may occur more slowly. In these cases, the symptoms of a threatened miscarriage are usually found on examination to be accompanied by a dilated cervix. If this is so, then eventual miscarriage is considered inevitable, even if neither the developing embryo or placenta have yet been lost. The doctor will advise the woman to rest in bed until miscarriage ’proper’ occurs.

Incomplete abortion

In some cases, this may not be until a couple of days later.

It is very difficult for a doctor to be sure that all the contents of the womb have been expelled unless he has been able to examine everything that has been lost from the vagina. In practice this happens very rarely, so he will usually err on the safe side and advise a D and C operation to clean out the uterus.

This is a very important procedure as any remaining parts of the developing pregnancy may become infected and give a woman a high temperature, or cause prolonged period like bleeding and pain.

Common causes of early miscarriages abnormalities in the developing embryo are by far the most common causes of miscarriages which occur during the first three months of pregnancy.

Chromosomes are minute chemical packages contained within each cell of the body and they are inherited equally from both parents to determine all bodily characteristics of the developing baby. Sometimes mistakes occur in the structure of these chemical packages. This is very serious, as even minute mistakes can have disastrous effects on the bodily shape and characteristics of the baby. It would seem that in the case of a foetus having chromosomal abnormalities, miscarriage is simply nature’s way of reducing the number of abnormal or defective babies being born.

Any illness which causes a high temperature like ‘flu or malaria may result in a miscarriage. It is vitally important that a pregnant woman with flu asks her doctor to visit her immediately, so that he can make every effort to lower her temperature as soon as possible.

A woman expecting twins or triplets is more prone to miscarriage than a woman with a single pregnancy. This could possibly be due to the womb cavity not being able to stretch quickly enough to accommodate the babies’ rapidly increasing size.

Severe kidney disease, disease of the thyroid gland and diabetes also increase the risk of miscarriage. This may be due to the increased physical stress that these diseases inevitably place on the woman during pregnancy.

Very rarely, unusual infections may enter the womb and induce miscarriage. Unfortunately, the discovery of these unusual germs by special testing often occurs too late for any effective treatment. However, such infections tend not to recur in subsequent pregnancies.

Contrary to popular belief, it would seem that shock or emotional upset play little part in causing miscarriage.

Delayed miscarriage

Sometimes, after the symptoms of a threatened miscarriage have disappeared and all seems well, the signs of pregnancy such as morning sickness or breast tenderness disappear, and the mother no longer ‘feels’ pregnant. In this situation the doctor may then notice that the uterus is too small for the expected duration of pregnancy.

A pregnancy test usually reveals that the baby has died, and this is then termed a ‘missed abortion’. After some time -often several weeks later- the symptoms of miscarriage return, and the pregnancy – is then finally expelled from the womb. If miscarriage fails to occur of its own accord, the doctor will usually advise a D and C to clean out the womb.