Spontaneous Abortion

The emotional upheavel and distress surrounding the decision to have an abortion, be it the result of knowledge of foetal abnormality or simply an accidental and unwanted conception, cannot nearly match the heartache incurred after a spontaneous abortion, or miscarriage. A woman who has experienced one or more miscarriages suffers the misery of having her hopes for the future destroyed, or fearing that it was her fault that she lost her baby, of suspecting that there is something wrong with her that has caused the loss and that she will never again become pregnant. A spontaneous abortion usually passes through several stages. The first stage is threatened abortion in which a woman, usually less than 20 weeks pregnant, notices a small amount of bloody discharge from the vagina and experiences cramping pains in the uterus. Either the symptoms subside or progress to an inevitable abortion, in which there is increased bleeding, the uterine cramps increase in severity, and the cervix opens for expulsion of the whole of the contents. A spontaneous abortion occurring after 20 weeks is more likely to be incomplete, the remains of which need to be surgically removed.

Spontaneous abortion is a common occurrence, affecting about one in every ten pregnancies, and can be caused by a number of factors.

At least half of all early spontaneous abortions are caused by defective development of the structures that grow from the fertilized egg, for example, the foetus, the placenta, and the membranes that surround the foetus and the amniotic fluid. Some of these aborted foetus have been found to have gross physical abnormalities caused by abnormal characteristics carried in the egg or sperm, or by the failure of normal development of chromosomes after egg and sperm unite.

In other cases illness may play a role in causing an abortion, especially during the first vital three months. One disease which can be extremely damaging to the foetus during this stage is German measles (rubella) contracted by the mother. The risk is highest when the infection occurs in the first four weeks, when the tiny developing organs are at their most sensitive – heart disease and deafness are two of the most common consequences of the disease. If an affected foetus does not atomatically abort, then the mother will be given the opportunity to have an induced abortion.

X-rays in large doses, radium and certain drugs may also cause abortion.

In case of foetal abnormality, it seems that the mother’s uterus in some way recognizes that something is wrong with the way that the baby is developing and chooses to reject it.

Surprizingly only very few spontaneous abortions are the result of emotional upheaval or physical accident, which in the latter case is a causative factor in only one in a thousand abortions.

Some women are unfortunately enough to abort repeatedly, usually after the first three months. In these instances, especially when there is no apparent foetal abnormality, attention is shifted to the possibility of physical problems occurring with the woman’s reproductive organs. In some women, an examination of the cervix may reveal a condition known as cervical incompetence. If the cervix has been damaged by previous childbirth or badly performed surgery, it may gape and refuse to keep the growing foetus within the confines of the uterus. In these circumstances the insertion of a stitch, known as a Shirodkar’s stitch, closes the cervix until the pregnancy is complete, when it is snipped to let the baby out.

Only about 3 per cent, at most, of threatened abortions can be prevented by rest and hormonal therapy – most spontaneous abortions are inevitable and cannot be controlled medically.