By Dr Nikhil Datar
A miscarriage, in layman’s terms, is defined as the spontaneous loss of a pregnancy before the age of viability. The foetus, before the age of viability is so small that it cannot survive even if best medical treatment is given. In India, we consider that a baby born after 24 weeks of gestation or foetal weight of 500 grams may have some chance of survival. Thus, when the foetus stops growing in the womb or is pushed out by the uterus before 24 weeks it is called a miscarriage.
Many a times the word miscarriage and abortion are common words that are used interchangeably. An abortion is something which is done voluntarily by a woman when she does not want to continue pregnancy. On the other hand, a miscarriage is natural and not by a woman’s choice. Generally one out of seven pregnancies is lost as a miscarriage. This means miscarriages are a very common occurrence. They are more common in the first three months.
About 10 to 20 percent of known pregnancies end in miscarriage. When we sow a seed we expect a plant to grow. At the same time, we also know that it is the law of nature that all seeds don’t grow. Take a step towards emotional healing by understanding what can cause a miscarriage, what increases the risk and what medical care might be needed.
What are the causes of miscarriages?
Signs and symptoms of miscarriage include:
- Bleeding from the vagina or spotting
- Cramps like you feel with your period
- Severe belly pain
It is a common myth that a miscarriage occurs due to woman’s negligence in eating or working or travelling. However, some of the causes are as follows:
Abnormality in the foetus
All male and female gametes are not normal. Pregnancy occurring out of these abnormal gametes will not be normal. When these miscarried foetuses were scientifically studied it was found that foetuses were genetically grossly abnormal. So it is Mother Nature’s way to discard and disallow these pregnancies from growing further.
Medical disorders in the mother
Uncontrolled diabetes, disorders of thyroid, high grade fever in early pregnancy can lead to a miscarriage. Hence it is advisable to check your health status before you plan a pregnancy. Obesity is also linked to increased chance of miscarriage. This is particularly true when BMI is very high.
A few studies have suggested that being deficient in folic acid is associated with a higher risk of early miscarriage. Vitamin supplementation is commonly recommended for pregnant women and women planning to conceive.
Viral infections such as toxoplasmosis, rubella, herpes can cause miscarriages. It is prudent to take vaccine for rubella before planning a pregnancy. Many other bacterial infections, including urinary tract infections can also cause miscarriages.
Deficiency of hormones like progesterone can lead to early miscarriage. In pregnancies achieved after treatment of infertility doctors prescribe these medications to improve the levels of hormones in the body.
The mouth of the uterus (cervix) stays closed all throughout nine months and opens up at the time of delivery. Sometimes the uterus opens up too early. This leads to a miscarriage usually in the second trimester of pregnancy.
Incidence of miscarriages amongst twins and triplets is higher than single pregnancies.
Some females have uteri in abnormal shape such as bicornuate uterus. Some uteri have or develop a septum. These anomalies may lead to miscarriages.
Fibroids especial large in size or those touching the lining of the uterus can lead to a miscarriage.
This is a rare complication in which the foetus does not get formed. Usually women having vesicular mole come the doctor with on and of bleeding. A sonography test makes the diagnosis. The gynaecologist requires to remove this bad pregnancy tissue by surgical procedure.
The immune system mistakenly creates small clots in the placenta leading to abnormal or poor blood flow to the foetus. These are complex conditions but rare. They may cause repeated miscarriages.
Interventions such as amniocentesis or foetal reduction can lead to miscarriage. Of course this incidence is very small.
Habits such as smoking, drug use, malnutrition, excessive caffeine and exposure to radiation or toxic substances.
Some things may make you more likely than other woman to have a miscarriage. These are called risk factors and some of them may include:
- Having two or more previous miscarriages.
- Being 35 or older. As you get older, your risk of having a miscarriage increases.
- Smoking, drinking alcohol or using harmful drugs. If you’re pregnant or thinking about getting pregnant and need help to quit, tell your doctor.
- Being exposed to harmful chemicals. You or your partner having contact with harmful chemicals, like solvents, may increase your risk of miscarriage. A solvent is a chemical that dissolves other substances, like paint thinner. Talk to your doctor about what you can do to protect yourself and your baby.
Always remember that miscarriages can be prevented to a large extent and one of the most vital steps is to get as healthy as you can before conceiving to provide a healthy atmosphere for conception to occur. It is important that for women to exercise regularly, eat healthy, manage stress, keep weight within healthy limits, take folic acid daily and most importantly do not engage in drinking and smoking habits.
(The writer is Senior Gynaecologist & Medical Director, Cloudnine Hospital Mumbai, Malad.)