Deep in the remote villages of Uganda and a few suburban areas, a miscarriage is almost always attributed to a bad omen. I have encountered a few women who reported toxic relationships because they had had two consecutive miscarriages. It only implies that society partly understands this quite a common occurrence. Let’s talk about it.
For simplicity, a miscarriage, or spontaneous abortion, is defined as the loss of a pregnancy before the embryo can survive. In Uganda, any loss of a pregnancy before 28 weeks of gestation is a miscarriage. This period varies in the different regions of the world: for example, many developed countries have reduced it further to 20 weeks. The reason for the variation isn’t rather far-fetched: it stems in the country’s ability to keep these babies alive. So perhaps, when the government of Uganda improves health care delivery further, who knows, we may change the definitions.
Miscarriage affects 10% to 15% or more of all pregnancies, with most of them occurring before six weeks or after 14 weeks of gestation. An incomplete miscarriage is the loss of some, but not all, of the products of conception. In an inevitable miscarriage, membranes break or dilatation of the cervix occurs in the first half of pregnancy. When the uterus keeps a failed pregnancy for weeks, we term it a missed miscarriage. A threatened miscarriage is a pregnancy whereby symptoms such as bleeding or cramping indicate that a miscarriage is possible but not necessarily automatic.
When the fetus and placenta separates from the wall of the uterus, a miscarriage occurs. 9 out of 10 miscarriages that happen in the first trimester are due to an abnormal fetus. More than 50% of these fetuses have defective genes that would cause defects incompatible with life. After 35 years of age, the risk of miscarriage increases.
Miscarriages that occur during the second trimester are usually related to a problem in the woman, which may include, chronic illnesses (like diabetes, high blood pressure, or thyroid disease), infection, abnormal female organs like fibroids, and drug use such tobacco and cocaine.
Exercising, working, and having sex doesn’t cause miscarriages unless a woman is already at high risk for this condition.
The most common symptoms of a miscarriage are vaginal bleeding and abdominal cramping. Close to 40% of women can have mild symptoms, but then carry on their pregnancies in a perfectly healthy manner.
Related article: FEMALE SEXUAL DYSFUNCTION: Let’s manage it.
A clinician diagnoses a miscarriage by a vaginal or ultrasound examination after taking the medical history. Clinicians can measure pregnancy-related hormones, but they don’t always show that a problem exists.
After a complete spontaneous abortion, you only need an ultrasonogram to confirm this then your body will only need to get back to normal before you try to conceive again.
However, for any incomplete miscarriage, medications can be prescribed to complete the process or a minor surgical procedure called dilatation and curettage (D&C) may be performed.
Talking about D&C, click on the link below to watch the video about the AIMS (Antibiotic use in miscarriage surgery) conducted in Uganda and Malawi.
It is paramount for a woman has had a miscarriage to take time to grieve and heal emotionally and physically, and in this case, a support group may help. There’s no need for a woman to change her diet or activities unless the clinician has directed otherwise.
Clinicians must investigate any spontaneous abortion such that they treat any correctable causes. I recently encountered a lady who was carrying the seventh pregnancy: she had had six miscarriages. It was unfortunate: it shouldn’t be allowed to occur anywhere under the sun.
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