DEFINITION
Abortion refers to the premature termination of a pregnancy before the baby is developed enough to survive outside the womb. This can occur during the first or second trimester before the 20th week of pregnancy. Most occur during the first 12 weeks of pregnancy, and most are isolated and unexpected cases. About 15 to 20% of recorded pregnancies end this way.
CAUSES
Some abortions cannot be explained. Most occur for the following reasons:
- Chromosomal abnormality (most common cause)
- advanced age of the mother
- uterine defects
- fibroids
- Scar tissue from previous surgery
- Insufficient progesterone (a female hormone is needed to maintain the pregnancy)
- infection in the genital tract
- Immunological factors that can cause clots in the fetus.
RISK FACTORS
These factors increase the chance of having a miscarriage. Tell your doctor if you have any of the following risk factors:
- advanced maternal age
- smoking
- Consume more than two glasses of alcohol per day
- Using illicit drugs (recreational drugs)
- Exposure to some environmental toxins
- Infections, for example cytomegalovirus (CMV) and HIV
- Chronic disease of the mother, for example, autoimmune diseases such as lupus and insulin-dependent diabetes with uncontrolled blood sugar levels
- High-dose radiation therapy to the uterus, ovaries, or pituitary gland during treatment for childhood cancer
If you had an abortion the first time you were pregnant, you may be at higher risk of complications during your next pregnancy. Such complications include:
- pre-eclampsia
- Threatened abortion
- induced labor
- Preterm labor
- low birth weight
- postpartum hemorrhage
SYMPTOMS
Symptoms include some or all of the following:
- vaginal bleeding
- Pink or brown discharge
- cramps
- Evacuation of products of conception (fetus, placenta, and surrounding membranes)
- Fever
Recurrent Abortions
Although abortion usually occurs only once, up to 1 in 20 couples experience two consecutive abortions, and 1 in 100 experience three or more. Sometimes these couples have underlying problems. Couples who have had 2 or more miscarriages should have a full medical evaluation to establish the cause and thus learn how to prevent it. Tests can detect the cause of recurrent miscarriages in at least 75% of couples.
- Chromosomal problems in a partner: 5%
- Uterine abnormalities: 10% to 15%
- Hormonal problems: 5% to 40%
- Immune system problems: 5% to 10%
- Unknown causes: 25%
DIAGNOSIS
The doctor will ask about your symptoms, the length of your pregnancy, and the date you noticed any changes in your condition. The doctor will perform a physical and pelvic exam. Before the abortion, tests may include:
- Ultrasound: to assess the health of the fetus or detect an ectopic pregnancy (in which the fetus develops outside the uterus)
- Blood tests: to check the exact level of the hormone (called human chorionic gonadotropin) essential for carrying an early pregnancy
After the abortion, tests may include:
- Tissue examination: to evaluate the expelled tissue and detect chromosomal defects
- Blood tests: to check for defects in the male or female chromosomes, or to check hormone and antibody levels
- Imaging tests: ultrasound x-rays to identify problems in the uterus
- Endometrial biopsy – shows the ability of the uterine lining to receive and hold an embryo
- Hysteroscopy: to look inside the uterus. A hysteroscope (a thin, lighted, fiberoptic instrument) is inserted into the vagina and through the cervix. The doctor can detect abnormalities in the size and shape of the uterus, as well as evaluate and take a sample of the endometrial lining. During this procedure, the doctor may also correct a uterine problem.
TREATMENT
Immediate care is observation only, especially for abortions in the first trimester of pregnancy. In case of bleeding or cramps, some medications may be indicated. A dilatation and evacuation (D&E) may be needed if the uterine contents were not expelled spontaneously. During a D&E, the doctor dilates the cervix, inserts a tool into the uterus, and aspirates any remaining material. You may need psychological support to emotionally recover from the loss. The goal of long-term treatment is to prevent future miscarriages. This is adapted according to the cause that caused the loss.
Medicines
Medications used to reduce the possibility of miscarriage are:
- antibiotics for infection
- Progesterone supplements (if levels of this hormone are too low)
- Aspirin and other medicines to treat blood clotting problems caused by immune conditions.
Surgery
To reduce the chance of another miscarriage, many physical abnormalities of the uterus can be corrected. If the cervix is weak, the doctor may place a stitch, usually early in the second trimester of the next pregnancy, to keep it closed until delivery. If the fibers are a contributing factor, they can be removed to prevent another miscarriage.
Service support
Many times, counseling with a professional helps women cope with their loss, some feel better if they participate in a support group. If you are diagnosed with a miscarriage, follow your doctor's instructions. If you are diagnosed with a miscarriage spontaneous, follow directionsyour doctor.
PREVENTION
Before you start planning your next pregnancy, consider the following health tips:
- Is your diet really ready to support another pregnancy?
- Do you have any habits you can change before having another pregnancy?
- What medications are you taking and could they affect the pregnancy?
- How is your health?
- Are there issues I need to resolve before trying to get pregnant again?
- Seek help to learn what your risks are and what you can do to lower them.