When Mrs M stepped into my consulting room, she was tense, anxious and almost in tears. “Doc, please try to save my baby,” she pleaded. Married for five years, Mrs M, a 32-year-old housewife, had had difficulty conceiving. She was eight weeks pregnant when she came to see me that day. The bad news was fresh vaginal bleeding that morning. Eight months earlier, a blood cyst in her left ovary had been removed by key-hole surgery. She subsequently conceived after receiving injections (GnRH agonist) to suppress her hormones. When I examined her that day, there was bleeding from the vagina.
The neck of the womb (cervix) was closed and the baby’s heart beats were present on the ultrasound scan. She was immediately admitted to hospital for observation. Then, that night, I received an urgent call: Mrs M was having intense abdominal cramps and had passed a large amount of blood with clots. I rushed to the hospital. Mrs M was in a state of shock, crying incessantly and calling out the name she had chosen for her child as soon as she knew she was pregnant. By then, the cervix was open and foetal tissues ware passing through – it was a miscarriage. What was needed now was an emergency operation to empty the uterus to stop the bleeding. Traumatic as the miscarriage (the loss of a foetus in the first 20 weeks of pregnancy) was for Mrs M, it is a fairly common occurrence. Let me explain.
The American College of Obstetricians and Gynaecologists( ACOG) says that about 15 per cent of known pregnancies end in miscarriage. The actual number is probably much higher because many miscarriages occur so early in pregnancy that a woman does not even know she is pregnant. More than 80 per cent of the time, it happens in the first three months of pregnancy (first trimester). In most cases, a miscarriage cannot be prevented because it is caused by random genetic or chromosomal change that occurs during conception and / or early foetal development. In few cases, a mother’s health condition – such as uncontrolled diabetes, thyroid diseases, infections, or problems with the uterus or cervix – may lead to miscarriage.
Certain factors like being an older mother (above 35), smoking, drinking, and previous history of miscarriage put a woman at higher risk of having a miscarriage. A number of terms are used to explain miscarriage. An inevitable miscarriage is bleeding and cramping with sighs that the cervix may be opening. An incomplete miscarriage, as in the case of Mrs M, is when the uterus expels the foetal tissues partially. This can lead to heavy blood loss. A blighted ovum is one that has occurred so early that no clearly defined foetal tissues have formed. A missed miscarriage is when there is foetal demise and the uterus does not expel the tissues for a while. Spotting and staining are common. Finally, a recurrent abortion is when a woman miscarries two or more consecutives times.
Mrs M came back for a check-up one week after her miscarriage. She was grieving and kept blaming herself for not resting adequately. She blamed her husband for shifting and changing furniture in her bedroom. “Doc,” she asked, “could the miscarriage be due to renovation in my baby’s room?” I reassured her, saying there is no medical evidence that all these activities caused her miscarriage. Losing a pregnancy is always heart- breaking. It is like the loss of a loved one. A patient should be treated with the respect and dignity she deserves. Telling her “You can always have another” or “It was just miscarriage” usually does not help. Consoling would be better: “I’m so sorry for the loss of your baby”. I suggested to Mrs M that she should take her time to grieve so that she could heal emotionally and physically before trying for another pregnancy. Mrs M is now 23 weeks pregnant and both the mother and baby inside her womb are well.
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