By Dr S Dash, MD (Consultant Obstetrician and Gynaecologist)
Pregnancy loss can be emotionally devastating to both mother and father. Frequently, the response tends to be, “Why me, and what could we have done differently?” It is important for these couples to realize that the miscarriage is usually not a result of something that they have done. It is also important to realize that they are not alone. In fact, human reproduction is one of the most inefficient biological processes known. Out of a hundred acts of unprotected sex, pregnancy results only in 50 per cent. Of these 50 pregnancies, 25 would have a miscarriage even without the woman knowing it. In the remaining 25 pregnancies, only 10 to 12 would go on to deliver normal healthy babies with the rest succumbing to miscarriages and pregnancy complications. Of these, recognized miscarriages share the largest piece of the pie. So, to sum it up, a hundred acts of intercourse would lead only to a ‘take home baby’ rate of 12. Statisticians propose that if this ‘take home baby rate’ was 25, there would not actually be any place to stand on Earth by 2010 !
Miscarriage before the 20th week of pregnancy is unfortunately quite common. It occurs in up to 20% of women who have missed a period and know that they are pregnant. This means 1 out of every 5 pregnancies would miscarry in the first three months.
After one miscarriage, a couple’s chance of becoming pregnant again and carrying that pregnancy to term is still very good. The odds start to work against you after 3 or more miscarriages, which is referred to as recurrent pregnancy loss. This is usually the point at which most doctors would begin investigating the possible causes. However, if a couple has suffered through two losses and if they are concerned enough, most doctors will begin the investigation early. The important point here is that even after a lengthy and usually expensive work-up to determine the cause, the reason for the miscarriage will only be discovered in 40-50% of the cases. But there is some good news. Even without treatment, couples who have had three miscarriages will be able to have a full term pregnancy in 50-70% of cases.
As previously mentioned, the cause of recurrent miscarriage is often never known. Sometimes, however, the cause can be identified as being the result of genetic problems, certain maternal infections, hormonal imbalances such as diabetes or thyroid problems, immune system disorders, or anatomic problems of the uterus. For cases in which a particular cause can be identified, treatment could potentially improve a couple’s chance of successful pregnancy.
Other areas of concern are environmental factors. For example, women who smoke are at a higher risk of pregnancy loss than non-smokers. In addition, heavy use of alcohol or illegal drugs, especially cocaine, could increase the risk of miscarriage. A common cause for miscarriages after the third month of pregnancy is a condition called ‘cervical incompetence.’ In this condition, the mouth of the womb is not strong enough to hold a pregnancy beyond 15 weeks. A surgical stitch on the mouth of the womb sometimes is the solution to this problem.
Sometimes miscarriages have also been attributed to sexual activity in the first 12 weeks of pregnancy. Abstaining from penetrative intercourse during the first three months of pregnancy is a wise idea for women with recurrent pregnancy losses.
An area of this problem not to be overlooked is the emotional impact on both parents. As an ob/gyn specialist, having to tell a couple that they have had a miscarriage is one of the toughest parts of the job. It is perfectly normal for these couples to experience significant grief and despair. It is also likely that self-blame and sometimes even denial will occur. Resist the urge to blame yourself. Neither one of you needs this type of self -punishment at this critical time. Instead, reach out to your family, your friends and your obstetrician. These people can provide the support that is so crucial at this stressful time.
When a woman has a miscarriage, the obstetrician would usually perform a vaginal and an ultrasound examination. If the ultrasound reveals a part of the abortus still inside the womb, the usual recommended intervention is an evacuation. This procedure is usually done under anaesthesia. Nothing active needs to be done if the necessary tests reveal a complete expulsion of the abortus.
In summary, even though it is difficult to determine the cause of a miscarriage, the chance of a subsequent successful pregnancy is good. When your next pregnancy occurs, be sure to see your specialist obstetrician early, so that close monitoring can be initiated.
