Understanding miscarriage

Posted on 6 June 2013

Some 15% of all recognised pregnancies end in miscarriage. Dr Martin Puzey, a gynaecologist and obstetrician at Mediclinic Cape Town, talks us through this distressing fact of nature.

What is miscarriage and why does it happen?
Also known as spontaneous abortion, a miscarriage is the loss of a pregnancy. More than 80% of all miscarriages occur in the first three months of pregnancy – over half of these are caused by problems with the foetus’s chromosomes, the minute particles inside our body cells which carry our genetic material. It is the chromosomes that determine our appearance, gender and blood type. Most often miscarriage is nature’s way of ending a pregnancy in which the foetus was not developing as it should, rather than a major problem appearing at the end of the pregnancy.

And chromosome problems with one pregnancy does not mean that it will happen in the next, unless in the rare case of recurrent miscarriages, in which case you and your partner would have a karyotype to study your chromosome structures.
Miscarriages after three months are generally due to illness or a problem with the mother.

What puts me at a higher risk of miscarriage?
•    Age can put you at greater risk – moms over 40 are more at risk than 20 year olds.
•    If you smoke or drink heavily, or use illegal drugs (especially cocaine), you would increase the risk of miscarriage.
•    If you have a poorly-managed chronic illness such as high blood pressure, diabetes, congenital heart disease or severe kidney illness, it can lead to miscarriage. But careful monitoring and treatment mean a good chance of a successful pregnancy.
•    Certain womb abnormalities are linked to miscarriage, mostly in the second trimester, and can be treated surgically.
•    Hormone imbalance can also lead to repeated miscarriage and can be addressed with progesterone supplements.
•    Poor nutrition and a low body mass index also put you at risk.

What are the signs of miscarriage?
Not all signs of miscarriage mean that you are miscarrying. If for example, you were to have bleeding or spotting during early pregnancy with little or no pain chances are that this is what is termed a threatened miscarriage.

The main symptoms are severe cramping pain in the lower abdomen and bleeding. Your doctor will do a physical examination to check whether the mouth of the womb is open. If it is, a miscarriage is likely. If not, chances are that it is simply a threatened miscarriage.

When should I see my doctor?
If you have bleeding after pregnancy has been confirmed, or if you have the pain or cramping associated with bleeding.

What can my doctor do?
Unfortunately, once miscarriage is inevitable, there is no stopping it – nature will take its course in most instances. However, your doctor can ascertain by ultrasound if the pregnancy is ongoing. The most important reason to see your doctor is to exclude a pregnancy that is outside of the uterus, as this could potentially threaten your life.

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