Spontaneous abortion is a very common problem in pregnancy and it is the most common type of pregnancy loss with about 1.5 million cases occurring yearly. Among women who know they are pregnant, the miscarriage rate is roughly between 10% to 20%. Although many women have miscarriage without even knowing it especially at the very early weeks of pregnancy.
Studies have shown that the incidence rate of miscarriage varies among women of different age groups which increases as the woman’s age increases.
- Children (6 – 13years) : very rare
- Teenagers (14 – 18years) : common
- Young adults (19 – 40years) : very common
- Adults (41 – 60years) : common
Miscarriage, as it is commonly referred to is the expulsion or loss of the fetus and other products of conception before the 20th week of pregnancy. This is different from when there is a deliberate termination of pregnancy either by surgical or pharmacological means, in which case, it is referred to as induced abortion or criminal abortion in countries where the law prohibits abortion, except in a few instances where deliberate termination of the pregnancy is permitted by the law.
There are several factors that causes a pregnant woman to miscarry or abort spontaneously. They may be maternal or fetal factors, but all of them predispose the pregnancy to the risk of abortion. The major causes include
- Infections e.g malaria, bacterial vaginosis, urinary tract infection e.t.c
- Chronic illnesses e.g diabetes, sickle cell disease, thyroid disorders e.t.c
- Incompetent cervix
- Some drugs interfering with pregnancy
- Fetal abnormalities
These factors are responsible for the different types of spontaneous abortion there are.
This is where there is vaginal bleeding occurring in the first 20 weeks of pregnancy without the expulsion of fetal tissue or rupture of membrane. Vaginal bleeding is usually painless here and may be scanty or moderate. The cervix is also closed in threatened abortion.
This is where there is vaginal bleeding with the dilatation of the mout the cervix. Vaginal bleeding is usually heavy and associated with lower abdominal pains and there may be passage of some fetal tissue. The reason it is called inevitable abortion is because the cervix is incompetent and cannot remain close to enable the fetus remain and develop properly in the uterus (womb).
This is where there is vaginal bleeding with passage of large clots and/or fetus and other products of conception. Vaginal bleeding is accompanied by lower abdominal pain and dilatation of the mouth of the cervix.
Here, there is vaginal bleeding with complete passage of the products of conception and the closure of the mouth of the cervix. Vaginal bleeding is usually heavy and painless.
This refers to fetal death in the uterus before 20 weeks of pregnancy. After 20 weeks, it is no longer referred to as missed abortion but rather Stillbirth. The product of conception are retained in the uterus after the demise of the fetus. This is suspected when the size of the uterus refuse to grow and fetal heart tone disappears. There may be intermittent vaginal discharge and absent maternal perception of fetal movements (if the fetus had started kicking).
The diagnosis of miscarriage is a combined product of the signs and symptoms the pregnant woman presents to the hospital together with a range of test and examination the doctor will conduct on both the woman and the pregnancy to determine the exact type of abortion it is and treatment plan to use. The investigation include:
- Ultrasound scan of the fetus
- Full blood count
- Malaria tests and sickling test
- Blood Grouping and cross-matching
- Blood clotting profile
- Pregnancy test
- Fasting Blood Glucose
Management plan of miscarriage or spontaneous abortion is dependent on what type the woman is presenting to the clinic with. The management covers both pharmacological and non-pharmacological measures.
- Strict bed rest in the hospital or at home and abstinence from sexual intercourse or lifting heavy objects especially in threatened abortion.
- Cervical circlage can be done for viable case of inevitable abortion.
- Evacuation of the uterus through Manual Vacuum Aspiration (MVA) with antibiotics to prevent infection for incomplete abortion, missed abortion and non-viable cases of inevitable abortion.
- Treatment of anaemia if present due to heavy bleeds.
- Counselling and psychological support
General Preventive Measures
Like most conditions, prevention of spontaneous abortion or miscarriage is possible for the woman who knows she is pregnant. This can be achieved by decreasing the risk factors of miscarriage through
- Good Ante Natal Care
- Avoiding drug and alcohol
- Prevention of infectious diseases like malaria
- Good manage of maternal chronic conditions like diabetes etc
- Avoiding X-rays and other forms of radiation during pregnancy.
- S. Campbell, A. Monga (2006), “Abortion” Gynaecology by Ten Teachers, 18th edition (pg 71-75).
- Msdmanual.com: “Spontaneous Abortion ” (Accessed 9/01/2018).
- WebMD, “Miscarriage Symptoms, Causes, Diagnosis, and Treatment”
- American Family Physician,Management of Spontaneous Abortion
- ScienceDirect, spontaneous-abortion