Dr Rotimi Adesanya
A young lady had called me to book an appointment for consultation. She mentioned that her pregnancy of 6 weeks was uneventful except for the bleeding she experienced for 4 days. She was told by her colleague not to worry that some women do menstruate while pregnant- this is a myth. After the consultation, the scan suggested that no fetal activity or signs of live in the foetus. The scan was reported as a case of miscarriage as a result of blighted ovum. The blighted ovum suggest that the fetus did not form well.
Miscarriage is the spontaneous loss of a pregnancy before the 20th week. About 10 to 20 percent of known pregnancies end in miscarriage. Miscarriage is a relatively common experience in women of child bearing age.
Symptoms
Most miscarriages occur before the 12th week of pregnancy (1st 3 months). Signs and symptoms of a miscarriage includes: Vaginal spotting or bleeding, Pain or cramping in the abdomen or lower back, Fluid or tissue passing from the vagina. Most women who have vaginal spotting or bleeding in the first trimester go on to have successful pregnancies after getting the necessary medical support.
Causes
Genes or Chromosomes Problems….Most miscarriages occur because the fetus isn’t developing as expected.. Chromosome problems might lead to: Blighted ovum. (Blighted ovum occurs when no embryo form); Intrauterine fetal demise ( an embryo forms but stops developing and dies before any symptoms of miscarriage occur); Molar pregnancy (Both sets of chromosomes come from the father and its associated with abnormal growth of the placenta with no fetal development).
Maternal Health Conditions…in a few cases, a mother’s health condition might lead to miscarriage. Examples includes uncontrolled diabetes, infections, hormonal problems, uterus or cervix problems and thyroid disease.
Steps to avoid Miscarriage
There are many steps a woman can take to lower her chances of having a miscarriage, this includes staying healthy before deciding to become pregnant. That’s because a woman may not know she is pregnant in the first few weeks, which can be crucial for the health and development of the baby.
The steps women can take throughout their pregnancies includes:
1. Diets and Supplements
Eat a healthy diet: Eating a balanced diet before and during pregnancy is not only good for the mother’s overall health, but essential for providing the developing foetus with essential nutrients for proper growth and development and keeping the pregnancy intact.
Folic acid: Taking 400 micrograms (5mg readily available over the counter) of folic acid each day can help lower the risk of neural tube defects, or birth defects of the brain and spinal cord which are common causes of miscarriage. The vitamin is also found in some green leafy vegetables, nuts, beans, citrus fruits, and fortified breakfast cereals.
2. Lifestyle
Stop smoking: Women who smoke have higher risk of having miscarriages, also babies born to mothers who smoke tend to be lower birthweight.
Avoid exposure to alcohol during pregnancy: Women who take alcohol have higher risk of having miscarriages
Avoid self medication: Be sure to inform your physician of any medications and herbal supplements you are taking, since they can all have adverse effects on the developing fetus. They can also cause miscarriage especially the first few weeks of pregnancy.
Maintain a healthy weight: Women who are obese may experience medical problems such as high blood pressure and diabetes which can lead to miscarriage.
3. Medical Conditions
Medical management of pre-existing conditions: Take control of any current or pre-existing medical problems, such as diabetes or high blood pressure. This can lead to miscarriage if not well controlled.
4. Infections
Lower your risk for infection. Pregnant women should avoid eating undercooked meat and raw eggs and avoid all contact and exposure to cat feces and cat litter, which may contain a parasite, toxoplasma gondii, that causes toxoplasmosis. This may cause miscarriage. Bacteria and some viral infections could also cause miscarriage.
5. Radiations and Chemicals
Avoid exposure to harmful substances: These include lead, pesticides, and radiation (i.e., x-rays), which may harm the developing fetus and subsequently leads to miscarriage.
6. Domestic Violence
Stay away from Physical Abuse: Women who are abused during pregnancy may be at increased risk for miscarriage. The doctor can help to find community, social, and legal resources to help deal with domestic violence.
Conclusion
Women of childbearing age especially those who intend to conceive should start the preparation before conception (Pre-conception). Women can go for pre-natal care where the doctor will check, test , screen, and advice on pre-natal medications. This will help to identify women who may need help. They are to register for antenatal care early in pregnancy. This measures will also help in reducing the risk of miscarriage to a large extent.
Routine activities including high-intensity activities such as exercise, jogging ,cycling, sexual intercourse and work don’t cause miscarriage.
Adesanya is a Consultant Public Health Physician and the Medical Director at the Federal College of Education, Akoka Medical Centre, Lagos.
