Life After Miscarriage

Oh No! Not again. That was the bitter cry of anguish of a young woman, 23, watching helplessly as fluids mixed with blood clots drip down from her private part for the third time in 12 months after her wedding. Another miscarriage has happened again!

There is always something very beautiful and exciting about being pregnant, especially the first timers; The attention, care, pampering and love from the people around the pregnant woman are good experiences that radiate a feeling of fulfilment. But when the source of the joy, the fetus, spontaneously expelled before viability, different kinds of bad emotional symptoms like anger, bitterness, fear, worry, sadness bereavement etc. take center stage in defining the mood and feeling of the woman and or of the spouse.

Miscarriage is not only very devastating for the couples especially the woman, it is equally a frustrating and heart-wrenching experience. One moment they cling glasses in celebration of a positive pregnancy report, few weeks after they watch the report’s result going down the drain.

Despite all the anguish, bitterness, frustration, grief and general feeling of bereavement, there is light at the end of the tunnel. Medical experts and medical reports say women who experience miscarriage still have a very high chance of carrying a pregnancy to term.

WEB MD medical reference says you can get pregnant after a miscarriage. According to the journal, at least 85% of women who have one miscarriage go on to have normal pregnancies and births. Adding that having a miscarriage doesn’t translate to fertility problem.

Credit: Fabwoman.ng

Miscarriage Prevalence

Miscarriage is the spontaneous or unplanned expulsion of a foetus from the womb before it is able to survive independently outside the womb. Miscarriage happens when pregnancy or fetus usually less than 500g, unintentionally got expelled before viability age. According to medical experts, miscarriages occur naturally without any human intervention.

The age of fetal viability varies from country to country. According to Dr Odetayo, T.O , Senior Registrar, Obstetrics & Gynecology, Lagos state University Teaching Hospital (LASUTH) fetal viability age in Nigeria and other developing countries is before 28 week gestation, adding that babies born from 28weeks will survive outside the womb.

Taking cognizance of technological development and fetal salvage rate, the World Health Organization gave different viability age for different countries viz Norway 16 weeks, Australia 20 weeks, UK 24 weeks, Spain & Italy 26 weeks

Dr Odetayo, The O&G expert said 50% of all pregnancies end in miscarriage, most often before a woman misses a menstrual period or even knows she is pregnant. However, he said, about 15-25% of recognized or confirmed pregnancy will end in a miscarriage. This assertion was corroborated by other medical experts.

Abiola AO et al, in a study “Knowledge, Prevalence and Psychological Effect of Miscarriage among women of reproductive age group attending Obstetrics and Gynecology Clinics of Lagos University Teaching Hospital, Nigeria” say determining the prevalence of miscarriage is difficult and it is not possible to be precise about the frequency of spontaneous miscarriage.  According to the scholars, this is due to difficulties in identifying the start of a pregnancy; many miscarriages occur very early in the pregnancy and are not being diagnosed but are regarded as a delayed or abnormal menstrual period. Adding that treatment of women with miscarriage at home do not go into miscarriage medical statistics. However, in spite of these difficulties, according to the study report, the prevalence values of miscarriage are still amazingly high and quite alarming. The report states that one in five pregnancies (or 20%) end in natural miscarriage.  This number can go as high as 50% because so many early miscarriages happen before a woman even realizes she is pregnant.

While discussing miscarriage global trajectory, Odetayo said there is an upward trend in the yearly number of miscarriages in Africa and Nigeria because of poor medicare. Abiola et al study’s report also stated that rate of pregnancy loss is much higher in underdeveloped countries than the developed countries.

Except in the rare cases of late miscarriages, medical experts say 80% of miscarriages happen within the first trimester (3 months) of the pregnancy and less likely to happen after 24 weeks.

Miscarriage is the most common complication of human pregnancy; and is one of the most common clinical problems encountered by gynecologists in clinical practice. It has been estimated that one in four women who become pregnant will experience a miscarriage during their reproductive years and that it has both medical and psychological consequences. It is a complex phenomenon that can have a tremendous effect on the women’s psychological wellbeing in the short term and possibly in the long term. According to Dr Odetayo, miscarriages represent 45.5% of all gynecological admissions in most tertiary health institutions in Nigeria.

The mean age of the women involved in miscarriage, according to experts, is 28.4 ± 6.4 years.

Miscarriage 40% higher in black women- Voice-online.co.uk Photo: Getty Image

Symptoms & Signs:

– Spontaneous vaginal bleeding which may be preceded or followed by pain that may be crampy and radiates to the back and thigh.

-Bleeding may appear initially as spotting and there may be passage of tissues medically known as products of conception per vagina.

-Passage of fetal or placental tissue that may appear whitish and covered with blood.

-Passage of blood clots.

Bleeding may range from mild to severe.

Symptoms for miscarriages, that happen later than 12 weeks according to Dr Odetayo T.O of LASUTH include spontaneous discharge of fluid known as drainage of liquor. The liquor is the fluid in the sac surrounding the foetus. Once the sac breaks, the liquor is let out in form of intermittent leakage or a gush of fluid per vagina. According to the O&G expert, the leakage may be followed by painful uterine contractions till the products of conception are expelled in parts or whole.

TYPES OF MISCARRIAGE

Dr Odetayo listed six types of miscarriage thus:

Complete Miscarriage- Complete spontaneous expulsion of the products of conception usually happens before the 12^th week of pregnancy.

Incomplete –Part of the products of conception have been expelled and some are still left in the womb. This will need to be evacuated.

Inevitable- Here there is no expulsion of any products yet, but the mouth of the womb (cervix) is already opened to let out the products of conception.

Missed- Here there is no further growth of the foetus. This is associated with loss of feeling of being pregnant.

Threatened- There may be bleeding and or pain without an attempt at expulsion of the products of conception. Here there is threat of miscarriage but cervix not dialated.

Septic- Presence of genital infection following a miscarriage. Any of the above variants except complete miscarriage can become septic if appropriate care is not accessed in good time.

A study titled “Spontaneous abortions (miscarriages): Analysis of cases at a tertiary centre in North Central Nigeria” conducted by Abiodun S Adeniran et al, Department of O&G, University of Ilorin Teaching Hospital found that the most common type of miscarriage in the study was incomplete miscarriage followed by threatened, inevitable, missed, and complete miscarriage.

MISCARRIAGE MYTHS

Many speculative factors have been given as causes of miscarriage. They include:

-Eating of snail

-Mothers unfulfilled desire to eat a particular food

-Mothers thought or bad mood

-Mother’s exposure to upsetting and frightening situation

-Mother’s carelessness

– Large-sized penis of spouse/ partner

Abiola AO et al in the study cited earlier noted that few of the respondents associated stress to miscarriage, many women in the study still hold on to various beliefs/ myths about the cause of miscarriage. According to the researchers, this is not unexpected as these beliefs have not been replaced by a concrete medical information on the cause of miscarriage.

Majority of the women believed eating of snail and mother’s unfulfilled desire to eat a particular food can cause miscarriage. Some of the respondents believed that mother’s thought or bad mood, mother’s exposure to upsetting and frightening situation and mother’s carelessness cause miscarriage.

These factors are shots in the dark. They are at best conjectures. They are stereotypes, beliefs and myths.

Publisher’s Note:

1. Keep a date with us next week for medical explanations to miscarriage causes, risk factors, miscarriage diagnosis & treatments, psycho- social consequences of miscarriages and how to prevent miscarriages.
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