Guardian

AN 11-year old girl realized that she had started to grow hair between her legs. She got worried and asked her mom about the hair. Her mom calmly said: “That part where hair has grown is called a monkey; be proud that your monkey has grown hair.” Next morning at breakfast she told her sister: “My monkey has grown hair.” Her sister smiled and said: “That’s nothing, mine is already eating bananas.”

Words Of Wisdom

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Fertility

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Love Dictionary: What is Miscarriage?

A COMPLETE spontaneous abortion at about six weeks after conception, i.e. eight weeks from the last menstrual period (LMP)

Noun

The expulsion of a fetus from the womb before it is able to survive independently, esp. spontaneously or as the result of accident.

An unsuccessful outcome of something planned: “the miscarriage of the project”.

Miscarriage is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently. Miscarriage is the most common complication of early pregnancy.

Terminology

The medical terminology applied to women’s experiences during early pregnancy has changed over time. “Miscarriage” or “early pregnancy loss” are currently used to describe the end of a pregnancy at a gestational stage before the fetus is considered viable. The age of fetal viability may be variably defined in different countries and contexts, but is often said to be around 24 weeks gestation. A fetus that dies while in the uterus after this defined “limit of viability” is referred to as a stillbirth.

Under UK law, all stillbirths should be registered, miscarriages are not.

In the recent past, health professionals used the phrase “spontaneous abortion” interchangeably with “miscarriage”. However, many women who have had miscarriages object to the term “abortion” in connection with their experience, because in everyday English, the word is strongly associated with induced abortions. Use of inappropriate terminology may cause women to feel that their experiences are not being recognised or appropriately acknowledged.

In the late 1980s and 1990s, doctors became more conscious of their language in relation to early pregnancy loss. Some medical authors advocated change to use of “miscarriage” instead of “abortion” because this would be preferred by women patients. In 2005 the European Society for Human Reproduction and Embryology (ESHRE) published a paper aiming to facilitate a revision of nomenclature used to describe early pregnancy events.

Historical analysis of the medical terminology applied to early pregnancy loss in Britain has shown that the use of “miscarriage” (instead of “spontaneous abortion”) by doctors only occurred after changes in legislation (in the 1960s) and developments in ultrasound technology (in the early 1980s) allowed them to identify miscarriages without having to rely upon women’s own description of events.

In countries where pregnancy termination remains illegal, doctors may still not distinguish between “spontaneous” and “induced” abortions in clinical practice.

Signs and symptoms

The most common symptom of a miscarriage is bleeding; bleeding during pregnancy may be referred to as a threatened miscarriage. Of women who seek clinical treatment for bleeding during pregnancy, about half will miscarry. Symptoms other than bleeding are not statistically related.

Miscarriage may be detected during an ultrasound exam, or through serial human chorionic gonadotropin (HCG) testing. Women pregnant from ART methods, and women with a history of aborting, may be monitored closely and so detection is sooner than women without such monitoring.

Several medical options exist for managing documented nonviable pregnancies that have not been expelled naturally.

Psychological

Although a woman physically recovers from a miscarriage quickly, in general, psychological recovery for parents may take a long time. People differ greatly in this regard: some are able to move on after a few months, but others take more than a year. Still others may feel relief or other less negative emotions. A questionnaire (GHQ-12 General Health Questionnaire) study following women having aborted showed that half (55%) of them presented with significant psychological distress immediately, 25% at 3 months; 18% at 6 months, and 11% at 1 year after miscarriage.

Besides the feeling of loss, a lack of understanding by others is often important. People who have not experienced it themselves may find it difficult to empathize with what has occurred, and how upsetting it may be. This may lead to unrealistic expectations of the parents’ recovery. The pregnancy and the miscarriage cease to be mentioned in conversations, often because the subject is too painful. This may make the woman feel particularly isolated. Inappropriate or insensitive responses from the medical professionals can add to the distress and trauma experienced, so in some cases attempts have been made to draw up a standard code of practice.[16]

Often interaction with pregnant women and newborn children is painful for parents who have experienced miscarriage. Sometimes this makes interaction with friends, acquaintances, and family very difficult.

Causes

Miscarriage may occur for many reasons, not all of which can be identified. Some of these causes include genetic, uterine, or hormonal abnormalities, reproductive tract infections, and tissue rejection.

Diagnosis

A miscarriage may be confirmed via ultrasound and by the examination of the passed tissue. When looking for microscopic pathologic symptoms, one looks for the products of conception. Microscopically, these include villi, trophoblast, fetal parts, and background gestational changes in the endometrium. Genetic tests also may be performed to look for abnormal chromosome arrangements.

Management

Bleeding during early pregnancy is the most common symptom of both impending miscarriage and of ectopic pregnancy. Pain does not strongly correlate with the former, but is a common symptom of ectopic pregnancy. Typically, in the case of blood loss, pain, or both, transvaginal ultrasound is performed. If a viable intrauterine pregnancy is not found with ultrasound, serial ²HCG tests should be performed to rule out ectopic pregnancy, which is a life-threatening situation.

If the bleeding is light, making an appointment to see one’s doctor is recommended. If bleeding is heavy, there is considerable pain, or there is a fever, then seeking emergency medical attention is recommended.

Whilst bed rest has been advocated in the past to help ensure that a threatened pregnancy might continue, and in one study possibly helped when small subchorionic hematoma had been found on ultrasound scans, the prevailing opinion is that this is of no proven benefit.

No treatment is necessary for a diagnosis of complete miscarriage (so long as ectopic pregnancy is ruled out). In cases of an incomplete miscarriage, empty sac, or missed abortion there are three treatment options:

• With no treatment (watchful waiting), most of these cases (65–80%) will pass naturally within two to six weeks. This path avoids the side effects and complications possible from medications and surgery, but increases the risk of mild bleeding, need for unplanned surgical treatment, and incomplete miscarriage.

• Medical management usually consists of using misoprostol (a prostaglandin, brand name Cytotec) to encourage completion of the natural process. About 95% of cases treated with misoprostol will complete within a few days.

• Surgical treatment (most commonly vacuum aspiration, sometimes referred to as a D&C or D&E) is the fastest way to complete the process. It also shortens the duration and heaviness of bleeding, and avoids the physical pain associated with the miscarriage. In cases of repeated spontaneous abortions, D&C is also the most convenient way to obtain tissue samples for karyotype analysis (cytogenetic or molecular), although it is also possible to do with expectant and medical management. D&C, however, has a higher risk of complications, including risk of injury to the cervix (e.g. cervical incompetence) and uterus, perforation of the uterus, and potential scarring of the intrauterine lining (Asherman’s syndrome). This is an important consideration for women who would like to have children in the future and want to preserve their fertility and reduce the chance of future obstetric complications.

Prevention

Currently there is no known way to prevent an impending miscarriage, however, fertility experts believe that identifying the cause of the miscarriage may help prevent it from happening again in a future pregnancy.

Source: en.wikipedia.org.