What you should know about miscarriage & abortion – By Dr Adetumilara Badru

Dr Adetumilara Badru is a wife, mother, Medical Doctor and a Sexual and Reproductive Health’s Right Advocate

Here was her session with us discussing abortion and miscarriage, the types, causes, signs & symptoms, immediate care and post abortion care follow up:

There’s a term known as “pregnancy viability” From the word viable itself, it means something feasible, something that can independently exist. So for a pregnancy to be called viable, it must have been for 28 completed weeks.
That as regards Nigeria, in other developed nations, they say 20, some 24 weeks but for Nigeria, it’s 28 weeks.

Why the difference? The organs are developed even before 20th week but not guaranteed. Developed nations have well equipped pediatric care units for support till baby is matured unlike a developing country like Nigeria.

Medically, the terms miscarriage and abortion are synonymous since they both mean end of pregnancy. In the mind of the public, abortion is usually confused with a deliberate termination of pregnancy while miscarriage is an accidental or non-induced end to pregnancy. So I’m going to define abortion/miscarriage now, It is the expulsion or extraction of the products (fetus and the placenta) of conception in whole or part via the birth canal before the age of viability which is 28 completed weeks. They both mean termination of pregnancy. The types that differentiate it.

There are two forms :

  1. Spontaneous abortion (publicly Known as Miscarriage)
  2. Induced abortion

1. Spontaneous abortion (publicly Known as Miscarriage)

From the word spontaneous, it means it happened without deliberate interference

Let’s breakdown the spontaneous (spt) abortion, Types of spt abortion:

  • Threatened abortion
  • Inevitable abortion
  • Incomplete abortion
  • Complete abortion
  • Missed abortion
  • Habitual/recurrent abortion
  • Septic abortion

Let’s talk about the causes then I will explain the types of spt abortion:

  1. Most common cause is fetal abnormalities
  2. Chromosomal abnormality in parents
  3. Uterine and cervical abnormalities
  4. Maternal infections
  5. Maternal medical conditions
  6. Multiple pregnancy
  7. Teratogenic substances
  8. Radiation exposure
  9. Autoimmune diseases
  1. Let’s start from the first which is fetal abnormalities. Baby still in the womb is called a fetus, when there’s an abnormality in the fetus then we have fetal abnormality
    This has caused 40% of spt/non-induced abortions. Example of these fetal abnormalities are anencephaly (no brain).

2. Chromosomal abnormality in parents, Chromosome carry genetic information, that help to transfer information from parents to children so they can have things in common. So if any of the parents is by chance carrying a chromosome with defects or issues like the popular Down syndrome, some fetus can’t cope growing with chromosomal defects so, they give up. Also, during the transfer of these chromosomes from parents to children, the chromosomes can be wrongly located in arrangement and cause chromosomal abnormality in the fetus, the fetus might not have the ability to cope and then give up

3. Uterine and cervical anomalies Uterine is from the word uterus which is publicly known as the womb
Cervical is from the word cervix which is the neck/opening of the womb located in the vagina. Some female babies, girls, ladies, mamas were born with abnormality of the uterus and/or cervix but mostly acquired.

What I’m trying to say is, the uterus can have its own abnormality which can be either from birth or as a result of injuries. Example, uterus having an extra wall which divides it into halves, called septate uterus. That’s from birth. Acquired anomalies can be fibroid, intrauterine adhesions (glued walls of the uterus caused from vigorous D&C abortion). The cervical abnormality is a condition called cervical incompetence. The cervix is shorter than normal length so, when pregnancy starts developing especially when it’s getting to 16weeks, the uterus gives way for the fetus and this puts an end to the pregnancy. This is very common, that’s why it’s very important when you’re a first timer momma, make sure you visit an O&G specialist to confirm your cervical patency.

4. Maternal infection has a great impact on the developing fetus. Like for malaria, there’s reduced oxygen and nutrient supply to the fetus. Urinary tract infection UTI and TORCHS infection harbor infectious organisms and they’re migrated into the womb to infect the fetus. So as a preggy, once you notice something is wrong down there visit an O&G specialist

  1. Maternal medical conditions like hypertension (will deprive the fetus adequate blood supply), diabetes, anaemia. All balls down to blood supply. There are pregnancies called “High Risk Pregnancy “ in this case, the preggy momma is dealing with an underlying medical condition including obesity and must be managed. Also mothers above the age of 35 yrs.

6. Teratogenic substances: drugs (like certain antibiotics, pain reliefs), alcohol, cigarettes smoking (reduces oxygen availability in the placenta)

7. Radiation exposure: preggy going for X-rays scan, MRI scan

8. Autoimmune diseases are conditions in which the immunity fights the body itself definitely the pregnancy isn’t left out; example: systemic lupus erythemasus SLE. You can read that up online pls. It’s an autoimmune disease

9. Multiple pregnancy, of course it’s game of survivor when you have more than one fetus growing at the same time but different pace for sure

Types of spt abortion:

Threatened abortion: bleeding+, abdominal pain+/-, uterine size normal, cervix closed, fetus alive
Inevitable abortion: bleeding++, abdominal pain++, uterine size reduced , cervix opened , fetus out
Incomplete abortion: bleeding++, abdominal pain++, uterine size normal , cervix opens , fetus out with placenta still in
Complete abortion: bleeding+, abdominal pain-, uterine size reduced , cervix opened , fetus and placenta out
Missed abortion: bleeding-, abdominal pain-, uterine size normal or small , cervix closed, fetus dead
Habitual/recurrent abortion: mostly due to cervical incompetence
Septic abortion

Immediate care:

I want to be careful here because any case that has to do with end of pregnancy needs a medical attention so, it’s better present at the hospital ASAP. If evacuation of remains is needed, it would be done. Fluid, antibiotics, blood be given as appropriate

2. Induced abortion

Self induced abortion is illegal in Nigeria so I’m sorry if I don’t mention safe medical methods of pregnancy termination

Surgical methods:

  • Dilation and evacuation (D&E)
  • Suction evacuation
  • D&C (not commonly practiced again due to its complications)

Once you’ve had a self induced abortion pls get an abdominal scan to confirm your uterus is empty. Septic abortion is a very terrible condition that follows induced abortion. Once there’s are leftover products of conception, it gets infected and person comes down with terrible infection.

In missed abortions, if dead fetus is left in the womb, it may result in a blood disorder in the mother. The dead fetus start releasing factors into the mother’s blood stream

Questions

Q: What happens if it is found that the cervix is not patent how can that be resolved

once it’s been detected that there is cervical incompetence, a surgical procedure is done towards 14/16 weeks. A non absorbable suture called mercylin tape is used to suture the cervix, patient is been placed on strict bad rest unless you want to use the toilet, then it is removed when the pregnancy is matured for delivery.

Q: My question is when a woman experiences abortions times and again, what could be the cause?

Mostly caused by cervical incompetence. Best thing is to get screened, check your cervical patency. The repeated abortions depends on the age of each pregnancy. How many weeks old was each pregnancy at the time of abortion. This also matters

Q: What is the best way to manage a threatened abortion?

The symptom is lower abdominal cramp and bleeding 🩸
So once you see this, at times there might not be abdominal cramp, just bleeding. Visit the nearest hospital and get an abdominal scan. Once it’s been confirm the pregnancy is still valid, then, strict bedrest unless you need to visit the restroom

Remember, only take doctor’s prescribed drugs, No room for alcohol nor cigarettes smoking, Let your doctor know of any form of infection.


You can follow Dr. Ade on Instagram she shares so much information about woman’s sexual and reproductive health ❤️❤️❤️ you can send her a DM if you have questions too.

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