ABORTION ( MISCARRIAGE)
Abortion is the expulsion or extraction from its mother of an embryo or fetus weighing 500gm or less when it is not capable of independent survival. An abortion that occurs spontaneously is known as Miscarriage.
“A miscarriage is a pregnancy that ends by itself before the baby is fully developed. It is Often’s the body’s way of ending a pregnancy when the unformed baby has a serious problem that would have kept it from developing well. “
Most miscarriage happens in the first three months of pregnancy. After a miscarriage, a woman can still become pregnant again and have a normal pregnancy and a healthy baby. Signs of miscarriage are PAIN and BLEEDING. The bleeding and pain usually begin like normal monthly bleeding and then get heavier and stronger. If the bleeding and pain continue for more than a few days, if the bleeding is much heavier than normal monthly bleeding or if a woman gets a fever or has a bad- smelling fluid from her vagina, part of the pregnancy may still be inside the womb. This is called as INCOMPLETE MISCARRIAGE. It often happens no matter how careful you are. DO NOT BLAME YOURSELF. But it can lead to heavy blood loss, a dangerous infection, or even death. The woman should go to a health centre or hospital where a trained health worker can empty the womb.
After a miscarriage a woman should rest and avoid heavy work or lifting for 2 weeks. She should not douche or wash inside her vagina. Also she should avoid sex until all bleeding stops because her womb is still open and could get infected.
MEDICAL TERMINATION OF PREGNANCY( MTP)
In India, Medical termination pregnancy (MTP) can be legally carried out within 12 weeks of pregnancy by a registered medical practitioner (RMP) having training and experience in gynaecology and obstetrics at a government approved and licensed clinic. It is safest to carry out an MTP within first 12 weeks of pregnancy. MTP can also be done legally after 12 weeks and before 20 weeks of pregnancy; this is called the second trimester termination. It requires the consent of two RMPs. MTPs cannot be done if the pregnancy is more than 20 weeks, as this is extremely dangerous to the mother. Termination of pregnancy after 20 weeks is illegal. If at all there is an emergency requiring termination of pregnancy after 20weeks, this needs immediate attention at a well-equipped district hospital.
In reality, early and safe MTP services may not be available or accessible to many women especially in rural areas and they may be forced to seek illegal abortions.
Most miscarriages happen when the unborn baby has fatal genetic problems. Usually, these problems are unrelated to the mother. Problems with the baby’s genes or chromosomes are typically the result of errors that occur by chances as the embryo divides and grows – not problems inherited from the parents. Examples are –
a)Blighted ovum – Blighted ovum occurs when no embryo forms.
b)Intrauterine foetal demise – In this condition, embryo is present but has stopped developing and died before any symptoms of pregnancy loss have occurred.
c)Molar pregnancy – It is a non-cancerous (benign) tumour that develops in the uterus. A molar pregnancy occurs when there is extra set of paternal chromosomes in a fertilized egg. This error at the time of conception transforms what would normally become the placenta into a growing mass of cysts. This is a rare cause of pregnancy loss.
Other causes of miscarriage include:
•Medical conditions in the mother, such as diabetes or thyroid disease
•Immune system responses
•Physical problems in the mother
CONDITIONS WHICH CAUSE MISCARRIAGE
•Is over age 35
•Has certain diseases, such as diabetes or thyroid problems
•Has had three or more miscarriages
A miscarriage sometimes happens because there is a weakness of the cervix, called an incompetent cervix, which cannot hold the pregnancy. A miscarriage from an incompetent cervix usually occurs in the second trimester.
There are usually few symptoms before a miscarriage caused by cervical insufficiency. A woman may feel sudden pressure, her “water” may break, and tissue from the foetus and placenta may be expelled without much pain. An incompetent cervix can usually be treated with a “circling” stitch in the cervix in the next pregnancy, usually around 12 weeks. The stitch holds the cervix closed until it is pulled out around the time of delivery. The stitch may also be placed even if there has not been a previous miscarriage if cervical insufficiency is discovered early enough, before a miscarriage does occur.
CONDITIONS WHICH DOES NOT CAUSE MISCARRIAGE
Activities which do not provoke miscarriage –
c)Working provided you are not exposed to harmful chemicals or radiation.
CLASSIFICATION OF ABORTION
a)THREATENED ABORTION – The process of abortion has started but has not progressed to a state from which recovery is impossible. If a woman is bleeding but her cervix hasn’t begun to dilate, there is a threat of miscarriage.
Clinical features are:-
i)Bleeding per vaginam
Treatment – 1. Rest: When active bleeding present.
2. Drugs: Sedation and relief of pain.
3. General measure: Pulse, Blood Pressure,
4. Temperature, P/V bleeding.
b) INEVITABLE ABORTION – It is the type of abortion where the changes have progressed to a state from where continuation of pregnancy is impossible. Clinical features :-
i)Increased vaginal bleeding
ii) Aggravation of pain in lower abdomen.
1. Correction of anaemia
2. Correction of dehydration
3. To accelerate process of expulsion
4. To maintain strict asepsis (to reduce post abortion complication).
1. Before 12 weeks: Dilatation, evacuation, curettage Suction evacuation and curettage Under G/A.
2. After 12 weeks: Take proper medication.
c)SEPTIC ABORTION – Any abortion associated with clinical evidences of infection of the uterus and its content is called septic abortion.
d) COMPLETE ABORTION – When the products of conception are expelled, it is called complete abortion.
2. History of expulsion of fleshy mass per vagina.
3. Subsidence abdominal pain.
4. P/V bleeding: Trace or absent.
e) INCOMPLETE ABORTION – When the entire product of conception are not expelled , instead a part of it is left inside the uterine cavity, it is called incomplete abortion.
1. Amenorrhoea History of
2. History of Expulsion of product of conception per vagina.
3. Continues lower abdominal colicky pain.
4. per vaginal bleeding (irregular).
5. Internal examination:
a. Uterus smaller than the period of amenorrhoea.
b. Patulous cervical OS often admitting tip of the finger.
c. Varying amount of bleeding. (P/V)
1. Correction of anaemia if necessary.
3. Dilatation and evacuation under G/A.
4. Histopathological examination of product of conception after removed.
f) MISSED ABORTION – When the foetus is dead and retained inside the uterus for a variable period, it is called missed abortion or silent miscarriage or early foetal demise.
METHODS OF ABORTION
There are two methods of abortion, the surgical method and the medical method in detail in the following sections:
SURGICAL METHOD OF ABORTION
There are many options available under the surgical method of abortion; the type of abortion depends on the number of weeks of pregnancy.
Method involves the usage of the cannula through which the evacuation (emptying) of the uterus is carried out, after the administration of local anaesthesia. A cannula is a thin tube structure which is attached to either an electric vacuum or a manual vacuum source. In the electric vacuum aspiration, commonly referred to as EVA, the cannula is attached to an electric vacuum pump whereas, in the manual type, the vacuum is created using an aspirator or syringe.
The size of the tube used for excavation (cannula) can range from 4 mm to 16 mm in diameter and is chosen based on the gestational age (in weeks). Depending on the duration of pregnancy, it can take about 3-10 minutes to perform the procedure.
Both the methods (electric vacuum aspiration and manual vacuum aspiration) are found to be safe and effective. However, certain complications of vacuum aspiration can include excessive bleeding, cervical injury, incomplete evacuation, anaesthetic complications, and on-going pregnancy though it is not commonly observed. The method is suitable for the first trimester pregnancies.
Dilatation and Curettage
Dilation and Curettage is another surgical method of abortion in which the cervix is opened and a thin instrument (Curette) is inserted into the uterus through which the tissues are scrapped or scooped (curettage). This method is suitable for the first–trimester pregnancies.
However, the process is less safe and may cause side-effects like a pain in many women. Hence, the WHO advises it to replace Dilatation and Curettage method by Vacuum Aspiration method wherever possible and as advised by the medical practitioner.
Dilatation and Evacuation
This is a surgical method that is also performed for first trimester abortions. The cervical preparation (softening of the neck of the womb for easier opening) is required, which is done with the help of osmotic dilators or biologically active substances. The function of osmotic dilators in softening of the cervix is to absorb the moisture from the tissues surrounding the cervix. Later, the uterus is emptied using the Electric Vacuum Aspiration with the help of cannula and forceps. The cannula may be plastic or metal and may be of varying diameters.
The preparation for achieving the required opening of the cervix (cervical dilatation) can take anywhere between 2 hours to 2 days, depending on the stage of the pregnancy. It is of utmost importance that the surgery is performed by a skilled and trained medical practitioner. In case the procedure is carried out in later weeks of pregnancy, it may result in more vaginal bleeding than the procedures performed in the first trimester of pregnancy.
MEDICAL METHOD OF ABORTION
The second method carried out for abortion is the medical method of abortion where pills or tablets are used for the expulsion of the foetus. The kind of pills that are provided by the doctor depends on the weeks of gestation.
The effects of the medical methods of abortion are similar to those associated with spontaneous abortion or miscarriage and may include abdominal cramping and prolonged period-like bleeding which can last for about 9 days on an average and in rare cases can last for about 45 days as well. Other side effects may include nausea, vomiting, and diarrhoea.
Medical method of abortion works best up to 6-7weeks from the Last Menstrual Period, after which the chance of retained products of conception increases.
Symptoms of miscarriage are as follows:-
•Vaginal bleeding or spotting.
•Severe cramps in lower abdomen
Various risk factors are –
•PREVIOUS MISCARRIAGE – Women who had two or more consecutive miscarriages are at higher risk of miscarriages.
•UTERINE OR CERVICAL PROBLEM – Certain uterine abnormalities or weak cervical tissues (incompetent cervix) might increase the risk of miscarriage.
•SMOKINGS, ALCOHOL ADDICTION – Women who smoke during pregnancy have a greater risk of miscarriage than do non-smokers.
•WEIGHT – Being overweight or underweight has been linked with an increased risk of miscarriage.
•CHRONIC CONDITIONS – Women who have a chronic condition, such as uncontrolled diabetes, have a higher risk of, miscarriage.
Some women who suffered from miscarriage develop a uterine infection, also known as septic miscarriage. Symptoms and sign are:-
c)Lower abdominal tender ness
d)Foul smelling vaginal discharge.
Often, there’s nothing you can do to prevent a miscarriage. Simply focus on taking good care of yourself and your baby. Seek regular prenatal care, and avoid known risk factors – such as smoking and drinking alcohol. If you have a chronic condition, work with your health care team to keep it under control.
If you have threatened miscarriage, your health care provider might recommend resting until the bleeding or pain subsides. You might be asked to avoid exercise and sex as well. Although these steps haven’t proved to reduce the risk of miscarriage, they might improve your comfort.
COPING AND SUPPORT
Emotional healing can take much longer than physical healing. Miscarriage can be a heart – wrenching loss at others around you might not fully understand. Emotions might range from anger and guilt to despair. Give yourself time to grieve the loss of your pregnancy, and seek help from loved ones. Talk to your health care provider if you’re feeling profound sadness or depression.
Homeopathic medication system is one of the most popular and widely accepted holistic medication approaches used all over the world. The choice of remedy for any disease is based on individualized symptoms and lifestyle habits using a holistic method. In such a way, a state of complete wellness can be achieved by eliminating all the signs and symptoms that the patient is suffering from. The main objective of homeopathy is not just to manage the adverse effects of abortion.
Some of the homeopathic remedies that are beneficial in treating abortion or miscarriage are given below:
“KINDLY CONSULT THE PHYSICIAN, BEFORE TAKING THESE MEDICINES”
•ALETRIS FARINOSA – Habitual tendency to abortion due to weakness and anaemia.
•ACONITICUM NAP – If the abortion is threatened due to fear and excitement.
•BAPTISIA – Threatened miscarriage from mental depression, shock and low fevers.
•KALI CARB / SABINA – Threatened abortion in the 2nd month. Habitual abortion every 2nd or 3rd month. Blood is generally dark red and clotted.
•PYROGENIUM – After effects of abortion, whether induced or otherwise, like fever, offensive diarrhoea, etc.
•SECALE COR – For abortion, more especially about the 3rd month with copious flow of black, liquid blood.
•VIBURNUM OP / VIBUR PRUN – Its use helps to prevent habitual miscarriages. They also help to prevent abortion due to an accident or due to drugging.
•APIS– For abortion during 1st and 3rd month of pregnancy.
•CAULOPHYLLUM – It is helpful in habitual abortions and when it is due to a weak uterus.