Sakal Times
31 July 2011

DR Meeta Nakhare DGO MRCOG (London) Obstetrician and Gynaecologist
The treatment for all forms of miscarriage is to remove any remaining foetal tissue that’s left in the womb. This is done by doing an evacuation of the uterine cavity.

In threatened abortions, the foetus is still inside the womb intact and can be saved. Therefore the first step in treatment is to get an ultrasound of the womb to see if the foetus is still alive. Bed rest and sex abstinence are the mainstay of treatment.

At the first sign of miscarriage you should see your obstetrician for help to keep your pregnancy to term.

Incompetent cervix
An incompetent cervix thins and widens prematurely so will cause miscarriage in second trimester of pregnancy. During pregnancy, while the uterus is enlarging, the cervix must remain closed, otherwise the foetus would fall into the vagina. Incompetent cervix accounts for up to 25 per cent of all second trimester miscarriages.

Incompetent cervix is suspected when a woman has three consecutive spontaneous pregnancy losses during the second trimester (the fourth, fifth and sixth months of the pregnancy). There will be a sudden loss of a large quantity of water from the uterus and the vagina followed by miscarriage.

Causes and symptoms
During a particularly difficult or rapid labour, or where a baby is unduly large, the muscle fibres of-the internal cervical os may occasionally be damaged and the next pregnancy miscarries at about the 20th week.

When the cervix is injured by excessive or forceful dilatation at an operation for the treatment of painful periods, or to perform an abortion, the circular muscular fibres around the internal cervical os may be damaged sufficiently to render the cervix incompetent in the next pregnancy.

Approx 70 per cent of women exposed in utero to (Diethylstilbestrol) have a small, T-shaped uterus and have an abnormally high frequency of poor pregnancy outcome.

Other factors could include trauma to the cervix, physical abnormality of the cervix, or having been exposed to the drug diethylstilbestrol (DES) in the mother’s womb. Some women have cervical incompetence for no obvious reason.

Treatment
After a miscarriage, making the decision to go in for another pregnancy is difficult. Collect as much information as possible to try to find out the possible causes of the loss and whether they might influence a future pregnancy.

In case of recurrent abortion, tests are usually done to try to find a cause. These include:
Hysterosalpingogram or hysteroscopy to make sure there are no defects in your uterus (womb).
Blood tests, such as serum progesterone, to rule out a luteal phase defect.
Blood tests for antiphospholipid antibodies (lupus anticoagulant).
The VDRL (Venereal Diseases Reach Laboratory) blood test, for sexually transmitted diseases.
Karyotype, for you and your husband, to rule out chromosomal abnormalities.

What are my chances?
If you’ve experienced recurrent miscarriage, you may feel hopeless and confused regarding a positive pregnancy outcome. Remember that miscarriage is not an uncommon event. Your testing will focus on trying to find out the known causes of recurrent miscarriage.

But knowledge of this problem is still limited, and no obvious cause is detected in up to 50 per cent of couples with repeated pregnancy loss. This can be very frustrating both to the patient and the doctor. The encouraging news is that the spontaneous cure rate is very high.