Causes of Abortion in First Trimester of Pregnancy

Pregnancy is a time of extreme joy. It is time when you heave a sigh of relief that all your efforts have paid off, and you will be expectant that in nine months’ a live baby would be born.
But things do not always turn out as expected. Because for one reason or the other, the pregnancy may be aborted. This is also called miscarriage.
It is well known that about 80 per cent of miscarriages occur in the first 12 weeks of pregnancy (the first trimester). The underlying cause in about half of cases involves chromosomal abnormalities. Other conditions that can produce similar symptoms include an ectopic pregnancy and implantation bleeding.

What is miscarriage?
A miscarriage is an event that results in the loss of a fetus during early pregnancy. It’s also called a spontaneous abortion. It typically happens during the first trimester, or first three months, of the pregnancy. It is known that , 10 to 25 percent of all clinically recognised pregnancies end in miscarriage. The cause of a miscarriage varies from person to person. Often the cause is unknown. Miscarriages that occur after three months, or between 14 to 26 weeks, are usually due to an underlying health condition in the mother.

Causes of miscarriage
During pregnancy, your body supplies hormones and nutrients to your developing fetus. This helps your fetus develop normally during your pregnancy. Most first trimester miscarriages happen because the fetus doesn’t develop normally. There are different factors that can cause this.

There are many reasons why a miscarriage may happen, although the cause is often not identified. If a miscarriage happens during the first trimester of pregnancy (the first three months), it’s usually caused by problems with the unborn baby (foetus). About three in every four miscarriages happen during this period. If a miscarriage happens during the second trimester of pregnancy (between weeks 14 and 26), it may be the result of an underlying health condition in the mother.

These late miscarriages may be caused by an infection around the baby, which leads to the bag of waters breaking before any pain or bleeding. In rare cases, they can be caused by the neck of the womb opening too soon. Chemical pregnancies may account for 50-75% of all miscarriages. This occurs when a pregnancy is lost shortly after implantation, resulting in bleeding that occurs around the time of her expected period. The woman may not realise that she conceived when she experiences a chemical pregnancy.

First trimester miscarriages
Most first trimester miscarriages are caused by problems with the chromosomes of the foetus.
• Chromosome problems
Most chromosomal abnormalities are the cause of a damaged egg or sperm cell or are due to a problem at the time that the zygote went through the division process.
Chromosomes are blocks of DNA. They contain a detailed set of instructions that control a wide range of factors, from how the cells of the body develop to what colour eyes a baby will have.
Sometimes something can go wrong at the point of conception and the foetus receives too many or not enough chromosomes. The reasons for this are often unclear, but it means the foetus won’t be able to develop normally, resulting in a miscarriage.

It’s estimated up to two-thirds of early miscarriages are associated with chromosome abnormalities. This is very unlikely to recur and doesn’t mean there’s any problem with the mother or father’s chromosomes.
• Placental problems
The placenta is the organ linking the mother’s blood supply to her baby’s. If there’s a problem with the development of the placenta, it can also lead to a miscarriage.
• External health conditions
External health conditions, lifestyle habits, and underlying conditions may also interfere with the fetus’ development, especially in the second trimester. Exercise and sexual intercourse do not cause miscarriages. Working won’t affect the fetus either unless you’re exposed to harmful chemicals or radiation.

Conditions that can interfere with a fetus’ development include
• poor diet, or malnutrition
• drug and alcohol use
• advanced maternal age
• untreated thyroid disease
• uncontrolled diabetes
• infections
• trauma
• obesity
• problems with the cervix
• abnormally shaped womb
• severe high blood pressure
• food poisoning
• certain medications.

Always check with your doctor before taking any medications to be sure a drug is safe to use during pregnancy.
Risk factors
An early miscarriage may happen by chance. But there are several things known to increase your risk of problems happening.

• The age of the mother has an influence:
in women under 30, 1 in 10 pregnancies will end in miscarriage
in women aged 35-39, up to 2 in 10 pregnancies will end in miscarriage
in women over 45, more than half of all pregnancies will end in miscarriage

• obesity
• smoking during pregnancy
• drug misuse during pregnancy
• drinking more than 200mg of caffeine a day – one mug of tea contains around 75mg of caffeine, and one mug of instant coffee contains around 100mg of caffeine; caffeine is also found in some fizzy drinks, energy drinks and chocolate bars
• drinking more than two units of alcohol a week – one unit is half a pint of bitter or ordinary strength lager, or a 25ml measure of spirits, and a small 125ml glass of wine is 1.5 units.

• Hormonal problems, infections or maternal health problems
• Lifestyle (i.e. smoking, drug use, malnutrition, excessive caffeine and exposure to radiation or toxic substances)
• Implantation of the egg into the uterine lining does not occur properly
• Maternal age
• Maternal trauma

Misconceptions about miscarriage:
An increased risk of miscarriage is not linked to:
• a mother’s emotional state during pregnancy, such as being stressed or depressed
• having a shock or fright during pregnancy
• exercise during pregnancy – but discuss with your doctor or midwife what type and amount of exercise is suitable for you during pregnancy
• lifting or straining during pregnancy
• working during pregnancy – or work that involves sitting or standing for long periods
• having sex during pregnancy
• travelling by air
• eating spicy food

Recurrent miscarriages
Many women who have a miscarriage worry they’ll have another if they get pregnant again. But most miscarriages are a one-off event.
About 1 in 100 women experience recurrent miscarriages (three or more in a row) and more than 60% of these women go on to have a successful pregnancy.

What Are The Chances of Having a Miscarriage?
For women in their childbearing years, the chances of having a miscarriage can range from 10-25%, and in most healthy women the average is about a 15-20% chance.
An increase in maternal age affects the chances of miscarriage
Women under the age of 35 yrs old have about a 15% chance of miscarriage
Women who are 35-45 yrs old have a 20-35% chance of miscarriage
Women over the age of 45 can have up to a 50% chance of miscarriage
A woman who has had a previous miscarriage has a 25% chance of having another (only a slightly elevated risk than for someone who has not had a previous miscarriage)

• Warning Signs
If you experience any or all of these symptoms, it is important to contact your health care provider or a medical facility to evaluate if you could be having a miscarriage:
• Mild to severe back pain (often worse than normal menstrual cramps)
• Weight loss
• White-pink mucus
• True contractions (very painful happening every 5-20 minutes)
• Brown or bright red bleeding with or without cramps (20-30% of all pregnancies can experience some bleeding in early pregnancy, with about 50% of those resulting in normal pregnancies)
• Tissue with clot like material passing from the vagina
• Sudden decrease in signs of pregnancy

Miscarriage Types
1. Threatened Miscarriage: Some degree of early pregnancy uterine bleeding accompanied by cramping or lower backache. The cervix remains closed. This bleeding is often the result of implantation.
2. Inevitable or Incomplete Miscarriage: Abdominal or back pain accompanied by bleeding with an open cervix. Miscarriage is inevitable when there is a dilation or effacement of the cervix and/or there is rupture of the membranes. Bleeding and cramps may persist if the miscarriage is not complete.

3. Complete Miscarriage: A completed miscarriage is when the embryo or products of conception have emptied out of the uterus. Bleeding should subside quickly, as should any pain or cramping. A completed miscarriage can be confirmed by an ultrasound or by having a surgical curettage (D&C) performed.
4. Missed Miscarriage: Women can experience a miscarriage without knowing it. A missed miscarriage is when embryonic death has occurred but there is not any expulsion of the embryo. It is not known why this occurs. Signs of this would be a loss of pregnancy symptoms and the absence of fetal heart tones found on an ultrasound.

5. Recurrent Miscarriage (RM): Defined as 3 or more consecutive first trimester miscarriages. This can affect 1% of couples trying to conceive.
6. Blighted Ovum: Also called an embryonic pregnancy. A fertilized egg implants into the uterine wall, but fetal development never begins. Often there is a gestational sac with or without a yolk sac, but there is an absence of fetal growth.

7. Ectopic Pregnancy: A fertilized egg implants itself in places other than the uterus, most commonly the fallopian tube. Treatment is needed immediately to stop the development of the implanted egg. If not treated rapidly, this could end in serious maternal complications.
8. Molar Pregnancy: The result of a genetic error during the fertilization process that leads to the growth of abnormal tissue within the uterus. Molar pregnancies rarely involve a developing embryo, but often entail the most common symptoms of pregnancy including a missed period, positive pregnancy test and severe nausea.

Treatments for Miscarriage
The main goal of treatment during or after a miscarriage is to prevent hemorrhaging and/or infection. The earlier you are in the pregnancy, the more likely that your body will expel all the fetal tissue by itself and will not require further medical procedures. If the body does not expel all the tissue, the most common procedure performed to stop bleeding and prevent infection is a dilation and curettage, known as a D&C. Drugs may be prescribed to help control bleeding after the D&C is performed. Bleeding should be monitored closely once you are at home; if you notice an increase in bleeding or the onset of chills or fever, it is best to call your physician immediately.

Prevention of Miscarriage :
Since the cause of most miscarriages is due to chromosomal abnormalities, there is not much that can be done to prevent them. One vital step is to get as healthy as you can before conceiving to provide a healthy atmosphere for conception to occur.

• Exercise regularly
• Eat healthy
• Manage stress
• Keep weight within healthy limits
• Take folic acid daily
• Do not smoke

Once you find out that you are pregnant, again the goal is to be as healthy as possible, to provide a healthy environment for your baby to grow in:

• Keep your abdomen safe
• Do not smoke or be around smoke
• Do not drink alcohol
• Check with your doctor before taking any over-the-counter medications
• Limit or eliminate caffeine
• Avoid environmental hazards such as radiation, infectious disease, and x-rays
• Avoid contact sports or activities that have risk of injury

Emotional Treatment for a Miscarriage
Unfortunately, miscarriage can affect anyone. Women are often left with unanswered questions regarding their physical recovery, their emotional recovery and trying to conceive again. It is very important that women try to keep the lines of communication open with family, friends and health care providers during this time.

Getting pregnant again:
You may want to ask your doctor to help you develop a conception plan before you try to get pregnant again. Being as healthy as possible can help you prepare for a pregnancy and lower your risk of another miscarriage.Your doctor will likely recommend tests to detect any problems that may have caused your previous miscarriage. These may include:

• blood tests to detect hormone imbalances
• chromosome tests, using blood or tissue samples
• pelvic and uterine exams
• ultrasounds
Your doctor may recommend that you wait several months before getting pregnant again. Depending on your health, your doctor may also require periodic testing throughout your pregnancy.
Remember that most miscarriages are out of your control. Healing doesn’t mean you have to forget about what happened. A symbolic gesture may also help with the experience.

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