Spontaneous abortion (Miscarriage)

Overview of Spontaneous abortion (Miscarriage)

INCIDENCE: The incidence of abortion is difficult to work out but probably 10–20% of all clinical pregnancies end in miscarriage and another optimistic figure of 10% are induced or deliberate.

About 75% miscarriages occur before the 16th week and of these about 80% occur before the 12th week of pregnancy.[1]

Indian epidemiology then other

Causes of Spontaneous abortion (Miscarriage)

The etiology of miscarriage is often complex and obscure. The following factors (embryonic or parental) are important:

• Genetic
• Endocrine and metabolic
• Anatomic
• Infection
• Immunological
• Thrombophilia
• Environmental
• Others
• Unexplained

Genetic factors:

• Majority (50%) of early miscarriages are due to chromosomal abnormality in the conceptus.
• Autosomal trisomy is the commonest cytogenetic abnormality. Trisomy for every chromosome has reported. T
• he most common trisomy is trisomy 16. Polyploidy has observed in about 22% of abort uses.
• Monosomy X (45, X) is the single most common chromosomal abnormality in miscarriages.
• Structural chromosomal rearrangements observed in 2–4% of abort uses. These include translocation, deletion, inversion and ring formation.
• Other chromosomal abnormalities like mosaic, double trisomy, etc. found in about 4% of abort uses.[1]

Endocrine & Metabolic factors:

• Luteal Phase Defect (LPD) results in early miscarriage as implantation and placentation are not supporting adequately.
• Deficient progesterone secretion from corpus luteum or poor endometrial response to progesterone is the cause.
• Thyroid abnormalities: Overt hypothyroidism or hyperthyroidism associate with increased foetal loss. Thyroid auto-antibodies often increase.
• Diabetes mellitus when poorly controlled causes increased miscarriage.
• Cervico–uterine factors: These relate mostly to the second trimester abortions.

(1) Cervical ANATOMICAL ABNORMALITIES incompetence, either congenital or acquired is one of the commonest causes of midtrimester and recurrent abortion.

(2) Congenital malformation of the uterus in the form of bicornuate or septate uterus may be responsible for midtrimester recurrent miscarriages. Causes of foetal loss are: (i) reduced intra-uterine volume, (ii) reduced expansile property of the uterus, (iii) reduced placental vascularity when implanted on the septum and (iv) increased uterine irritability and contractility.

(3) Uterine (fibroid) especially of the submucous variety might be responsible not only for infertility but also for abortion. This is due to distortion or partial obliteration of the uterine cavity. Other causes are: decreased vascularity at the implantation site, red degeneration of fibroid and increased uterine irritability.

(4) Intrauterine adhesions interfere with implantation, placentation and foetal growth. Depending on the severity of adhesions, corporal or cervicoisthmic, patient suffers from amenorrhea, hypomenorrhea, infertility or recurrent abortion.

Infection

• The accepted causes of late as well as early abortions. Transplacental foetal infections occur with most microorganisms and foetal losses could be caused by any.
• Infections could be—(i) Viral: Rubella, cytomegalovirus, variola, vaccinia or HIV. (ii) Parasitic: Toxoplasma, malaria. (iii) Bacterial: Urea plasma, chlamydia, Brucella. Spirochetes hardly cause abortion before 20th week because of effective thickness of placental barrier.

Immunological disorders

• Antiphospholipid antibody syndrome (APAS) is due to the presence of antiphospholipid antibodies.
• These are: lupus anticoagulant (LAC), anticardiolipin antibodies (ACAs) and b-glycoprotein 1 antibodies (b-GP1).
• Mechanisms of pregnancy loss in women with APAS are:

(a) Inhibition of trophoblast function and differentiation

(b) Activation of complement pathway

(c) Release of local inflammatory mediators

(d) Thrombosis of uteroplacental vascular bed. Ultimate pathology is foetal hypoxia.

Autoimmunity

• Natural killer cells present in peripheral blood and that in the uterus are different functionally.
• There is no relationship between uNK cell number and future pregnancy outcome though uNK cells help trophoblast invasion, proliferation and angiogenesis.
• Human leukocyte antigen (HLA) incompatibility between couples or absence of maternal blocking antibodies is not considered as the cause of recurrent miscarriage. [1]

Maternal medical illness

• Cyanotic heart disease, hemoglobinopathies are associated with early miscarriage.
• PREMATURE RUPTURE OF THE MEMBRANES inevitably leads to abortion. Paternal factors: Sperm chromosomal anomaly (translocation) can cause miscarriage.
• Some women who miscarry recurrently may have normal pregnancies following marriage with a different man.
• Thrombophilia: Inherited thrombophilia causes both early and late miscarriages due to intravascular coagulation and thrombosis.
• Protein C resistance is the most common cause. Other conditions are: Protein C deficiency and hyperhomocysteinemia antithrombin III or prothrombin gene mutation.

Environmental factors

• Conclusions relating to environmental factors are difficult to establish.
• Cigarette smoking—increases the risk due to formation of carboxyhemoglobin and decreased oxygen transfer to the fetus.
• Alcohol consumption should be avoided or minimized during pregnancy.
• X-irradiation and antineoplastic drugs are known to cause abortion.
• X-ray exposure up to 10 rad is of little risk.
• Contraceptive agents—IUD in situ increases the risk whereas oral pills do not.
• Drugs, chemicals, noxious agents—aesthetic gases, arsenic, aniline, lead, formaldehyde increase the risk.
• Miscellaneous—Exposure to electromagnetic radiation from video display terminals does not increase the risk.
• Women can use hair dyes, watch television and fly in airlines during pregnancy.[1]

Unexplained

• In spite of the numerous factors mentioned, it is indeed difficult, in the majority, to pinpoint the exact cause of miscarriage.
• Too often, more than one factor is present.
• However, risk of abortion increases with increased maternal age.
• About 22% of all pregnancies detected by urinary hCG (peri-implantation) are lost, before the clinical diagnosis.

COMMON CAUSES OF MISCARRIAGE:

First trimester

(1) Genetic factors (50%).

(2) Endocrine disorders (e.g. LPD, thyroid abnormalities, diabetes).

(3) Immunological disorders

(4) Infection.

(5) Unexplained.

Second trimester

(1) Anatomic abnormalities i.e.

(a) Cervical incompetence (either congenital or acquired).

(b) Müllerian fusion defects (bicornuate uterus, septate

uterus).

(c) Uterine synechiae

(d) Uterine fibroid

(2) Maternal medical illness

(3) Unexplained

Classification of Spontaneous abortion (Miscarriage)

Abortion is classified in to two parts i.e.

1. Firstly, Spontaneous Abortion
2. Secondly, Induced Abortion

Spontaneous Abortion is classified in to

A] Isolated Abortion i.e.

• Threatened
• Inevitable
• Complete
• Incomplete
• Missed
• Septic

B] Recurrent Abortion

Induced Abortion classified in to:

A] Legal (MTP) Abortion

• Unsafe

B] Illegal Abortion

Risk factors are things that make you more likely to develop a disease in the first place.

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology of Spontaneous abortion (Miscarriage) 

• In the early weeks, death of the ovum occurs first, followed by its expulsion.
• In the later weeks, maternal environmental factors are involved leading to expulsion of the fetus which may have signs of life but is too small to survive.
• Before 8 weeks: The ovum, surrounded by the villi with the decidual coverings, is expelled out intact.
• Sometimes, the external os fails to dilate so that the entire mass is accommodated in the dilated cervical canal and is called cervical miscarriage.
• Between 8 weeks and 14 weeks: Expulsion of the fetus commonly occurs leaving behind the placenta and the membranes. Additionally, A part of it may be partially separated with brisk hemorrhage or remains totally attached to the uterine wall.
• Beyond 14th week: The process of expulsion is similar to that of a “mini labour”.
• The fetus is expelled first followed by expulsion of the placenta after a varying interval.[1]

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Sign & Symptoms of Spontaneous abortion (Miscarriage)

• Symptoms of spontaneous abortion include crampy pelvic pain, bleeding, and eventually expulsion of tissue.
• Late spontaneous abortion may begin with a gush of fluid when the membranes rupture.
• Hemorrhage is rarely massive. A dilated cervix indicates that abortion is inevitable.
• If products of conception remain in the uterus after spontaneous abortion, vaginal bleeding may occur, sometimes after a delay of hours to days.
• Infection may also develop, causing fever, pain, and sometimes sepsis.[3]

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Diagnosis of Spontaneous abortion (Miscarriage)

• Clinical criteria
• Usually, ultrasonography and quantitative beta subunit of human chorionic gonadotropin (beta-hCG).
• Diagnosis of threatened, inevitable, incomplete, or complete abortion is often possible based on clinical criteria and a positive urine pregnancy test.
• Ultrasonography and quantitative measurement of serum beta-hCG are usually also done to exclude ectopic pregnancy and to determine whether products of conception remain in the uterus (suggesting that abortion is incomplete rather than complete).
• However, results may be inconclusive, particularly during early pregnancy.[3]
• Missed abortion is suspected if the uterus does not progressively enlarge or if quantitative beta-hCG is low for gestational age or does not double within 48 to 72 hours.
• Missed abortion is confirmed if ultrasonography shows any of the following:
• Disappearance of previously detected embryonic cardiac activity
• Absence of such activity when the foetal crown-rump length is > 7 mm
• Absence of a foetal pole (determined by transvaginal ultrasonography) when the mean sac diameter (average of diameters measured in 3 orthogonal planes) is > 25 mm.
• For recurrent pregnancy loss , testing to determine the cause of abortion is necessary.

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

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Treatment of Spontaneous abortion (Miscarriage)

• Observation for threatened abortion
• Uterine evacuation for inevitable, incomplete, or missed abortions
• Emotional support
• For inevitable, incomplete, or missed abortions, treatment is uterine evacuation or waiting for spontaneous passage of the products of conception. [3]
• Evacuation usually involves suction curettage at < 12 weeks, dilation and evacuation at 12 to 23 weeks, or medical induction at > 16 to 23 weeks (e.g., with misoprostol). The later the uterus evacuate, the greater the likelihood of placental bleeding, uterine perforation by long bones of the fetus, and difficulty dilating the cervix.
• These complications reduce by preoperative use of osmotic cervical dilators, misoprostol, or mifepristone.
• If complete abortion suspect, uterine evacuation need not done routinely. Additionally, Uterine evacuation can done if bleeding occurs and/or if other signs indicate that products of conception may be retained.
• After an either induced or spontaneous abortion, parents may feel grief and guilt. In detail, They should give emotional. [3]
• Spontaneous abortion probably occurs in about 10 to 15% of pregnancies.
• The cause of an isolated spontaneous abortion is usually unknown.
• A dilated cervix means that abortion is inevitable.
• Confirm spontaneous abortion and determine its type based on clinical criteria, ultrasonography, also quantitative beta-hCG.
• Uterine evacuation is eventually necessary for inevitable, incomplete, or missed abortions.
• Often, uterine evacuation is not needed for threatened also complete abortions.
• After spontaneous abortion, provide emotional support to the parents.[3]

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Homeopathic Treatment of Spontaneous abortion (Miscarriage)

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Spontaneous abortion (Miscarriage):

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Medicines:

Aconite nep

• Impending abortion either from anger or fright, fear that something terrible will happen to her.
• Dizzy especially on rising from a recumbent position, afraid to turn over, to move or to leave the bed.

Alteris

• Habitual tendency to abortion in feeble persons of lax fibre and anemic condition, even after hemorrhage has set in.
• Furthermore, Weight in uterine region, tendency to prolapses uteri.
• General weakness of mind also body.
• Weak either from long sickness or defective nutrition.

Ambra

• Threatening abortion, with tendency to convulsions, specifically in excitable women.[2]

Apis Mell

• Stinging pains in one or the other ovarian region, more and more frequent.
• All labour- pains are produced, sometimes flowing also finally abortus.
• Urine scanty, no thirst.
• Prolonged also difficult constipation.
• Miscarriage especially in third and fourth month; with profuse flow.

Arnica

• Abortus in consequence of a shock, injury.
• Particularly if she commences to flow, either with or without pain, or to have pains without flowing.
• A bruised feeling all over, so that it hurts her to move.
• Where the period of quickening has passed the motion of foetus hurts her.

Asarum

• Threatened abortion from excessive sensibility of all the nerves.
• From even imagining something unpleasant might happen to her, a disagreeable sensation is felt, momentarily arresting all her thoughts also functions.

Belladonna

• Threatened miscarriage with profuse hot hemorrhage.
• Backache, headache also the peculiar uterine tenesmus of the remedy .
• Violent aching of the body. Additionally, the least jar is painful.

Cimicifuga

• One of our most powerful retainers of abortion.
• The pains indication the threatened miscarriage flies across the abdomen from side to side doubling the patient up.
• It suits habitual abortion especially in women of a rheumatic diathesis.

Calcarea carb

• Leuco phlegm Asia, disposition to hemorrhages.
• Cold and damp feet, vertigo; additionally disposition to leucorrhoea.
• Painful nipples.
• Colic, pain in loins; In detail, varices of sexual organs.[2]

Cinamonum

• Useful for abortion from a strain or misstep with profuse hemorrhage also slight pain.

Caulophyllum

• A very useful remedy in false labour pains also also as a preventive of abortion.
• There is severe pain in the back and sides of the abdomen, feeble uterine contractions and scanty flow.
• Severe pains in back and loins; threatening abortion.
• Besides this, Great want of uterine tonicity; uterine contractions tormenting, irregular, feeble and attended with only slight loss of blood, menstrual irregularities after miscarriage.
• Habitual abortion from debility with passive hemorrhage.

Carbo-Veg

• Menses too pale and scanty, or too copious and premature, with varicose condition of sexual organs.
• Frequent headache, abdominal spasms.[2]

Sabina

• This is a remedy useful to prevent impending abortion occurring about the third month, ushered in by the appearance of blood, which is oftentimes the first symptom.
• Then follow pain in the small of the back, going around and through the pubes; there are forcing and dragging pains from the sacrum to the pubes.
• The flow is bright red and clotted.
• It is useful for metritis accompanied especially by flooding from miscarriage. 

Secale core

• For miscarriage in the early months of pregnancy Secale may be the remedy, especially in feeble and cachectic women.
• It is useful for checking the tendency to miscarriage in the later months, when the muscular tissue of the womb largely develop.
• It indicated by frequent labour-like pains, a copious hemorrhage of black fluid blood, a wan sunken countenance, tingling and formication of the extremities and a desire for air.

Viburnum Oppulus

• Threatening miscarriage when the pains come from the back around to the lower part of the abdomen and go into the thighs.
• It will often stop these spasmodic pains.
• It is a remedy to use in frequent and early miscarriages.

Sepia

• It is one of our most important remedies as a preventive of miscarriage.
• It indicate by nervous irritability, laxness of tissues and a sense of weight in the anus.[2]

Diet & Regimen of Spontaneous abortion (Miscarriage)

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.
• Avoid known miscarriage risk factors — such as smoking, drinking alcohol and illicit drug use.
• Take a daily multivitamin.
• Limit your caffeine intake. A recent study found that drinking more than two caffeinated beverages a day appeared to be associated with a higher risk of miscarriage.[4]

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References use for Article Spontaneous abortion (Miscarriage)

[1] DC Dutta’s Text Book of OBSTETRICS

[2] Homoeopathic Therapeutics By Lilienthal

[3] https://www.msdmanuals.com/en-in/professional/gynecology-and-obstetrics/abnormalities-of-pregnancy/spontaneous-abortion

[4] https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298

Frequently Asked Questions

What is Spontaneous abortion?

Abortion is the expulsion or extraction from its mother of an embryo or fetus weighing 500 g or less when it is not capable of independent survival (WHO). This 500 g of foetal development is attained approximately at 22 weeks (154 days) of gestation. The expelled embryo or fetus is called abortus. The word miscarriage is the recommended terminology for spontaneous abortion.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Spontaneous abortion?

• Alteris
• Ambra
• Arnica
• Belladonna
• Cimicifuga
• Calcarea carb
• Cinamonum
• Caulophyllum
• Sabina
• Secale core
• Viburnum Oppulus
• Sepia

What causes Spontaneous abortion?

• Genetic
• Endocrine and metabolic
• Anatomic
• Infection
• Immunological
• Thrombophilia
• Environmental

What are the symptoms of Spontaneous abortion?

• Crampy pelvic pain, bleeding, and eventually expulsion of tissue.
• Gush of fluid when the membranes rupture
• Hemorrhage is rarely massive