Threatened Miscarriage

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Indian epidemiology then other

Causes of or Threatened Miscarriage:

• The exact etiology not always known.  It widely accept that the vast majority of spontaneous abortions cannot prevent or modified likely because they are due to chromosomal abnormalities in at least half of all cases.
• For pregnancy losses that determine to have a normal chromosomal makeup, termed euploid abortions, maternal and paternal factors play a more significant role. Optimization of maternal health before pregnancy, correcting structural abnormalities of the uterus, and minimizing exposure to teratogens or infections during early pregnancy can reduce the risks for spontaneous abortion.
• When optimizing maternal health, special consideration should be given to chronic illnesses such as diabetes and thyroid disease, as well as extremes of weight and use of tobacco products, alcohol, or illicit drugs.

Other causes

• Some studies have shown that folic acid supplementation immediately before and during early pregnancy may reduce the risk of spontaneous abortion.
• It has also been shown in several studies that increasing paternal age is associated with increased risk for pregnancy loss, likely due to increased chromosomal abnormalities.
• Women should also educate about reducing the risk of traumatic events and should be screened for risk for intimate partner violence.
• It is reasonable to recommend preconception counseling to modify these risk factors.

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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, on the other hand, focuses on the functional changes that occur in the body due to the disease. It explains how the disease disrupts normal physiological processes and how this disruption leads to the signs and symptoms we see.

Imagine a car accident. Pathogenesis would be like understanding how the accident happened – what caused it, the sequence of events (e.g., one car ran a red light, then hit another car). Pathophysiology would be like understanding the damage caused by the accident – the bent fenders, deployed airbags, and any injuries to the passengers.

In simpler terms, pathogenesis is about the "why" of a disease, while pathophysiology is about the "how" of the disease’s effects.

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The patient, having symptoms suggestive of pregnancy, complains of i.e.:

(1)  Firstly, Bleeding per vaginum is usually slight and may be brownish or bright red in color. On rare occasion, the bleeding may be brisk, especially in the late second trimester. The bleeding usually stops spontaneously.

(2) Secondly, Pain: Bleeding is usually painless but there may be mild backache or dull pain in lower abdomen. Pain appears usually following hemorrhage.

Pelvic examination should be done as gently as possible i.e.-

(a) Speculum examination reveals- Bleeding if any, escapes through the external os. Differential diagnosis includes cervical ectopy, polyps or carcinoma, ectopic pregnancy and molar pregnancy.

(b) Digital examination reveals- The closed external os. The uterine size corresponds to the period of amenorrhea. The uterus also cervix feel soft. Pelvic examination is avoided when ultrasonography is available [1]

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Routine investigations of Threatened Miscarriage include:

(1) Firstly, Blood—for hemoglobin, hematocrit, ABO and Rh grouping. Blood transfusion may be required if abortion becomes inevitable and anti-D gamma globulin has to be given in Rh-negative nonimmunized women.

(2) Secondly, Urine for immunological test of pregnancy is not helpful as the test remains positive for a variable period even after the fetal death.

Ultrasonography (TVS) findings may be:

• A well-formed gestation ring with central echoes from the embryo indicating healthy fetus.
• Observation of fetal cardiac motion. With this there is 98% chance of continuation of pregnancy.
• A blighted ovum evidence by loss of definition of the gestation sac, smaller mean gestational sac diameter, absent fetal echoes and absent fetal cardiac movements. Serum progesterone value of 25 ng/mL or more generally indicates a viable pregnancy in about 95% of cases. Serial serum hCG level is helpful to assess the fetal well-being. Ectopic pregnancy must rule out during investigations [2]

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

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• Rest- The patient should in bed for few days until bleeding stops. Prolonged restriction of activity has got no therapeutic value.
• Drugs- Relief of pain may ensure by diazepam 5 mg tablet twice daily. There is some evidence that treatment with progesterone improves the outcome. Progesterone induces immunomodulation to shift the Th-1 (proinflammatory response) to Th-2 (anti-inflammatory response). Use of hCG is not preferred.

The prognosis is very unpredictable. In isolated spontaneous, Threatened Miscarriage, the following events may occur:

(1) In about two-thirds, the pregnancy continues beyond 28 weeks.

(2) In the rest, it terminates either as inevitable or missed miscarriage. If the pregnancy continues, there increase frequency of preterm labor, placenta previa, intrauterine growth restriction of the fetus and fetal anomalies. Blighted ovum It is a sonographic diagnosis. There is absence of fetal pole in a gestational sac with diameter of 3 cm or more. Uterus is to evacuate once the diagnosis made.[1]

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Homoeopathic treatment of Threatened abortion

Homeopathic medicines are individualized, selected based on the individual case history of the patient, by taking into consideration the cause like hormonal imbalance, nutritional factor, emotional stress, the nature of the patient, and other factors which may be acting as a maintaining cause in the Threatened Abortion.

Threatened abortion, as it is a problem, requires a constitutional as well as acute remedy to control bleeding. Homeopathy focuses on the root cause of the problem and helps in the treatment of Threatened abortion. A well-chosen homeopathic remedy helps in controlling the amount of blood loss and, abdominal pain.

Medicines:

Aconite

• Threatened abortion from anger, especially fright; fears that something terrible is going to happen her; dizziness on rising from a recumbent position.

Arnica

• Threatened abortion as a result of fall, blow, shock, concussion, particularly when blood comes out without pain. *Sore pain all over body as if from a bruise.[2]

Belladonna

• Severe bearing down, as if everything would protrude through vulva; additionally pains come on suddenly and cease suddenly.

Caulophyllum

• With severe pain in back and loins but uterine contraction feeble; slight flow. Habitual abortion from uterine atony.

China

• If hemorrhage continues after abortion and there is giddiness, drowsiness and fainting.
• Extremely useful in removing the after-effects of hemorrhage, such as, heaviness in head, ringing in ears, coldness of extremities.

Sabina

• Threatened miscarriage, esp. during third month with pain commencing in the small of back and going round and through the pubes.
• Pain runs through from sacrum to pubes. Bright red, clotted flow of blood or bright red blood, partly fluid and partly clotted, increasing with every motion.

Viburnum

• Threatened abortion with intense cramping pains in uterus and bearing down.[2]

• Advice on discharge: The patient should limit her activities for at least 2 weeks and avoid heavy work. Coitus avoid during this period. She should follow up with repeat sonography at 3–4 weeks’ time.
• The following indicates unfavorable outcome: falling serum β-hCG, decreasing size of the fetus, irregular shape of the gestational sac or decreasing fetal heart rate.[1]

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[1] DC DUTTA Text book of Gynaecology

[2] The Homoeopathic Prescriber by K. C. Bhanja

Frequently Asked Questions

What is Threatened Miscarriage?

Threatened Miscarriage is a clinical entity where the process of miscarriage has started but has not progressed to a state from which recovery is impossible.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Threatened Miscarriage?

• Aconite
• Arnica
• Belladonna
• Caulophyllum
• China
• Sabina
• Viburnum

What causes Threatened Miscarriage?

• Abnormalities of the uterus
• Maternal and paternal factors
• Chronic illnesses
• Increasing paternal age
• Folic acid deficiency
• Traumatic events

What are the symptoms of Threatened Miscarriage?

• Bleeding per vaginum
• Mild backache or dull pain in lower abdomen