When Rosemary Maina, 32, suffered her third miscarriage in as many years, she was torn between giving up on trying again and forging ahead, hopeful that the next time would be the one. And as she struggled through the pain of loss, her marriage suffered too.
“I have always had blood pressure issues and I thought that it was why I lost my babies. It did not also help that my mum and aunts had all suffered numerous miscarriages. But after the third miscarriage at 15 weeks, the doctor told me I had an incompetent cervix. And I think my husband heard that it meant that I could not bear him a child. We are on a rocky road now,” she says.
An incompetent cervix is where the opening of the womb, the cervix, weakens and opens up too early, before the baby is ready to be born. And with Rosemary being pregnant again, at 11 weeks now, she is being monitored closely by her doctor, with the hope that this time around she will walk out of hospital with a baby in her arms.
“I am going in for a cervical stitch next week. The doctor says this will fortify my weak cervix so that it stays closed for as long as we need it to be.”
But is there any truth to Rosemary’s assumption that she may have inherited the unlucky streak?
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Science is not certain about that. And while researchers note that most miscarriages are caused by chromosomal changes in the foetus, which stop the progression of pregnancy, they will not altogether rule out that unexplained recurrent miscarriages may sometimes run in families. This means that it is a good thing to mention it to your doctor to cover your bases.
The loss of a baby through miscarriage has traditionally been handled as a private affair. The parents are left to deal with the emotional impact on their own. Some studies suggest that even after a healthy subsequent birth, the emotional effects still linger on, especially on the mother.
The difference between a miscarriage and a stillbirth is in the timing. A miscarriage, medically known as a spontaneous abortion, is the loss of a foetus anywhere before the 20th week of pregnancy, while a stillbirth is a later loss. Up to 80 per cent of these happen within the first 12 weeks, after which there is a lower risk of miscarriage, although it can still occur.
According to research done in rural western Kenya, the cumulative probability of miscarriage was estimated to be 18.9 per cent between 2011 and 2013. There was a declining weekly miscarriage rate as gestation progressed to 20 weeks. Even though this study provides the initial description of miscarriage in rural Kenya, the near accurate estimation could be higher if information from very early pregnancy is captured for more conclusive estimations.
Why do miscarriages and still births happen?
Most times, miscarriages happen so early that a woman may not even know she has lost a pregnancy. And many of these early miscarriages are due to chromosomal changes in the foetus. The changes are such that the pregnancy stops developing, thus prompting the expulsion of the foetus.
Even though they can happen to anyone, there are some predispositions that make some women more vulnerable than others. One of the most common causes of miscarriage is when the foetus has catastrophic genetic issues. Other risk factors include;
· Cervical and uterine abnormalities
· Chronic medical conditions such as uncontrolled diabetes, HIV infection or thyroid disease
· Use of street drugs, alcohol consumption and smoking
· Medication; you should always consult your doctor before buying drugs over the counter when expectant
· Having had two or more previous miscarriages
· Exposure to toxic chemicals
· Advanced age; mostly women above 35
· History of birth defects
The symptoms include bleeding that upgrades from light to heavy, cramps, weight loss, contractions, tissues resembling blood clots passing from the vagina, diminishing signs of pregnancy. The doctor can confirm the miscarriage by carrying out a pelvic examination to check if the cervix is closed or dilated. An ultrasound scan can be done to check on the heartbeat. Blood tests to compare levels of pregnancy hormones can also be done. To examine chromosomal abnormalities when recurrent miscarriages occur, genetic tests from both partners can be requested to check the genetic association.
What to know after recurrent pregnancy loss
Many women who have suffered recurrent pregnancy loss can still have a healthy pregnancy and deliver healthy babies if they continue to try. In fact, it is estimated that 65 per cent of women who have had unexplained pregnancy loss are likely to have a successful next pregnancy. Furthermore, there is compelling evidence that effective care post-miscarriage reduces the risk of pregnancy loss in women previously considered at a higher risk. According to Mariestopes Kenya, physical recovery after pregnancy loss happens fairly quickly for most women.
If you have suffered two or more miscarriages or stillbirths, you should see your fertility specialist. Full disclosure of pregnancy history is paramount for effective treatment. Your specialist may suggest treatments options that may include:
1. Surgery; to fix uterine problems like scar tissue or fibroids. The doctor could evaluate you for a cervical stitch in the case of an incompetent cervix.
2. Medication; to treat medical conditions such as autoimmune disorders and drugs to control blood sugar levels
3. Change in lifestyle; stop illicit drug use, cigarette smoking and limit alcohol and caffeine intake
4. Genetic screening; where chromosomal abnormalities are responsible, fertility experts might suggest in vitro fertilisation.
Other causes of pregnancy loss
1. Constricted umbilical cord
Constriction of the umbilical cord causes the unborn baby to experience compromised blood supply and reduced oxygen levels. The foetus may respond by intense kicking to free the cord. If such kicking worsens with changes in the mother’s position, extra attention needs to be taken when the foetus struggles to correspond to changes in position.
2. Ectopic pregnancy
Ectopic pregnancy develops in one of the Fallopian tubes. It is unfortunate that it is impossible to save an ectopic pregnancy. Women with pelvic inflammatory disease, smokers or nearing 40 years of age are associated with an increased risk of ectopic pregnancy. In addition, while it is rare to become pregnant while using an intrauterine device for contraception, if it does happen, one is highly likely to have an ectopic pregnancy. Other risk factors include:
· History of ectopic pregnancy
· Fertility treatment
· Unsuccessful tubal ligation.
If you experience a sharp and intense pain, dizziness and heavy bleeding, seek immediate medical attention. If the Fallopian tube has ruptured, treatment through surgery can save a potentially serious situation.
12 weeks of pregnancy
When 80 per cent of miscarriages happen.
22 per 1,000 births
The WHO estimates Kenya’s stillbirth rate at 22 per 1,000 births. Almost half of them happen during labour.
Central region in Kenya
Is reported to have the lowest infant mortality rates. 80 per cent of these were women aged between 20 - 34 years which considered the peak of the women’s reproductive age.
SHOULD YOU TRY AGAIN SOON AFTER A MISCARRIAGE?
You would think that it makes absolute sense to give your body a break before conceiving again; time to rest. But a 2010 study on 30,000 Scottish women suggested otherwise. The study findings, published in the British Medical Journal, showed that the women who got pregnant within six months of suffering a miscarriage were less likely to suffer another. These women also had a lower chance of getting an ectopic pregnancy. This is where the fertilised egg attaches anywhere else but the uterus.
Nancy Nzalambi is a research scientist with NHIF