This is the concluding part of last week’s article. Another method of family planning is the use of condoms by both men and women. It’s safe and helps to prevent sexually transmitted infections.
Condom is available in most pharmacies and shops without the need for prescriptions. Hormones, such as the daily pill can also be used too. Two or three monthly injections are other choices. Devices, such as intra-uterine devices, are another effective method of contraception. In a stable couple that had completed their children, vasectomy by the man or Fallopian tube ligation by the woman are effective permanent contraceptive methods. The choice of contraception method will depend on the age of the user, the urgency, reason for the contraception as well as any need to address any other illness in the man or woman.
The reader will recall that in Part 1 of this series; we discussed the differences between miscarriage and deliberate termination of unwanted pregnancy or abortion either as therapeutic abortion or termination for non-medical reason.
In this article, we will look at Miscarriage, what causes it and how to deal with it as well as how to prevent miscarriage. Unlike abortion that is intentional, miscarriage is a desirable pregnancy that could not continue to viability. The experience causes extreme distress to the woman and the male partner. It’s even more painful if the pregnancy is one that has been sought for some time otherwise called “precious pregnancy”.
What causes miscarriage? Age: Maternal age and number of previous miscarriages are two risk factors for a further miscarriage. As the mother ages, her eggs (oocytes are also aging). Therefore, aging oocytes (eggs) are candidates for a pregnancy at the risk of being miscarried. As we shall see below, the advancing age is not to say that miscarriage does not occur in younger women. It does. The risk of miscarriage is highest among couples where the woman’s age is greater than 35 and the man is over 40.
Also, one miscarriage begets another miscarriage. The risk of a further miscarriage increases after each successive pregnancy loss. Combined with advancing age, the outlook for the woman worsens if there had been previous miscarriages. Maternal cigarette smoking and caffeine consumption have been associated with an increased risk of spontaneous miscarriage according to Royal College of Obstetricians and Gynaecologists (UK). Meanwhile, heavy alcohol consumption is toxic to the embryo and the developing foetus. There are some disease states that very often lead to miscarriages. Among them is the disorder that is called Antiphospholipid syndrome. The good news is that antiphospholipid syndrome is the most important treatable cause of recurrent miscarriage.
Sadly, two to five per cent of couples could be born with genetic errors. One of such is what is clinically termed Robertsonian translocation could, unfortunately, occur in one parent thus leading to miscarriages. Although carriers of the said error are usually physically normal, their pregnancies are at increased risk of miscarriage and may result even in a live birth of babies with multiple inborn malformation and/or mental disability which is due to a poor chromosomal arrangement.
I had earlier mentioned problems that increasing maternal age may bring such problems as deformed eggs (oocytes). In some couples with recurrent miscarriage, chromosomal abnormalities of the miscarried pregnancy account for over half of further miscarriages.
Focusing on the particular woman (potential mother) for the moment, a lot of miscarriages occur because of badly formed womb (uterine abnormalities/malformations). Generally, the frequency of occurrence of uterine malformations appears to be higher in women suffering miscarriages in the second quarter of pregnancy as compared to the first quarter of pregnancy. Quiet often, such miscarriages are due to weakness in the neck (cervical weakness) of the womb of the woman. Cervical weakness (cervical incompetence) is a recognised cause of second quarter miscarriages. In our environment in Nigeria and indeed in Africa, cervical weakness is commonly occurring as a result of frequent surgical abortion (legal or illegal) procedures that affect the neck of the womb.
In a lot of ways, some physical illnesses in the woman may lead to miscarriages. Diseases, such as diabetes mellitus and thyroid disease, have been associated with miscarriage. Women with diabetes who have high uncontrolled blood sugar level in the first quarter of pregnancy are at risk of miscarriage and foetal malformation. However, well-controlled diabetes mellitus is not a risk factor for recurrent miscarriage, nor is treated diseases of the thyroid.
Yet, diseases, such as polycystic ovary syndrome (PCOS), have been linked to an increased risk of miscarriage. Polycystic ovarian syndrome is a frequent cause of infertility in women. Still, when the pregnancy does occur, the pregnancy is vulnerable to miscarriage.
Infection and any serious infection for that matter, is a threat to any pregnancy. Any infection that tends to stay for a long time in the reproductive tract of a woman carries a risk to potential pregnancy. Example, the presence of bacterial vaginosis in the first quarter of pregnancy, has been reported as a risk factor for second quarter miscarriage and preterm delivery of the baby.
Finally, some diseases of the blood such as inherited thrombophilias have been implicated as a possible cause in recurrent miscarriage and late pregnancy complications. In the next article, we will look at what investigations can be done to address miscarriages and what solutions that is available including the role that you can play.
