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Tag: stillbirth

  • Your role in preventing miscarriage, abortion, stillbirth and preterm (6)

    Closely related to all that we have discussed—miscarriage, stillbirth, and abortion – so far is prematurity.

    What is it? Prematurity is a term for the broad category of newborn born at less than 37 weeks’ of pregnancy.  Weight may also be used as indicator of prematurity. Doctors will often try to care for babies born alive who weighs about 400gram and above.

    Premature babies merely manage to escape the peril of other dangerous instances that I have mentioned ealier. Even though being born alive gives hope, it does not mean that the danger of early death is over. In fact, according to the World Health Organisation (WHO), premature births carry considerable risk.

    Indeed, “preterm birth is the most common direct cause of newborn mortality. Preterm birth and being small for gestational age (SGA), which is the reasons for low-birth-weight (LBW), are also important indirect causes of neonatal deaths. LBW contributes to 60percent to 80percent of all neonatal deaths. The global prevalence of LBW is 15.5percent, which amounts to about 20 million LBW infants born each year, 96.5percent of them in developing countries”, according to WHO.  We can now see that premature birth of a baby, though much better than being miscarried or being born a stillbirth, constitute extreme danger to the baby.

     

    What causes premature birth? 

    A baby born early has less time in the mother’s uterus to grow and gain weight, and much of a foetus’s weight is gained during the latter part of the mother’s pregnancy.

    There are some factors that make prematurity possible. Black people tend to have higher risk of still birth than our white cousins. One can only speculate why this is so. It might be that we (mothers and also fathers) tend to be more prone to hypertension which is dangerous for the baby if the mother should have high blood pressure in pregnancy. Again, the age of the mother matters. Mothers who are over 35 years old not only carry the risk of miscarriage, deformed babies, high blood pressure in pregnancy and still birth, but she is also vulnerable to having a premature baby.  Just as in stillbirth, multiple pregnancies is a known cause of “prem babies”.

    I have earlier mentioned in preceding articles that maternal diseases is a material risk to medical abortion, miscarriages and stillbirth. The same sets of maternal illnesses may cause the baby to be born earlier than necessary. Such diseases include as previously mentioned, maternal hypertension, diabetes mellitus and thyroid diseases. Similarly, a pregnant woman who uses toxic substances, are exposing their unborn child to early immature birth. Mothers of lower socioeconomic status are also more likely to have poorer pregnancy nutrition, inadequate prenatal/antenatal care, and pregnancy complications – all factors that can contribute to low birth weight and hence premature birth.

    Why is prematurity so important and why is it crucial that we prevent premature birth? In general, the lower a baby’s birthweight, the greater the risks for complications. The following are some of the common problems of low birthweight babies and prematurity: low oxygen levels at birth, inability to maintain baby’s own body temperature as well as difficulty feeding and gaining weight while outside the womb. Most crucially, the baby is very vulnerable to infection of any of his or her organs.

    Independent breathing by the baby may become problematic and can suffer what doctors call respiratory distress syndrome (a respiratory disease of prematurity caused by immature lungs). Remember that immature lung itself is a cause of stillbirth. Being immature may lead the baby to suffer bleeding (stroke) into his or her brain, young as the baby may be. This bleeding could then cause a host of neurologic problems.

    Immature birth could also cause serious diseases in the gut (necrotizing enterocolitis) whereby feeding and maintaining food may become a problem for the baby.  Though not well recorded in Nigeria and perhaps not as common as in other lands, sudden death (cot death) as the name implies could cause early demise of the premature baby.

     

    Prevention

    Prevention is cheaper and better than cure. Prevention will help us avoid gloom and agony of complications premature births. Therefore, at antenatal visits, the health of both mother and foetus can be checked. Because maternal nutrition and weight gain are linked, as I earlier mentioned,  with foetal weight gain and birthweight, eating a healthy nutritious diet and gaining the proper amount of weight during pregnancy are essential measures.  Mothers and potential mothers should avoid alcohol, cigarettes and illicit drugs, unknown and toxic local preparations which can contribute to poor foetal growth outcomes, among other complications.

    In conclusion of this series therefore, the reader will observe that the pregnant woman or potential mothers are not all that helpless in the face of threats of abortion, miscarriages, stillbirth and premature births. There are small steps that the aspiring mother, the husband and indeed the couple can do to prevent these adverse outcomes. I have discussed these in all the articles. For other reasons and factors that you as a mother/fathers cannot deal with, I urge you to work with your doctors or ask for qualified medical personnel to help you all the way. Start early even before you get pregnant. Good luck to you.

  • Your role in preventing miscarriage, abortion, stillbirth and preterm (5)

    In the last 4 weeks, we have been dealing with extremely emotive issues of miscarriage and abortion. If the former two names and experiences evoke huge sensitivities in you, then spare a thought for parents that escaped miscarriages, abortion of any sort but nurtured desirable pregnancy beyond 20 weeks, had a raised hope, often desperately wanted the baby that the woman was carrying; but in the end, the foetus ended as still birth. Pray too for the clinicians (doctors, nurses, counsellors and so forth) that had to undergo grief periods from time to time in empathy with the parents of still birth foetuses. Sadly, even if the mother is innocent, stillbirth can result in guilt  feeling in the woman.

    What then is still birth?  Stillbirth is typically defined as foetal death at or after 20 to 28 weeks of pregnancy. It results in a baby born without signs of life. Put in another way, still birth is the birth of an infant that has died in the uterus (womb) after having lived and survived through at least the first 28 weeks of pregnancy.  In some countries, a baby is considered as viable and “human” from 24-weeks onward. In Nigeria, this threshold is 28weeks. The weight of the stillbirth baby may also be used as a guide. Such guides may be 350gm and above.  Therefore, a baby is full human being from 28weeks. Now imagine the death of such human being in the womb of his or her mother. This is called stillbirth—a  truly tragic event.

    What causes stillbirth and Preventions? Very often, the cause of still birth is not known. In a wisdom that has stood the test of time however, the ancient says that there is no smoke without fire. So, the fact that we do not know some of the causes of still birth is not to say that there is no cause. We simply don’t know enough at this stage.

    That said, there are some causes which are well known and well documented. Those are the ones that I will now discuss below. Being black as compared to white population exposes us to risk of stillbirth.

    In some situations, the causes of still birth are simply those reasons that could otherwise have caused the baby to be miscarried in the first instance. Infection such as syphilis and other bacterial infections could be shocking the baby to death. Malaria is a dangerous illness—killing over 600,000 people yearly— to a fully grown strong adult person. Most of these deaths are children and pregnant women.  How much less a defenceless individual that depends, in the womb, on the mother for survival? Malaria is a terrible cause of stillbirth especially in an environment like ours where healthcare is chaotic. So, while pregnant, take any fever or any illness seriously and seek medical assistance urgently.  Foetus with defects of whatever cause and in particular, lung that is underdeveloped (pulmonary hypoplasia) in which nature had perceived, it may be difficult for the baby to survive in life, may be expelled from the womb before it reaches maturity. Blood disorders resulting from incompatibility with the mother’s blood (rhesus incompatibility) may result in death of the unborn baby.

    If this had not been done via miscarriage, it may be done at the level of stillbirth. Similarly, as I mentioned under causes of miscarriage, genetic and chromosomal abnormality in the baby may be a good reason for the death of the foetus.  For whatever reason and if not detected or managed properly, a baby in the womb that is not growing in keeping with its age (growth retardation) may die in the womb.

    Similarly, in some occasions, late induced abortion may end up as still birth.

    Diseases of the mother such as uncontrolled diabetes, high blood pressure, pre-eclampsia (see earlier published article on Hypertension), and diseases of the liver may all combine or act individually to compromise the live of the developing baby.

    Yet, some mothers are the cause of the death of their baby via the use of dangerous substances whilst being pregnant. Mothers who consume recreational drugs such as alcohol, cigarette (nicotine) are putting the lives of their baby at risk. On the other hand, some medicines that qualified doctors prescribe may have unpleasant effects on the baby. Thus, it’s important to work with your doctor and nurses before and during pregnancy drawing their attention to any medication that you are given to take. Some medicines must as a matter of fact not be taken in pregnancy.

    Pregnancy that goes over the due date for delivery may also end up in stillbirth. Pregnant women must therefore be vigilant to check and keep their date of delivery. Any competent doctor will be watchful and not allow a pregnancy to be unduly overdue. The key to preventing still birth due to overdue date is early pregnancy dating by ultrasound. So, once a woman misses her menstrual period, she should contact and consult a doctor for assessment as soon as possible.  In addition, once a pregnancy is confirmed, the woman should keep her antenatal dates with religious conviction in other to prevent the agony of stillbirth.

    Further, there are disorders that are associated with the afterbirth (placenta) of the baby. If there is excessive bleeding for example or undesirable detachment (placenta abruptions) of the placenta from its place before the baby is born, it may result in still birth. Physical trauma may be from falls or severe beating from domestic fighting or a kick to the pregnancy may result in death in the womb of the baby.

    Multiple pregnancies such as twins may cause one or more of the growing babies to compete for food and nutrients. One baby may take more to the detriment of the other thus leading to death.

    With all these, it’s important that potential pregnant and indeed pregnant mothers should work very closely with their doctors to prevent unpleasant outcomes.  Next week, we shall deal with premature births.

  • Your role in preventing miscarriage, abortion, stillbirth and preterm explained (4)

    So far, we have looked at abortion – both legal and illegal. We discussed possible reasons for legal abortion though not everyone may agree with my position. I believe the true test of decision on if abortion should be done or not is first to weigh in the letter of the law and also pertinently to pause and consider:  “What will I do, if I got an unwanted pregnancy or what will I do if my daughter or sister or any member of my family faces an issue of undesirable pregnancy?”

    We have also looked at miscarriages and what causes it.  I am sure that a host of my readers will wonder what sort of investigations can be done to lead to causes of miscarriage.

    Investigation: Treatment of miscarriages is best handled by skilful specialist in the field.

    That said, the simplest and ironically the grandest place to begin is to attend a qualified medical doctor for initial assessment of detailed history and examination. The doctor will collect information about previous miscarriages, any prior operations, current and past medications, use of substances, including traditional medicine preparations, nature of work and exposure to environmental hazards.

    The attending physician of competence will consider some investigations in line of the causes that I have outlined earlier.  Examples of investigations that you may be expected to do are ultrasound of the pelvis that may help outline the organs of reproduction. Blood sample may be required for test on hormones that I have mentioned as well as to determine other disease states such as diabetes.. Still, genetic testing may be required on both couples.

    The attending gynaecologist may also request for examination of the womb via a camera that is called hysteroscope whereby the doctor can see firsthand, the structure and appearance of the womb. Patients should not be too alarmed at the request for these investigations.

    Are there treatments for Miscarriages? Yes, there are treatments that can be offered for miscarriages, based upon the findings of the attending physician. However, it’s important that the couple see the attending doctor prior to getting pregnant again. Medications are available to deal with deficiencies in hormonal levels.There are also some therapies that are directed against blood disorders that affect pregnancies.  In the case of genetic abnormalities in the parents that leads to miscarriages, the couple could consider egg or and sperm donation as the case may be. Pregnancy may thus be achieved through in-vitro fertilisation.   Where the miscarriage is due to abnormalities of the womb, this may be corrected through surgery. Where the pregnancy loss is due to weakness in the neck of the womb, this may be corrected via tightening the said neck via surgery shortly after pregnancy has occurred. However, it’s important that all these be arranged with the doctor prior to the pregnancy.

     

    Prevention of Miscarriages: Certainly, there are some measures that individuals and couples can undertake to reduce their risk of miscarriage. Example, obesity that may give rise to diabetes should be controlled. Sugar level should be thoroughly brought under control. Nutritional changes along with exercise and weight reduction measures could help to bring down the risk of diabetes and obesity associated with pregnancy losses.

    Further, abortion if it is to be done is best done by the skilful medical professionals. This is important to safeguard the integrity of the neck of the womb (cervix): defect of which may cause miscarriages of pregnancies. Also, persistent infection that may have been introduced during abortion procedure is best minimised at the hands of trained professionals.

    Potential mothers are best advised to avoid consumption of alcohol or nicotine (cigarette) during pregnancy so as to avoid unwanted effects on the foetus. In the same line of thought, pregnant women should avoid substances whose contents are not known or well documented.

    Finally, I have mentioned in another article earlier in the year that the reproductive or fertility chances of women are at their peak between ages 22 and 32. Beyond the age of 35, fertility begins to decrease at an alarming rate and the ensuing pregnancies begin to carry considerable vulnerability to foetal abnormality and the risk of premature expulsion from the womb. The older the woman gets beyond this age bracket before mentioned, the higher the risk of miscarriage.

  • Your role in preventing miscarriage, abortion, stillbirth and preterm explained (3)

    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.

  • Preventing miscarriage, abortion, stillbirth and preterm (2)

    On this note, let us begin the difficult task of dealing with  the reasons for Induced Abortion.

    It’s an ironical that while millions of women are desperately looking for babies, others are either having unwanted babies or terminating credible pregnancies of viable and non-deformed foetus.

    The most common reason for abortion is unplanned pregnancy caused by unprotected sex or failed protection. Abortion may also result from unwanted pregnancy – that is pregnancy that was initially desired but no longer wanted. Other reasons may be rape, incest or social shame and embarrassment.

    Likely Consequences of Abortion:  Earlier I mentioned that abortion can be caused by a medical reason or it may be due to what the law sees as illegal.

    Induced Abortion is not without consequences.  First, let us deal with potential risky outcomes in illegal abortion. When induced abortion is handled by qualified medical doctor, the medic ensures that certain dangers are avoided or minimised. This may not be so in induced illegal abortion in the hands of quacks.

    Bleeding: The victim could bleed seriously depending on the age of the pregnancy. Such may be so much as to cost the woman her life if care is not taken. Even if blood is transfused, transfusion also carries many risks.

    Infection:  Very often, illegal abortion is done in an unhygienic environment. Thus, the procedure may give rise to infection of the womb which may lead to infertility. The blood may also be infected with serious bacteria. This outcome may cause septicaemia and if left untreated, may lead to death.  In inexpert hands, perforation or severe damage of the womb, gut, and other internal organs may leave the woman severely injured.  As mentioned, all these complications may cause the woman to become infertile after the abortion.  Abortion  causes Asherman syndrome in which the lining of the womb get stuck, thus not allowing menstrual blood flow to pass out and sperm to migrate into the womb for egg fertlisation.

    Guilt and mental health issues: Depending on the disposition of the woman, she may feel guilty of having “killed” a person. She may become anxious and even depressed. All these may subsequently affect her sexual life as well as impair the relationship with her partner.

    Infertility could result from excessive vaginal bleeding during or after an abortion or childlessness could result from infection that was introduced into the woman’s reproductive tract during the abortion procedure.  In addition, Asherman’s syndrome which I explained above could cause the woman and hence the couple to become childless.

    Death: The woman may die from anaesthesia or as a result of infection or excessive bleeding.

    Therapeutic Abortion: However, therapeutic abortion (abortion done for medical reason) can be as a result of illness in the mother or to prevent mental or physical illness in the mother. Examples of this is hypertension or preeclapsia that occurs in pregnancy.

    On the other hand, abortion can also be done because of severe malformation of the foetus in which if such foetus was to be allowed to term, it may lead to impairment of the physical or mental health of the mother.

    Moreover, there are controversial areas where request for abortion is not clear cut.  Example of this is rape of the woman. Another important controversial event is incest where a member of the same family impregnates a woman in the same lineage. To most reasonable individuals and societies, incest is an abomination and any pregnancy resulting from it should not stand. The same can be said of rape by known or unknown persons. However, the critical test is if continuing the pregnancy will affect the mental and physical health of the woman that is involved. If any of these traumatic events will cause harm to the woman (victim), then abortion may be carried out according to the law.

     

    Unwanted consequences of therapeutic/medical abortion

    In general, in medical hands with poor clinical skills, lapses may occur such that the consequences of therapeutic abortion may mirror that of abortion in the hands of quarks or in the hands of non-medical personnel.

    Thus, abortion done by a competent medical doctor will guide against excessive bleeding, infection and ensure that the woman enjoys her reproductive rights.

     

    Prevention of Illegal Abortions

    The first and, perhaps the most important preventive measure, is education. An informed woman who understands the way her body functions and is well-motivated to promote her own health, will likely take steps not to get an unwanted pregnancy. This is likely to lead her to take preventive measures. Such will  include counselling. This will enlighten her about her body and its functions.

    Also, the healthcare worker may inform the woman about family planning. These include abstinence and calendar (calculation of ovulation periods), especially for a religious individual, who may object   other physical or chemical methods of family planning.

    The next set of articles will explore miscarriage otherwise called spontaneous abortion.