Don’t panic at the sight of blood

Miscarriage or a pregnancy loss is a devastating experience for any woman. When a baby is born there is much to celebrate, but when by a tragic twist of fate, a baby is lost, it is hardly talked about. Yet many hopes have been shattered and the sorrow needs to be shared; the question "will I be able to conceive again?" needs to be answered.

From the day that you get to know that you are pregnant, any bleeding through the vagina will strike fear in your heart. 'Am I going to lose the baby' you wonder.

Thankfully, this does not always happen. Until you are 24 weeks pregnant, per vaginal bleeding poses the threat of a miscarriage, but once this period is past, the baby has a significant chance of survival outside the womb. The baby cannot live outside the womb, before it is mature enough to breathe and assimilate its nutrition. The arbitrary time limit is 28 weeks.

This means that once your pregnancy is 28 weeks, even if you need an emergency delivery, the chances of the baby surviving are high. With the availability of good premature baby care facilities, now even a foetus of 24 weeks can live outside its mother's womb, in a premature baby care unit with special facilities.

Per vaginal bleeding before completion of 24 weeks of pregnancy is the main feature of a miscarriage. Thus, if bleeding occurs before this time, it could lead to a miscarriage. If there is bleeding after 24 weeks and the baby dies, it is called a still birth. Hence any bleeding through the vagina during pregnancy cannot be passed off as normal. Fortunately, it does not always amount to losing your baby.

Bleeding can occur due to local causes, such as lesions in the vagina. But a significant amount is uterine bleeding. The baby could be alive in a number of instances, so do not panic at the sight of blood.

What should be done?

Seek medical advice immediately, whether it is before 24 weeks or after. If the bleeding is not accompanied by abdominal pain, and your doctor finds that the baby is still alive through an ultra sound scan and positive pregnancy test, you need not panic. You need to rest, probably stay in hospital till the bleeding settles. Sexual intercourse must be avoided until the bleeding ceases. For the duration of the bleeding you will be given folic acid tablets. Once the bleeding stops you can go home, but if it occurs again, you should get to hospital immediately.

The management of this problem differs if your baby is mature enough to live outside and the bleeding poses a significant threat to its life. Then immediate delivery is warranted. This will usually be done by a caesarean section. The baby will be looked after in the special care unit with intensive monitoring and interventions.

If, however, it is confirmed that your baby is not living, you need to be brave and face the future. Severe per vaginal bleeding associated with lower abdominal pain, passage of foetal parts or the foetus itself would point to a miscarriage. Sometimes the foetus can be dead within the uterus and the patient would only be having brownish vaginal discharge, with or without abdominal pain.

Here the problem is not that simple. The doctors will confirm that the little heart of the baby is not beating anymore. It is dangerous to keep a dead foetus within the womb and measures are taken to evacuate the uterus. This may be done surgically, under anesthesia. This is called evacuation of retained products of conception. This is a minor procedure where the uterus is accessed through the vagina and the retained parts of the foetus and placenta are taken out. You will also be given medication to prevent severe bleeding. Sometime your doctor will decide to give you drugs so that the dead foetus will pass without surgical intervention. Either way there is nothing to be alarmed about. The procedure is necessary to prevent further complications like bleeding and infection.

Can the next baby be affected?

'Will it happen again' is the next question. Not necessarily. Only one or two out of a hundred pregnant mothers suffer recurrent miscarriages. Your next pregnancy could be completely normal, depending on the reason for the miscarriage.

Causes for miscarriages:

Prevention is always better. Not much can be done about foetal genetic defects, but the next baby may be normal. Prevention of intra uterine infection and rubella is the most important. Therefore plan your pregnancy beforehand. Get the rubella vaccine, at least three months before your pregnancy. Meet your family doctor and start taking folic acid which is a vitamin. All women should take folic acid soon after marriage.

Have a well balanced diet. If you have diabetes or any other medical disorders make sure that it is well controlled. Uncontrolled diabetes and thyroid problems can lead to foetal demise. Always, plan before conception.

Do not take medication unnecessarily. But avoiding medication for fear of miscarriage is not wise. If your doctor prescribes a drug for some other illness, knowing that you are pregnant, he does so after weighing the risks and the benefit. Not taking it could be more harmful. If there is structural problem in the womb like weakness of the cervix, you may need to have a stitch to strengthen the birth passage. This is a minor procedure that does not cause any discomfort or problems for sexual life. It will be removed once you are close to term.

Recurrent miscarriage

Recurrent miscarriages, that is three pregnancy losses consecutively, will usually have a serious underlying cause, and will need to be investigated extensively. Even then once the diagnosis is made, for instance of Anti Phospholipid Syndrome, patients will be put on medication and the pregnancy can be continued successfully. Cases of people who still do not benefit are rare and they may need various other assisted reproduction techniques. So hope is always there. Technology today is so advanced that nothing is impossible.