Pregnancy is a period of hope, excitement, change and a bit of caution. Being attentive during this time goes a long way in reducing the chances of mishaps — including early pregnancy loss.
According to Dr Duru Shah, director, Gynaecworld, Centre for Women’s Health and Fertility, Mumbai, early pregnancy loss occurs during the first three months of pregnancy.
Common causes of early pregnancy loss
Problems in development of placenta usually lead to the end of pregnancy. “The foetus receives its nutrients through the placenta; it produces hormones which support the pregnancy,” Dr Shah tells Happiest Health. “When there is maldevelopment of the placenta, it can lead to pregnancy loss.
“Other common causes are undiagnosed or undertreated diabetes mellitus, thyroid disorder, polycystic ovary syndrome (PCOS), anatomic abnormality in the uterus and autoimmune disorders in the expectant mother.”
Dr Sarada Saranu, senior gynecologist, Kamineni Hospitals, Hyderabad, says that pregnancy loss occurring before eight weeks is caused due to genetics and chromosomal abnormalities. “There are 46 chromosomes in a human body and abnormalities occur due to the decrease in number of chromosomes,” she says. “Example of chromosomal abnormalities are Turner syndrome or Down syndrome. If the aged sperm or ova fertilises, it leads to early pregnancy loss.”
Other causes are infections such as HIV (human immunodeficiency virus), UTI (urinary tract infection), high fever, malaria and blighted ovum. “Blighted ovum is where a gestational sac and placenta grow but the baby does not,” says Dr Saranu.
If a woman has rheumatoid arthritis or systemic lupus erythematosus (lupus, an autoimmune disease), her chances of losing the foetus increases, she says.
Symptoms of early pregnancy loss
Generally, if a woman is pregnant, then she misses her periods and experiences sleepiness, fatigue, fever, nausea and vomiting. “However, if these signs and symptoms are missing, then the chances of early pregnancy loss become higher,” says Dr Saranu.
Experts say those at risk usually complain of breathlessness and pain in the abdomen. “Spotting or vaginal bleeding, passage of clots or fleshy mass and cramps are the other symptoms,” says Dr Shah.
According to the American College of Obstetricians and Gynecologists (ACOG), a small amount of bleeding early in pregnancy is common, and in case the bleeding is heavy or happens along with pain like menstrual cramps, contacting a doctor is recommended.
Coping with the loss
The road to recovery for women starts with proper counselling by doctors, support of family and friends, and group therapy sessions. “These all are helpful in coping with the loss,” says Dr Shah.
Dr Saranu says that with technology like ultrasound or sonography in place, it is easy to detect any abnormalities in the foetus within weeks of its formation in the womb. “In case of abnormalities in a foetus, the termination of the same will be early and will help in avoid future complications,” she says.
Treatment of early pregnancy loss
Treatment in the form of pre-conceptional folic acid is needed a month prior to trying for pregnancy. “Also, after a proper evaluation, women who are planning for babies may need low-dose aspirin, insulin sensitisers like metformin and thyroid medications,” says Dr Shah.
Dr Saranu says folic acid helps in preventing abnormalities and defects in a foetus and helps in brain development.
Dr Shah says women who have gone through early pregnancy loss can be treated medically with oral tablets or a surgical day-care procedure under anesthesia.
Dr Saranu says good nutrition and a balanced diet are the keys to reduce changes of pregnancy loss. “Women should maintain an ideal body weight before planning their pregnancies,” she says.
After a first trimester pregnancy loss, it is recommended to wait for at least six months before trying again, says Dr Shah.
“Pregnancy loss is also caused due to inadequate progesterone in the early weeks,” says Dr Saranu. “Progesterone supplements help in decreasing the chances of early pregnancy loss. One should eat a regular diet and avoid greasy, oily and masala food after a pregnancy loss.”
Smoking and drinking alcohol while pregnant, strenuous physical activity and excess of mental stress can cause early pregnancy loss, says Dr Shah.
Vigorous activity — like running for 6km-9km at a stretch or doing treadmill for a long time — can also lead to early pregnancy loss.
Diagnosis of early pregnancy loss
No documented cardiac activity during sonography and a fall in serum HCG (human chorionic gonadotropin, a hormone produced during pregnancy) levels in the foetus are the ways through which early pregnancy loss is diagnosed, says Dr Shah.
According to the ACOG, HCG is detected during a pregnancy test. Low level of HCG means loss of pregnancy, but several ultrasound examinations are needed to confirm it.
The ACOG says that dilation of the cervix is one of the diagnosis criteria for pregnancy loss. A gynecologist may go for pelvic examination to check if the dilation of the cervix has begun or not.
“If a woman comes with pain in the abdomen, then ultrasound is done to check the foetal heart rate,” Dr Saranu says. “If the foetal heart rate is not visible, then scanning is recommended.”