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By Dr J Kabyemela, MD

Early pregnancy loss (miscarriage) is arguably the most common complication of pregnancy. Some estimates suggest that a quarter of all adult women will experience a miscarriage in their reproductive years, and this is not counting such complications as ectopic pregnancy or events such as induced abortion. Many practitioners in the field actually contend that this miscarriage figure, high as it may seem, is actually a conservative estimate. All this boils down to one fact: that early pregnancy loss is depressingly common.

A matter that is highlighted in this chapter is the fact that early pregnancy loss does not necessarily take the form of spontaneous miscarriage. There are other forms of pregnancy loss such as missed abortion (miscarriage) or blighted ovum. These are explained fully below. Most women who are unfortunate enough to experience any of these will not even have heard of them before.

Pregnancy loss, even when early, can be very distressing. It is therefore some comfort, however small, for a woman to learn that it is not a result of what she did or didn't do that led to the loss. This is virtually always the case.

It is also true that in most cases, a miscarriage is a one-off event.

It may help the woman to know that she is not alone and that her dark hour is unlikely to recur.

How common is loss of pregnancy in the early phase?

Unfortunately, very common. It is practically impossible to know what proportion of pregnancies do not make it beyond the first trimester but conservative estimates put the rate at around 25 per cent or a quarter of all pregnancies.

If taken in the context of women who conceive, at least a quarter of them will experience a miscarriage or another form of early pregnancy loss. Some women experience more than one pregnancy loss.

Miscarriage is certainly one of the most common problems gynaecologists deal with in their day-to-day work.

Apart from spontaneous miscarriage, what are the other forms of early pregnancy loss?

Other forms of pregnancy loss include blighted ovum (also called anembryonic pregnancy), missed abortion, ectopic pregnancy, molar pregnancy and induced abortion.

Blighted ovum (anembryonic pregnancy)

What is a blighted ovum?

This is a form of abnormal pregnancy development. In essence, at conception, the embryo fails to develop and the pregnancy consists of an empty sac. The pregnancy will feel normal to the mother. However, six to ten weeks into the pregnancy, she will experience light vaginal bleeding, which may be no more than spotting. An ultrasound scan will easily and conclusively establish the diagnosis.

What causes blighted ovum?

The causes are not known. It is thought to be a result of crucial structural or chromosomal abnormality which makes fetal development impossible. It has nothing to do with the pregnant woman's actions or lack of them.

How does a blighted ovum pregnancy affect future pregnancies?

It has no bearing whatsoever on future pregnancies. The chances of a normal pregnancy, following a blighted ovum, are not diminished in any way.

How does the hospital deal with a blighted ovum?

Most obstetric units will probably offer evacuation of the uterus (a procedure known as D&C).

It is a minor procedure performed in the operating theatre, mostly under a general anaesthetic. It usually takes about fifteen to twenty minutes and the hospital stay should not be more than a few hours.

A blighted ovum can also be dealt with medically, using drugs which facilitate the expulsion of the uterine contents. There may be a delay of possibly two or three days before this occurs. A third alternative is to await spontaneous miscarriage. It is impossible to predict how long the waiting could be: it may range from days to a few weeks, and many women find this prospect too stressful.

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Early Pregnancy Loss (Miscarriage)

Missed miscarriage Antiphospholipid Ectopic Cervical weakness Causes Anembryonic