Being pregnant comes with excitement for every woman, especially if it does not present complications. However, when something goes wrong, it is always heart breaking and a tough reality to deal with. One such common incident is a miscarriage.

A miscarriage is a spontaneous termination of pregnancy. It may occur as early as 4 to 7 weeks of pregnancy and even just when fertilised ovum is implanted. It can also occur at 30 weeks of pregnancy.

According to the a recent research conducted by the National Institute of Child Health and Human Development (NICHD), the risk of miscarriage increases with a mother’s age, most commonly beginning at the age of 30 years and becoming worse after the age of 35.

"Most miscarriages happen in the first trimester of the pregnancy, that’s the first 22 weeks of the pregnancy.

Accounting for close to half of these are chromosomal abnormalities,” says Dr Achille Manirakiza, a medical resident at University Teaching Hospital of Kigali (CHUK).

Causes, signs and symptoms

Dr Iba Mayele, an obstetrician at Clinic Doctor Plaza in Kimironko, says it is more common in older women.

"Women over 40 years and above are likely to experience miscarriages due to the weakened uterus and increased risk of abnormality of the ova,” he says.

Dr Mayele explains that for young women, the miscarriages are due to the drugs they use to intentionally terminate unwanted pregnancies.

"Frequent abortions may also lead to the damage or weakening of the walls of the uterus, making it hard for the foetus to survive to its due date. Some of them make it a habit to swallow tablets every time they suspect they are pregnant, not knowing that they are risking their health. This in the long run may affect their reproductive system,” explains Dr Mayele.

About what causes miscarriage, he says, it may occur due to genetic defects in the ovum, hormonal disturbances, viral, bacterial and other infections.

Dr Mayele adds that use of substances such as alcohol and tobacco during pregnancy is also a risk factor for miscarriage. There may be anatomical defects in the cervix which can lead to miscarriage.

Dr Janvier Rusizana, who works at Clinic Doctor Plaza, says psychological problems, malnutrition, trauma and bacterial/viral infections are also among the common causes of miscarriage.

Dr Manirakiza says some of the signs and symptoms may be alarming or rare for a pregnant woman.

"Miscarriage is spontaneous. As the tissues are being lost, the mother will see blood coming out either as a gush or slowly, in a rare way. It may come with pain and some may experience nausea and vomiting,” he says.

How to manage a miscarriage

"There is no specific management, in case of a threatened miscarriage (where just bleeding occurs but the foetus is still in the uterus), but bed rest and abstinence may help, says Dr Rachna Pande, a specialist in internal medicine at Ruhengeri Hospital.

She adds that if it’s incomplete miscarriage - where part of the fetus is expelled and a part remains - dilatation and curettage is done, where the remaining foetal parts are removed by dilatating the cervical opening and curetting it.

Since the main cause of miscarriage is genetic defects, Dr Rusizana advises couples to first visit the hospital for a chromisal test to detect if they are at risk.

"However, apart from going for check-ups to detect possible infections, pregnant women should stay away from drugs, improve on the nutrition and avoid stressful scenarios,” he says.

Aftermath

Experts advise that after any miscarriage, one should get specialised consultation to ensure the mother is safe from further danger. And again, the woman should request for a genotypic profile to see if there are no chromosomal changes.

However, Dr Mayele advises that after a miscarriage, it is good for a woman to wait for at least six months before trying to conceive again, especially if the miscarriage happened when the foetus was six months and above.

He adds that the six months are important because it helps one to calm down and also to allow time for the uterus to heal, especially if one had undergone dilatation and curettage.