Pregnancy Loss

Welcome to yet another Ndlalane Health newsletters - your trusted source for empowering insights and transformative change.

We continue to honor the resilience of women across the globe, as you might already be aware that August is women’s month in South Africa, but we extend this privilege to all women worldwide. Let’s turn our attention to a sensitive yet vital topic: pregnancy loss. A heart-wrenching experience that affects countless women, often in silence.

In this edition, we'll dive deep into the complexities of this challenging subject. We'll explore the emotional, physical, and psychological impact, while providing essential guidance from experts. Our goal is to shed light on this important issue and empower you with the knowledge and support you need.

I'm your host, DocSakhi, and I'm here to navigate this journey with you, step-by-step. This is a safe space for healing and growth.  Are you ready? Let's get started.

Pregnancy is a remarkable natural physiological process in which a fertilized egg develops into an embryo, then into a fetus within a woman's uterus. This magical journey typically lasts around 40 weeks, during which time the fetus grows and develops into a brand-new baby with their own little personality.

The process of pregnancy begins with fertilization, where a sperm cell penetrates and fuses with an egg cell, forming a zygote. The zygote then travels to the uterus and implants into the uterine lining, beginning the process of embryonic and fetal development. Over the course of the pregnancy, the embryo develops into a fetus, complete with organs, limbs, and all the necessary systems to sustain life outside the womb.

This is a profound experience that involves significant physical, emotional, and psychological changes for the expectant mother. As the fetus grows, the mother's body undergoes dramatic transformations to accommodate and support the developing life. Morning sickness, fatigue, hormonal shifts, and other symptoms are common during pregnancy.

This is generally a healthy, joyous and exciting natural process, but unfortunately it is not without any complications because there are a number of potential complications that can arise that may lead to pregnancy loss.

What is pregnancy loss?

Pregnancy loss is the death of an unborn baby (fetus) at any time during pregnancy. Pregnancy loss may occur in as many as 1 in every 4 pregnancies. Most pregnancy losses happen during the first trimester. This is often so early that the mother doesn’t even know she is pregnant. Pregnancy loss includes:

Miscarriage: A miscarriage is the spontaneous loss of a pregnancy before the 20th week of gestation. Miscarriages can occur for a variety of reasons, including chromosomal abnormalities, uterine or cervical problems, hormonal imbalances, infections, and chronic health conditions. Miscarriages can be emotionally difficult for the expectant parents to cope with.

Ectopic Pregnancy: An ectopic pregnancy occurs when the fertilized egg implants outside the uterus, typically in the fallopian tube. Ectopic pregnancies require immediate medical attention, as they can be life-threatening for the mother if left untreated.

Stillbirth: A stillbirth is the loss of a baby after 20 weeks of pregnancy, usually occurring during labor or delivery. Stillbirths can be caused by a variety of factors, including placental problems, chromosomal abnormalities, umbilical cord issues, and maternal health conditions.

Therapeutic Abortion: In some cases, a pregnancy may need to be terminated for medical reasons, such as severe fetal abnormalities or to protect the health and safety of the mother. This is known as a therapeutic abortion and is typically a difficult decision for the expectant parents.

What causes pregnancy loss?

About half of early pregnancy losses are from problems with genes or chromosomes. But other things can also play a role. It is usually not caused by anything the mother did. Things that may play a role include:

• Abnormal embryo development

• Hormone problems in the mother. These include low levels of progesterone or a thyroid problem.

• High blood pressure or diabetes in the mother

• Problems in the uterus. These include scar tissue inside the uterus, abnormally shaped uterus, or fibroids.

• Opening of the uterus lower segment and cannot stay closed during pregnancy (incompetent cervix)

• Infection from germs. These include cytomegalovirus (CMV), mycoplasma, chlamydia, ureaplasma, listeria, or toxoplasma.

• Autoimmune diseases such as lupus. These cause the body to make antibodies against its own normal tissues. Other autoimmune problems include antiphospholipid antibody syndrome.

• Injury or trauma

• Exposure to toxic substances and chemicals, such as anticancer medicines

When pregnancy loss happens 3 or more times, it is called recurrent pregnancy loss. It is often hard to find a cause for recurrent losses. Couples may need more testing. Most pregnancy losses are single events. A woman with an early pregnancy loss without a known cause has a very good chance of a normal pregnancy in the future.

Some things can make a pregnancy loss more likely can include:

• Being an older mother

• Having a pregnancy loss in the past

• Smoking cigarettes

• Using alcohol

• Drinking more caffeine

• Using cocaine

• Having a low folate level. Folate is a B vitamin.

• Being under or overweight

I hope you are still with me. Lets continue to get into more details nd hopefully make some of your questions a bit more clear. The word abortion derives from the Latin aboriri-to miscarry. Abortion is defined as the spontaneous or induced termination of pregnancy before fetal viability. It thus is appropriate that miscarriage and abortion are terms used interchangeably in a medical context. But because popular use of abortion by laypersons implies a deliberate intact pregnancy termination, many prefer miscarriage for spontaneous fetal loss.

More than 80 percent of spontaneous abortions occur within the first 12 weeks of gestation. With first-trimester losses, death of the embryo or fetus nearly always precedes spontaneous expulsion. Death is usually accompanied by bleeding. An intact gestational sac is usually filled with fluid and may or may not contain an embryo or fetus.

The rate of clinical miscarriages is almost doubled when either parent is older than 40 years. Other causes maybe be grouped into these categories:  embryonic, maternal, and paternal.

50 percent of miscarriages are caused by the embryo, which commonly display a developmental abnormality- they appear to have chromosomal anomalies and would terminate before 12 weeks of gestation however chromosomal normal fetuses abort later peaking at about week 13.

In relation to the maternal aspect of causes we can consider certain things or risks that influence or promotes a pregnancy to terminate such as Infections.  Some common viral, bacterial, and other infectious agents that invade the normal human can cause pregnancy loss. Many are systemic and infect the fetoplacental unit by blood-borne organisms. Others may infect locally through geni-tourinary infection or colonization. However, despite the numerous infections acquired in pregnancy, these uncommonly cause early abortion except infection with Chlamydia and other polymicrobial infection.

Lifestyle choices are also associated with an increased miscarriage risk especially chronic and heavy use of substances like drugs and alcohol. 

Excessive caffeine consumption has also been associated with an increased abortion risk. heavy intake of approximately five cups of coffee per day about 500 mg of caffeine-slightly increases the abortion risk.  

Lastly the paternal risk factors, the chances are very low if the father is under 25 years but any time after that it peaks every after 5 years and drastically increases at age 40 years. In other words, men that are older than 25 carry some risk to causing a miscarriage and 40 years or more is even likelier the risk.

Once pregnancy loss occurs, the fetal tissues must be removed from the uterus to prevent further complications. How this is done depends on the week of pregnancy and the type of loss. In early pregnancy loss, your body may naturally get rid of all of the pregnancy tissues. Sometimes the healthcare provider may give you medicines to cause your body absorb the tissues or to get rid of them more quickly. Other times, you may need surgery to remove the tissues. The doctor would know which treatment is best for you considering your unique circumstances.

Coping with Pregnancy Loss

Experiencing the loss of a pregnancy is an incredibly difficult and traumatic event for expectant parents especially those who were looking forward to having a child. The emotional impact can be overwhelming, leaving individuals and couples to grapple with a range of complex feelings, including grief, guilt, anger, and despair. Navigating this challenging experience requires compassionate support and resources to help facilitate the healing process.

Pregnancy loss, regardless of the stage of gestation, represents the death of a longed-for child and the dashing of hopes and dreams. Expectant parents may experience intense feelings of grief, similar to the loss of a loved one. It is important to acknowledge and validate these emotions, allowing individuals to work through the grieving process at their own pace.

Grief may manifest in various ways, such as sadness, anxiety, irritability, changes in sleep and appetite, and difficulty concentrating. It is crucial to provide the necessary time and space for parents to mourn their loss, without pressure to "move on" before they are ready (American Psychological Association, 2020).

Navigating the emotional aftermath of pregnancy loss can be immensely challenging, and expectant parents should not have to do it alone. Seeking support from family, friends, and professional resources can be invaluable in the healing process.

Support groups, both in-person and online, can connect individuals with others who have experienced similar losses, providing a safe space to share their stories and emotions. Counseling and therapy can also help parents work through the complex feelings associated with pregnancy loss, developing coping strategies and tools to manage their grief.

It is important to understand that the grieving process is unique to each individual, and there is no "right" way to cope with pregnancy loss. Encouraging open communication, validating emotions, and providing compassionate support can help expectant parents navigate this difficult journey (American Psychological Association, 2020). In addition to the emotional toll, pregnancy loss can also have physical implications for the expectant mother. Depending on the type of pregnancy loss, the individual may require medical treatment, such as medication or surgery, to address any complications and facilitate the physical recovery process.

In conclusion I would say, thank you for reading all the way to this far and remember, coping with pregnancy loss is a profound and deeply personal experience, requiring compassionate support, validation of emotions, and access to resources to facilitate the healing process. Acknowledging the emotional and physical impact of pregnancy loss is the first positive step towards a path of healing, understanding and trying again.

See you on our next learning adventure. #BeInTheKnow. Cheers bye for now.

References

American College of Obstetricians and Gynecologists. (2018). Early pregnancy loss. https://www.acog.org/patient-resources/faqs/pregnancy/early-pregnancy-loss

American Psychological Association. (2020). Coping with the loss of a pregnancy. https://www.apa.org/topics/pregnancy-loss