Miscarriage

A miscarriage is a common event.

One in seven of known pregnancies miscarries in the first 3 months, and probably twice as many miscarry before the woman knows she is pregnant, when the development of the embryo stops and the woman has a ‘silent abortion’ that is indistinguishable from the normal menstrual bleed.  About 1% of women miscarry in the second trimester, and a similar proportion of women have an ectopic pregnancy.


Causes of miscarriage

Most first-trimester miscarriages occur because of foetal abnormalities. In most cases there in no recurrent aetiological factor, and, reassuringly, the outlook for the next pregnancy is not worse than for any other pregnancy.

However, the risk of foetal abnormality increases with age of the parents. The relationship between maternal age and miscarriage has been frequently documented (see Table below). Recent studies also begin to suggest that the age of the father and thus the quality of his sperm also plays a significant role in the outcome of a viable pregnancy.  A study has shown that the miscarriage rate in younger women with male partners aged 35 or more is double that of women with younger husbands (Ford et al 1994).  A similar effect was seen on conception rates.

In later stages of the pregnancy (week 11-22) maternal factors such as the presence of a systemic disease, uterine abnormalities (e.g. the presence of uterine fibroids), or cervical incompetence become more common causes of miscarriage.

Relationship between maternal age and miscarriage

Age of mother

Chance of miscarrying

18-20

12%

20-24

13%

25-29

14%

30-34

16%

35-39

19%

40-42

25%

43-46

50% or more

 

 

 

  

 

 




What does Chinese medicine say causes miscarriage?

The concept of age affecting fertility is well discussed in Chinese medicine.  Aging leads to a decline of reproductive function, meaning that the building blocks that will later constitutes a foetus (sperm and egg cells) decline in their quality and are thus less likely to mature into a healthy embryo.  Thus the rate of infertility and miscarriage increases. 

Increasing the health of both parents before conception will ensure that the quality of the sperm, egg as well as the foetus’ environment is optimised so that the best possible conditions are created for a healthy pregnancy.  Thus preventative treatment for the gametes (sperm and egg) is important to lower the chances of abnormalities.  This is easier to achieve in males, as sperms are constantly reproduced and thus can be influenced.  However, the nourishment and development of the female follicle can be influenced by Chinese herbal medicine and acupuncture, so that a more mature egg is released.


Types of miscarriages

Threatened miscarriage

A threatened miscarriage is diagnosed when there is bleeding from the vagina before the 24th week of pregnancy, and as long as no products of conception have been passed and the cervix remains undilated.  Three out of four threatened miscarriages settle down, and when this happens there is no increased risk of foetal abnormality.  A good indicator for the outcome is the foetal heart beat. If it is still detectable (usually possible from week 7), only about 2% of women will miscarry. 


Inevitable miscarriage

A miscarriage becomes inevitable when the cervix dilates significantly or products of conceptions are passed.  Most inevitable miscarriages are accompanied by a considerable amount of clotted vaginal bleeding and lower abdominal pain, which can be severe.  Upon completion of the miscarriage, which can take several hours, the pain should subside, and vaginal bleeding should be mild. On examination, the lower abdomen is not tender, and the uterus has returned to its normal size.

If bleeding or pain continues over several days, an ultrasound should be performed to see if the uterus has been completely emptied.  If more than 10% of tissue has remained in the uterus, a D&C is usually performed to avoid the risk of infection.


Recurrent miscarriage

Few women (less than 1%) miscarry successively.  If a woman has miscarried three times, her chance of another miscarriage is increased to 30%, as well as risking to deliver a preterm baby.

A recurrent miscarriage may be caused by the following:

  • hormonal dysfunction (ovary, placenta, thyroid) (30%)
  • uterine or cervical abnormalities such as fibroids or congenital abnormality of the uterus (10%)
  • endometrial infections (10%)
  • chromosome abnormalities of either parent (3%)
  • sperm factors (2%)
  • presence of a serious chronic illness such as renal disease or SLE (1%)

In many cases (about 60% of miscarriages below 12 weeks, and 35% of miscarriages above 12 weeks), no physical causes can be established. The mainstay of treatment is generally tender loving care and rest.  In such a case Chinese medicine can diagnose and treat the perhaps more subtle but nevertheless important reasons for a recurrent miscarriage.


Chinese medicine treatment of miscarriage

A threatened miscarriage is inevitable in severe foetal abnormalities, and no treatment can change the outcome.  In a minority of women however the reason for the threatened abortion lies within the physiology of the mother, and timely treatment with acupuncture and/or Chinese medicine may save the pregnancy.  If there is any doubt as to the nature of the miscarriage, or if the woman had a history of infertility or miscarriage (see below), acupuncture and/or Chinese medicine is recomended.

Chinese medicine can have a very useful role in the treatment of recurrent miscarriages as it detects any possible weaknesses in either one or both partners, and, by correcting them, can ensure that conditions for a future pregnancy are optimised.  This is particularly the case if underlying menstrual conditions are present that need to be regulated, such as the existence of polycystic ovaries or endometriosis, or where a weak hormonal output from the ovaries during pregnancy might endanger the development of a foetus.

 

Case study:

F (33) has had two miscarriages by the time she came to the clinic. She had not had any further tests as she was only eligible to have more investigations after three miscarriages. However, F was traumatised by the miscarriages and wanted to avoid another one by all costs. I asked her to record her BBT charts, and we started the treatment. After one month recording her temperature it was clear that her body temperature was well below acceptable levels for the body to carry out a pregnancy: her temperatures were lower than 35.5, and only slightly higher after ovulation. I asked for a thyroid test to exclude hypothyroidism, and a progesterone test on day 21 of her cycle. The thyroid test came back normal, and the progesterone test showed low progesterone (25). For this patient we had to increase her metabolic rate, to increase her body temperature, improve blood flow and support the corpus luteum function. With each month of Chinese herbal medicine, her BBT went higher. After four months, her pre-ovulatory BBT was an acceptable level of 36.2. She conceived that month, and has just passed the 12 week scan.

 

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