Causes of Poylcystic Ovary Syndrome (PCOS)

The exact cause of PCOS is not known but a hormonal imbalance is the basic problem encountered in a woman suffering from this disease. This can lead to anovulation (lack of ovulation) or irregular ovulation, scanty or irregular periods, and cysts within the ovaries.

Infertility resulting from ovulation problems can occur due to :

• Abnormally high levels of androgen (male hormone).
• Low follicle-stimulating hormone (FSH).
• Insulin resistance.

Falling Pregnant with PCOS

Infertility is a common problem in women with PCOS but pregnancy is still a possibility and women should not lose hope. Many women with PCOS do not know they have this condition until they undergo investigations for infertility. There are various treatment options for infertility and this must be with a gynecologist. Failure of one therapeutic measure to achieve the desired result does not mean that a woman will not fall pregnant.

Fertility medications such as clomiphene citrate or gonadotropin injections may help to stimulate ovulation and increase chances of pregnancy. Clomiphene citrate can achieve ovulation in a large number of cases and can result in a successful pregnancy within a few months. However, one of the main side effects of this drug is having a multiple pregnancy. If positive results are not achieved within 6 months, gonadotropin injections to stimulate the ovaries may be tried.

Other options

• An alternative to ovarian stimulation is ovarian drilling or laparoscopic ovarian diathermy (LOD). Small holes are drilled into the ovary by means of a hot diathermy probe or laser.
• Drugs used to treat diabetes, such as metformin, may help to increase the response to fertility drugs.
• IVF may be tried to achieve pregnancy.
• Losing excess weight with lifestyle changes such as diet and exercise may be helpful.

Causes of Endometriosis

Just as with PCOS, the cause of endometriosis is not clearly understood. Tissues from the endometrial lining of the uterus get implanted in some site other than the uterus, such as the fallopian tubes, ovaries, bladder, abdomen or other abnormal sites and give rise to various symptoms.

Although a many women with endometriosis have no problems with conceiving, the chances of endometriosis causing infertility are relatively high. Infertility may be caused by anatomic factors such as adhesions and scarring caused by endometrial tissues in the pelvis, or hormonal factors which hinder ovulation, fertilization or implantation of the fertilized ovum. Pain during intercourse caused by endometriosis may restrict the act and be a factor in reducing chances of pregnancy.

Falling Pregnant with Endometriosis

Women with mild or moderate endometriosis have a fairly good chance of conceiving, even without any specific treatment. Infertility is more likely to occur in women who have severe endometriosis.

There are various treatment options available for endometriosis which may increase chances of conception. Surgical treatment often gives better results than hormonal or other medical treatments when the aim of treatment is to achieve pregnancy. Assisted reproduction techniques such as intrauterine insemination or in-vitro fertilization (IVF) may provide better results when combined with surgical treatment. Surgery aims to remove any endometrial tissue or adhesions, as well as repair any damage done to organs. Laparoscopic surgery is the method of choice in most cases.

]]> http://www.phaa.com/chances-of-pregnancy-with-pcos-and-endometriosis.htm/feed 0 http://www.phaa.com/a-step-by-step-guide-to-childbirth-delivery-labor-process.htm http://www.phaa.com/a-step-by-step-guide-to-childbirth-delivery-labor-process.htm#comments Fri, 07 May 2010 17:20:18 +0000 Dr. Paul http://www.phaa.com/?p=300 The thought of childbirth or delivery can be daunting and extremely scary, especially if this is your first baby. The uncertainty and lack of knowledge of what is transpire is the main hurdle that a first time mother has to overcome. Childbirth classes can be helpful to you prepare for this final stage of your pregnancy and answer many of your questions.

Alternatively you can discuss your concerns with your gynecologist and obstetrician who will direct you to appropriate reading material and videos on the labor process.

Signs of Labor

The question that most women want to ask is “How will I know when labor is starting?” That is indeed a very important question but it is often very difficult to differentiate between ‘true’ and ‘false’ labor pain.

The basic point you need to remember is that if the pain is coming regularly, increasing in intensity with each contraction, and the gap between pains is gradually becoming less, then chances are that you are going into labor.

On the other hand, ‘false’ labor pain causes contractions that come irregularly, do not increase in intensity, and are often relieved upon walking or lying down.

The other signs of labor, in addition to true labor pains are :

1. Membrane rupture – which may come as a gush of fluid from the vagina or as a slow trickle.
2. Low back pain.
3. A red-tinged mucus discharge from the vagina – known as “show”.

Stages of Labor

The labor process is divided into 3 parts.

First Stage of Labor

This is the time from onset of regular contractions (onset of labor) till the cervix is fully dilated (10cm). At this point the cervix is said to be fully effaced – there is no rim of cervix felt around the head.

This is usually the longest stage of labor and can take from 8 to 12 hours if this is your first pregnancy, or 6 to 8 hours in subsequent pregnancies. Although it may be difficult to pinpoint exactly when labor started, as a rule, contractions occurring every 2 to 3 minutes and lasting for 30 to 45 seconds signify that the labor process has started and delivery is imminent.

Second Stage of Labor

This is the time from full dilatation of the cervix to birth of the baby. This can take from a few minutes to 2 hours, and will usually take between 45 minutes to 2 hours if this is your first childbirth, or may take only 15 to 45 minutes in subsequent deliveries.

With each contraction you get an urge to push (you should push during contractions and rest in between) until the baby is finally out. The umbilical cord is clamped and cut after delivery of the baby.

Third Stage of Labor

This is the time taken from birth of the baby till delivery of the placenta. After delivery of the baby, the uterus contracts so that the placenta separates out from it and can be removed. You might have chills and trembling at this stage.

Sometimes, the hour following delivery of the placenta is referred to as the “fourth stage of labor” and is important because this is the time when there is maximum chance of severe bleeding (postpartum hemorrhage). Women with certain risk factor

You may choose to have a natural birth without any drugs or you may want to go for something to help you relieve the pain during childbirth. Your doctor will be the best person to advise you regarding your medication options. Normally IV (intravenous) or epidural medications are given for pain relief.

During delivery, the position of your baby is very important. Normally the baby comes out head first but at other times the buttocks or feet may be the first to come out (breech delivery) or the face or shoulder may be the presenting part.

You may need an episiotomy (a surgical incision given in the area between the vagina and anus to help easy delivery of the baby) or a forceps delivery. A Cesarean section may need to be done in certain situations, where the baby cannot come out through the vagina, or in case of some life-threatening condition to save you or the baby.

Swine flu is a highly contagious viral infection which produces flu-like symptoms such as fever, chills, sore throat, cough, headache and body aches. Although the entire population is at risk, certain groups of people are in more danger of contracting the disease as well as having more severe complications once they do get the disease.

Pregnant women fall under this high-risk group and complications as well as deaths have occurred, especially in the third trimester (last 3 months) of pregnancy. It could be that pregnant women are particularly at risk because their normal immune mechanism is suppressed during pregnancy, making them more vulnerable, and so more likely to get a severe form of the disease.

If you are pregnant and you suspect you have swine flu, or if you are suffering from any flu-like symptoms, you should immediately contact your  doctor or gynecologist and obstetrician and follow their advice closely. Starting early antiviral treatment for swine flu is the most reliable way of controlling the severity of the disease but you should first get your doctor’s approval for using it during pregnancy.

Because the swine flu poses a threat to pregnant women, they are considered as a priority for swine flu vaccination programs. Any misgivings about the side effects of antiviral medicines or vaccines should be set aside considering the seriousness of the disease that could occur in pregnant women, provided that you are being supervised by your doctor.

What are the Symptoms of Swine Flu?

You are likely to have flu-like symptoms such as fever, which may be accompanied by chills, headache, body aches, sore throat or cough. You may feel unusually tired, with loss of appetite and this should not be mistaken for symptoms associated with pregnancy.

Not all pregnant women who get the swine flu will have severe symptoms and complications but to be on the safe side, a consultation with your doctor is advisable. Even if the rapid flu test is done to confirm or rule out swine flu, the doctor may start you on medication even before the test results are available.

What are the Complications of Swine Flu?

• Pneumonia is the most serious complications that can develop and at times, breathing difficulties can lead to respiratory failure. Women who are HIV positive are at even greater risk.

• As well as being a danger to you, it may cause you to go into early labor and thus result in the delivery of a premature baby. Spontaneous abortion (miscarriage) is another possibility and if you experience any uterine or abdominal cramping or notice bleeding in pregnancy, then you should see a doctor immediately.

• Pre-existing conditions such as diabetes, asthma, COPD and heart problems may become worse.

• Severe dehydration may develop and some cases of swine flu infection report severe vomiting and diarrhea which can complicate the dehydration further.

• In pregnant women where death has occurred as a result of swine flu infection, delayed initiation of treatment with antiviral medicines has been cited as a cause.

Complications of Antiviral Medicines and Swine Flu Vaccines

Although certain side effects may occasionally occur with antiviral medicines and vaccines, you should remember that these are of less importance when compared to the complications that could develop if you are suffering from swine flu while you are pregnant. Early treatment with antiviral medicines can reduce the severity of the disease, prevent complications and even avoid death.

Nausea, vomiting, diarrhea and headache may occasionally occur as side effects of the antiviral drugs that are being used. More severe complications are breathing difficulties and wheezing, especially if you suffer from asthma or chronic obstructive pulmonary disease (COPD). Your doctor will decide on what type of antiviral is best for you, bearing your condition in mind.

Swine flu vaccination can be given at any stage of pregnancy and has there is no significant evidence of it being harmful for you or your baby. In fact, pregnant women have been included in the priority list for being vaccinated against swine flu as they are so vulnerable to the complications of it.

Prevention and Precautions

Vaccination against swine flu should be given to all pregnant women, whatever the stage of pregnancy, as a means of prevention.

If you are pregnant, you should take all precautions not to contract swine flu. Swine flu is spread from person to person by sneezing, coughing or touching surfaces infected with the virus. Basic precautions that can be taken to reduce chances of spreading or contracting the disease are

1. Staying away from people suffering from flu-like symptoms or those suffering with diagnosed swine flu.
2. Covering your nose and mouth with a tissue when coughing or sneezing and then disposing off the tissue immediately.
3. Washing hands regularly with soap and water or an alcohol based sanitizer.
4. Cleaning surfaces such as table tops and door handles regularly.
5. You can carry on with your daily activities such as going to work but take precautions to avoid contact with any infected person. If this is difficult, speak to your colleague who is unwell or your employer. Given you pregnant state, they will understand.
6. If a family member has been diagnosed with swine flu, you should keep away from that person as far as possible. It may be advisable to commence with antiviral medicines as a means of preventing the disease as close contact with a person in your home is almost unavoidable.

Prevention is always better than cure and this is the approach you should adopt so that you can continue with a safe pregnancy and deliver a healthy normal baby.

While the pill (oral contraceptive) and injection are the favored methods, there are odd cases where teen girls are using hormonal skin patches and vaginal rings that release hormones. The “morning after pill” is an emergency hormonal contraceptive, which is effective when used within a certain period of time after having unprotected sex.

Whatever the method of use, this means of contraception makes use of hormones such as estrogen and progesterone, together in certain preparations, or progesterone alone in others. These are hormones, that are normally present in a woman’s body, vary in concentration at different stages of a woman’s life such as at the time of puberty, pregnancy and menopause.

In trying to prevent unwanted pregnancies by using hormones you are increasing the levels of these hormones in the body. In an adolescent, where the body is already trying to cope with a surge of hormones, the addition of extra hormones may lead to effects that may have long term complications.

Complications and Effects of Teen Hormone Contraception

As a teenager, before you think of starting on hormone contraceptives, you should be aware of the risks so that you can make a well informed decision about it. It might help to talk to your doctor or the school nurse before even contemplating hormone contraceptives. They may be convenient and effective in preventing pregnancy but can give a false sense of security in that you may opt not to use condoms during intercourse. This results in an increased risk of contracting STD’s (sexually transmitted diseases) like HIV, syphilis and gonorrhea.

Research has shown that use of hormonal contraceptives in young girls definitely increases the chance of breast cancer. The younger the age of starting on hormonal contraceptives, the greater risk of developing breast cancer at a later stage. Another effect of earlier and hence prolonged use of hormonal contraceptives is that there is a risk of infertility developing later on in adulthood. As a result of suppressing ovulation artificially for a long time, ovarian function may not be able to restore completely when contraceptives are withdrawn.

Hormonal contraceptives may cause weight gain. As a teenager or young woman, this can have a significant impact on your self image, confidence and social interaction. While some type of oral contraceptives may be used for the treatment of acne in teen girls, it is also possible that using a hormone contraceptive can trigger or aggravate acne. Similar to weight gain, acne has a profound psychosocial impact particularly in teens.

Increased risk of developing cervical cancer after prolonged use is a well-documented fact and needs to be considered before starting on hormonal contraceptives from a young age. Smoking and the increased risk of developing heart attacks or stroke with the use of oral contraceptives in young women is another consideration that should not be overlooked. Teens with a history of liver disease or migraines may aggravate their conditions further with the use of hormone contraceptives.

Chances of blood clots, especially deep vein thrombosis (DVT) are also increased. Mood changes, irritability, depression, nausea, headache, painful breasts and spotting are some of the side effects which may occur. Depletion of certain vitamins from the body, such as vitamin B6, and folic acid is also a possibility and while these micronutrients are necessary for all age groups, they are of particular importance to the developing body of a teenager.

There is also the danger of weakening bones due to calcium loss if hormone contraceptives are used for a long time. This is more so if injectable forms of hormonal contraceptives are used and is of special significance in teenagers whose bones are still growing. Bones may become brittle and fracture easily. With some types of contraceptives (those containing progesterone only, as in the mini pill or implants) your periods can become irregular, scanty or stop altogether.

A teenager may not be able to fully understand the impact of sexual intercourse and the responsibility that comes with it. Some teens may see this as a ‘license’ to become more liberal with their bodies, practicing unprotected sex with more than one partner. This increases the chance of contracting STD’s and with the ever increasing rate of HIV infection, this could be disastrous for a young person.  Abstinence is always a better option until a person is mature and within a secure relationship to partake in sex and the early use of hormone contraceptives may blur these lines at at times for teens.

The considerations above are not only relevant for the teenager in question but also for the parent(s) who assist teens with acquiring hormone contraceptives. While avoiding a teen pregnancy may be the main focus, the impact of using a hormone contraceptive from an early age can have other consequences, some of which can be more detrimental to one’s life and career, than teen pregnancy.

Acne Before Pregnancy

Acne, if pre-existing prior to pregnancy, may settle or even totally resolve during pregnancy. However many pregnant women with pre-existing acne experience an aggravation. The oil gland (sebaceous gland) increases production of oil (sebum) and when this combines with dead skin cells, dirt or cosmetic applications, it will form a plug that will block the pore from which the oil exits onto the skin surface. This will form a papule (pimple) and if it gets infected by bacteria, it will become a large, cyst like pimple.

Myths relating to acne during pregnancy are usually unfounded. Whether you are pregnant with a male baby or eat unusual foods during pregnancy as a result of cravings has no bearing on developing acne during pregnancy.

Acne and the Oral Contraceptive Pill

One of the treatment options for acne is the oral contraceptive pill, which mimics pregnancy so that the body will not release an egg cell (ovum). One would think that pregnancy would therefore settle every case of acne, however this is not always the case. In fact, the converse is true. The female sex hormones exist at high levels during the course of pregnancy and this can affect the oil production on the skin as well. Women who had acne prior to falling pregnant are more prone to this aggravation.

Acne After Childbirth, Breastfeeding

After childbirth, acne that started up during pregnancy may not resolve. If breastfeeding, the hormonal change may persist for a period of time and this continues to contribute to the acne. However, breastfeeding women should not consider stopping feeding in order to settle their skin condition. This is irresponsible since breastfeeding can have a significant health impact on the baby, whereas acne is a cosmetic skin condition.

Treating Acne in Pregnancy

Any oral medication for the treatment of acne during pregnancy is not recommended, even antibiotics. Acne in pregnancy should be conservatively managed with a combination of good skin care and antibacterial skin applications. Vitamin A cream should be avoided altogether as there is always the risk of high amounts absorbing into the blood stream and affecting the fetus. It is important to not that acne during pregnancy is difficult to treat due to the extensive changes in hormone levels as a result of the physiological state.
Avoid using OTC (over the counter) skin care products until you first consult with your doctor. Not all these products are safe during pregnancy and even some natural or herbal acne products may have the potential to affect your pregnancy. Never continue with your oral contraceptive as a means of controlling the extent of the pimples and acne drugs like isotretinoin should never be considered. Attempting to cover up the pimples and acne scars with cosmetics like foundation or powder will often aggravate your acne further and lead to infections prompting the need for antibiotics. The best approach to acne during pregnancy or when breastfeeding is patience and a “wait and see” approach.

Amount of Alcohol Allowed During Pregnancy

The amount of damage to the developing baby will depend on how much, how frequently and in what stages of pregnancy alcohol is consumed. However this cannot be accurately determined as individual tolerance or sensitivity may be contributing factors.  If a woman decides to have the occasional drink during pregnancy, a limit of one or two units of alcohol once or twice a week may be considered to be relatively safe, although it cannot be over-emphasized that no amount of alcohol can be said to be absolutely safe for the baby. Binge drinking or drinking more than five units of alcohol on any one occasion may prove to be extremely harmful for the baby.

A unit of alcohol may be taken as :

• Quarter of a pint of strong beer or lager
• Half a pint of regular beer, lager or cider
• Half of a small glass of twelve percent strength wine
• A small glass of sherry
• A single measure of spirits

Alcohol Dangers in First, Second and Third Trimester

Alcohol consumption during the first three months of pregnancy increases the chance of miscarriage. In later stages of pregnancy, it can affect physical growth of the baby as well as development of the brain. Drinking, especially often and in excess, in any stage of pregnancy can affect the baby in various ways, such as :

• Low birth weight of the baby
• Premature birth
• By affecting the development of the fetal brain, intellectual capacity of the baby may be hampered.
• Fetal alcohol syndrome (FAS) – the severity will depend on the amount of alcohol intake by the mother during pregnancy. Both physical and mental features such as a small head, small eyes, facial abnormalities, malformations in the heart and low IQ may be present.
• Learning disabilities and behavioral problems are more likely to occur in these children as they grow up.
• Research shows that children born of mothers who drank even moderately during pregnancy are more likely to indulge in alcohol from a younger age than children of non-drinkers.

Every effort has to be made by the mother to give up alcohol during pregnancy if she would like to deliver a healthy baby without any physical or mental defects. Alcoholism can be treated and if necessary, she should seek advice from her doctor prior to falling pregnant.

Cigarette smoke exposes the mother and child to thousands of toxic chemicals like hydrogen cyanide and carbon monoxide. These toxins are not filtered out by the mother’s body and once in the bloodstream, it quickly reaches the unborn baby.

Effects of Smoking in Pregnancy

The consequences of smoking during pregnancy are numerous and can be far reaching, even posing a risk to the baby’s life. These risks may include :

• Increased risk of abortion (miscarriage).
• Higher risk of stillbirth.
• Delivery of low birth weight babies.
• Premature labor and delivery – premature babies may encounter various health hazards.
• Cleft lip and/or cleft palate and other birth defects are more common.
• Learning disorders, behavioral problems and attention deficit disorders (ADHD).
• Cerebral palsy and mental retardation.
• Respiratory problems such as asthma and susceptibility to colds due to a less efficient immune system.
• Sudden infant death syndrome (SIDS)
• Children of maternal smokers are more likely become cigarette smokers themselves when they get to their teens.

The dangers of cigarette smoking during pregnancy is not limited to the effects it has on the fetus. Mothers are equally at risk of developing life-threatening conditions as a result of complications in pregnancy arising from cigarette smoking.

Effects of Smoking on the Pregnant Mother

Smoking during pregnancy can cause a number of complications beyond the risks associated with cancer, chronic obstructive pulmonary disease (COPD) like emphysema and coronary artery disease. These potential dangers for the mother include :

• Placenta previa is a condition where the placenta is attached very low down in the uterus and may even block the os (opening of the cervix). Hemorrhage or excessive bleeding during delivery may prove fatal for the mother as well as the baby.
• Abruptio placentae is the premature separation of the placenta from the uterus, leading to hemorrhage. This can put the mother’s and baby’s life at risk as well as necessitate an emergency cesarean section.
• Hypertension (high blood pressure) during and after pregnancy.

Secondary (‘Second Hand’) Smoke during Pregnancy

A pregnant woman who does not smoke may still be at risk if her husband or partner is a smoker. Inhaling second hand smoke may be as dangerous for the baby as when the mother is a smoker herself. Care should be taken to avoid second hand smoke at home and also in public places such as restaurants and parties.

Nicotine is a very addictive substance and quitting cigarette smoking is not an easy to do, even though a pregnant woman may be aware of the dangers posed to her baby and herself. It is advisable to discuss the matter with your doctor and consider methods of quitting cigarette smoking.

People say that a pregnant lady “blooms” while this may be true there are many changes that occur within the body at this time, of course we can all expect the expanding waistline but what about the heartburn, stretch marks, continual backache as the big day draws near not to mention those mood swings. The women especially when nearing her due date can feel anything but in “bloom”. Listed below are some of the “joys” of pregnancy.

Changes to the body besides the obvious

Stretch marks

Yes your stomach will grow and grow and grow as the baby develops and along with this growth stretch marks can sometimes appear on the stomach and thighs, however you can help these a little by moisturising your skin and helping to keep it supple. The good news is that not all women get them and they do fade the colour of them and how much they show will depend on the colour of your skin.

Aches, pains and backache

As your pregnancy develops your uterus will expand and with this along will come various aches and pains along with a nagging backache, these aches and pains and especially backache is due to the pressure of the babies head near the pelvic bone and the increase in weight and loosening of the joints in preparation for the birth.

Changes to the breasts

Most women find that there breasts will suddenly balloon in size as the pregnancy develops; they will also appear more full. This is down to the hormone changes that are occurring in preparation for the birth and in particular ready for breastfeeding. Towards the end of your pregnancy your breasts may feel very heavy, full and they might be causing you some discomfort due to their tenderness.

Dizzy spells

Its not uncommon in pregnancy for the women to have dizzy spells, this is usually to down to the growth of new blood cells at the beginning of your pregnancy. As the uterus expands in size pressure is felt on the blood vessels which in turn can lead to dizziness or light headedness.

Heartburn and indigestion

Almost all pregnant women will suffer from heartburn and indigestion particularly later in pregnancy, as your baby gets bigger the uterus will push against the stomach and heartburn will be a constant thing. If you suffer from heartburn in the beginning this is usually due to the change in hormones, hormones will slow down the muscles of the digestive tract leading to sluggish digestion which results in indigestion.

Increased Sex drive and pregnancy

A lot of women find that their sex drive increases during pregnancy and unless your doctor specifically tells you for medical reasons to abstain then this is perfectly safe, however as your stomach gets bigger you may have to find a position which is more suitable to accommodate your growing stomach. The only reasons you might have to refrain is if you have had miscarriages in the past or if you should begin to bleed or have stomach pains, but you cant hurt the growing baby by having sex while pregnant in normal circumstances.

Every year there are hundreds of thousands of women suffering from the devastating affects of miscarriage; while some get through this time relatively easy for others it can be devastating, leaving the women with many feelings such as grieving, guilt, inferiority and depression. One thing that almost all women will have in common is the question why me?

Unfortunately in many cases the question can’t be answered as miscarriages can and do just happen without what seems to be any clear reason, this is very often the hardest part to deal with. However some causes can be explained and while this doesn’t make it any easier to deal with at least you’re not left wondering why.

What is a miscarriage?

The medical explanation for miscarriage is the spontaneous loss of pregnancy before 24 weeks, studies into miscarriage have shown that around ¼ of all pregnancies do actually miscarry many times with women not realising they have had a miscarriage as most happen within the first 6 weeks.

Are there any symptoms or signs of a miscarriage?

You should always be wary of any bleeding during early pregnancy, while some women do bleed during the first few months and have even been known to bleed lightly throughout the pregnancy, bleeding can be a sign of a miscarriage.

The bleeding can range from lightly spotting to heavier bleeding and a doctor’s advice should be sought. Often with a miscarriage there is stomach pain, very much like the pain you get when your period is due, this is a clear sign something is wrong and you should get help immediately.

If you have any stomach pain and/or bleeding the best thing you can do is to lie down straight away and call your doctor for advice. Some women are advised to spend the first three months in bed this way particularly if they have suffered two or more miscarriages in the past.

Why does miscarriage happen?

Unfortunately in a lot cases the cause for it is unknown, this can be one of the hardest things for the women to deal with, and in around 60% of the cases it is thought to be a problem with the way the sperm and the egg join together initially. Another cause is the egg not attaching to the wall of the womb properly and it comes away, age also seems to be a factor with miscarriages being more common in older women.

Types of miscarriage

The medical profession put miscarriages into different categories depending on the outcome of an internal investigation made by the doctor, they are:

• Threatened miscarriage – this is when bleeding starts early in the pregnancy but on examination the cervix is found to be closed and the pregnancy can continue to full term.
• Inevitable miscarriage – this term describes bleeding in early pregnancy and on examination the cervix is found to be open, a miscarriage will also certainly occur in this case.
• Incomplete miscarriage – a miscarriage occurs but there is still some tissue left in the womb, the cervix will usually be found to be open.
• Complete miscarriage – this term describes the pregnancy being lost and the womb is empty.
• Missed miscarriage – this occurs when no bleeding or other sign of miscarriage has taken place but the pregnancy has stopped growing.

The aftercare of miscarriage

Some women deal with miscarriage better than others so there are no clear guidelines for aftercare, the physical effects will usually heal quicker than the mental effects with any bleeding usually settling down after around 10 days.

The emotional side however can take a long time, grief will be a normal sign after miscarriage and the couple should take adequate time to do so, it is important for the couple to talk about what happened and to be there for each other. During this time the women in particular will be very emotional and will need a lot of support from their partner, family and friends, they may also need to see a miscarriage councillor.