GYN CHRONICLES
GYN CHRONICLES
PREGNANCY MISCARRIAGE
Dr . Maureen Owiti
One of the most distressing things in obstetrics is the mother losing her baby . It is something obstetricians deal with almost on a daily basis . Obstetrician - is one of those words that everyone can ’ t pronounce and no one quite understands what they do . In this part of the world every gynaecologist is also an obstetrician hence the title obstetriciangynaecologist .
An obstetrician is the doctor who takes care of the needs of the woman and her unborn child prior to conception , during pregnancy , and up to the first 6 weeks from delivery . A gynaecologist is the doctor who looks after issues in the reproductive system when the woman is not pregnant ( carrying a child ). Unfortunately not all pregnancies will end up with a bouncing bundle of joy . We divide pregnancy loss into early ( prior to 20 weeks of pregnancy ) and late after 20 weeks , however the cut off can be 24-28 weeks based on survival rates of infants in the hospital setting .
Despite advances in medicine I think it is clear that survival of a pre-term baby born in Ganze dispensary and one at Kenyatta National hospital or a prestigious private hospital in Nairobi will not be the same .
Joyce ( not her real name ) recently conceived through use of oral fertility drugs , and is very happy to be
‘‘ Up to 15 % of recognized pregnancies will end up as miscarriages and the figure rises to between 25 % -50 % if we were to do blood tests on all women around the expected date of their next period . That is a huge figure and the question all parents ask is why ? What happened ? What caused this and from there they move to how can we prevent it from happening again ?’’ pregnant . You can imagine the horror she had when we had to tell her that unfortunately the pregnancy was not progressing as expected . 5 week scan showed yolk sac but no fetal parts and subsequent scans showed no subsequent development of fetus . Managed with a medical evacuation and she subsequently conceived 6 months late after counseling and currently doing well in the 4th month of pregnancy .
Up to 15 % of recognized pregnancies will end up as miscarriages and the figure rises to between 25 % -50 % if we were to do blood tests on all women around the expected date of their next period . That is a huge figure and the question all parents ask is why ? What happened ? What caused this and from there they move to how can we prevent it from happening again ?
In their shoes these are very valid questions . In principle we should be able to answer these questions but in practice it is easier said than done ; reason being the causes are varied and some tests quite expensive to perform .
As in all cases when you meet a couple you go through the obvious : take a history and try to find out if there is anything that can be picked
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