MARKETING AFRICA MAL 18/17 mal 18:17 online | Page 64

associated with abdominal cramping.
This leads to expulsion of clots and
products of conception followed by a
reduction in pain and bleeding.
There is a continuum from:
Threatened miscarriage: minimal
dark blood and no pain closed
cervix; Inevitable miscarriage: pain
(abdominal or back pain), more
bleeding, cervix is open but no
expulsion of foetus or products of
conception; Incomplete abortion:
more pain, more bleeding, open
cervix and partial expulsion of
products of conception (POCs);
Complete abortion: pain subsides,
min bleeding cervix closed, total
expulsion of POCs uterus; Septic
abortion: this occurs when an
incomplete abortion gets infected
- POCs are a very good culture
medium for bacteria hence risk is
high. Here additional symptoms
include fever; Missed abortion: this
is when woman presents with clinical
features of pregnancy that disappear
spontaneously without any outward
sign such as bleeding or pain.
Management varies from wait
and see (expectant management),
use of medication (conservative
management) or a surgical evacuation
(active management) of the uterus
with or without the use of antibiotics
depending on severity of symptoms.
So what causes a miscarriage?
To make my work easier I will
first list the known causes of early
miscarriages and then go to explain
each one and it’s management where
feasible. These are Genetic, Anatomic,
Endocrinological, Immunological,
Infectious/microbiological,
Psychological, Environment, and
Iatrogenic.
What any woman who has
experienced a loss should remember
is that re-assurance and counseling
are probably the most important facet
of management. In some studies it
is proven that prenatal and antena