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