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An extended definition of infertility includes women who conceive but cannot carry a pregnancy to the full term that is women who have repeated miscarriages or pregnancy failures.
The medical term for a miscarriage is an abortion. Most miscarriages start with vaginal bleeding which is initially slight and painless. This is called a threatened abortion, because the pregnancy is threatened by the bleeding. This bleeding takes place from the mother, and is not fetal blood. About half the time this stops spontaneously and results no harm to the pregnancy. At this stage, the most useful test is an ultrasound scan (usually done with a vaginal probe). If a fetal heartbeat can be seen, this means that there is a 95 % chance that the pregnancy will proceed normally. On the other hand, if the ultrasound scan shows that the fetus has not developed properly and this includes patients with a "blighted ovum" or anembryonic pregnancy, when no fetus can be seen; or a missed abortion or intrauterine fetal death, when the fetus is seen but the heart is not beating, then nothing can be done to save the pregnancy.
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In these cases, the bleeding progresses, and the uterus starts contracting. The patient feels these contractions as painful cramps, and the mouth of the uterus (the cervix) opens. Such a situation is called an inevitable abortion (because it cannot be stopped). If a portion of the pregnancy tissue has already been expelled by the contractions, then this is called an incomplete abortion.
In patients with a blighted ovum, missed abortion, inevitable or incomplete abortion, the treatment is a uterine curettage (D&C) - a short surgical procedure which is performed to empty the uterus and remove the pregnancy tissue called the products of conception. It is now also possible for the doctor to terminate the pregnancy non-surgically, by using a combination of drugs such as RU 486 (mifepristone, an anti progestin) or methotrexate, and prostaglandins (such as misoprostol).
Abortions which occur in the first twelve weeks of pregnancy are called first trimester abortions. Those which occur between the 13th to 20th weeks are called second trimester abortions.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
