Malaria, UTI can trigger threatened abortion –Physician

 

Toluwalope Kareem

A consultant in foetal medicine and genetics, Dr. Femi Oloyede, speaks to TOLUWALOPE KAREEM about threatened abortion

What is threatened abortion?

A threatened abortion is a common gynecological condition in which a pregnant woman experiences spotting of blood or bleeding before 28 weeks of gestation. The hallmark is the bleeding, which may just commence spontaneously or sometimes after a provocation. Other symptoms are not necessary to classify a woman as having threatened abortion. It is actually the commonest simple gynecological condition in women.

What causes a threatened abortion?

Most times, the underlying cause remains undiagnosed. It is however recognised that factors from the mother or foetus or even both could predispose to it. The causes can be characterised into two groups based on whether the cause is from the mother on the placenta.

From the mother, any conditions that result in a feverish state may be a trigger. The commonest are conditions such as malaria, typhoid and urinary tract infections.

Another factor is if there is an uncontrolled medical disorder in the mother such as thyroid disease, diabetes mellitus, etc.

Other factors are trauma, especially with transmission of pressure to the abdomen, e.g. RTA (Renal Tubular Acidosis) or vaginal during coitus.

Threatened abortion may also be triggered when a pregnant woman is exposed to toxic chemicals or radiation. This probably occurs in women who are exposed by virtue of occupation. For instance, women working as radiographers, anesthetics staff, etc. The good thing is that modern medical practice now has protection policies that reduce the level of exposure

Lastly, low levels of hormones, especially progesterone, may also be a factor.

From the angle of the foetus or placenta, threatened abortion may be triggered by an abnormality in chromosome constitution, as in Down Syndrome. This is the commonest reason for spontaneous miscarriages. Unfortunately, it is the least diagnosed.

Severe congenital malformation that may not be compatible with survival may also be a factor. Others include sudden psychological challenges. For example, shocking news could provoke bleeding.

How is threatened abortion diagnosed?

The diagnosis is based on three cardinal points. Firstly, the woman would have missed periods, as evidence of pregnancy. This is called amenorrhea. Secondly, she would experience spotting or bleeding per vaginal; lower abdominal pain does not need to accompany the bleeding.

Thirdly, examination of the womb will show that the opening, otherwise called the cervix, remains closed. These criteria are very important because an error in diagnosis can lead to mismanagement. The thin line between threaten and inevitable abortion could be the state of the cervix, in terms of opening or not. Yet the management methods are the complete opposite.

What happens if a pregnant woman is diagnosed with threatened abortion?

When a woman is diagnosed with threatened abortion, the pregnancy could still progress with good management. It may also end up as inevitable abortion. The fate depends on many factors. The first thing is to curtail physical activities as medical consultation begins.

How is a threatened abortion managed?

It is important to manage it and the management begins with an investigation to confirm the suspicion and most likely the cause. The baby can survive threatened abortion; survival is possible and it is the goal of management.

It is important to note the fact that spotting may be due to unrecognised chromosomal abnormality. It is therefore of utmost importance that all pregnancies that continue after treatment, must be screened for the possibility of chromosomal abnormality between 11 and 14 weeks. This could be done using ultrasound scan parameters or some blood markers in the mother’s blood. It will be painful for a pregnant woman to survive miscarriage but is delivered of an imbecile due to undiagnosed chromosomal abnormality.

What is the best treatment for threatened abortion?

The best treatment for a threatened abortion is enough of bed rest. Bed rest is the hallmark of the treatment. Any other identified cause such as UTI (urinary tract infection) is usually treated.

What should be avoided during threatened abortion?

One thing that should be avoided is any sort of strenuous physical activity.

Does the management of threatened abortion require the use of drugs?

The onset of pain may suggest a uterine activity, and this suggests progression to worse forms of abortion. However, sole analgesics such as paracetamol often suffice.

How long does a threatened abortion last?

There is no defined time, nor can one give a time, however, what is known is that after cessation of bleeding, it is advised that the pregnant should rest adequately for at least five days before the resumption of activities.

Are there any possible complications that make come if threatened abortion is not handled well?

The woman is at higher risk of being infected, which may sometimes be fulminate and life-threatening. It may progress to inevitable abortion, resulting in incomplete fetal expulsion.

Can threatened abortion cause birth defects?

It is the reverse.

How can missed abortion be avoided?

Missed abortion is defined as the cessation of symptoms of pregnancy but the fetus is still in the uterus but non-living. Not within a personal effort to avoid.

What should one eat with a threatened miscarriage?

Any normal balanced diet is appropriate.

Can a threatened miscarriage be misdiagnosed?

Yes, it could be diagnosed as ectopic pregnancy

How can threatened abortion be prevented?

Certain advice would be given, and the advice would include avoiding stressful physical activities, especially in early pregnancy. Ensure that medical conditions are well controlled before conception.

How long does a threatened abortion last?

There is no defined time, nor can one give a time, however, known is that after cessation of bleeding, it is advised to rest adequately for at least five days before the resumption of activities.

What are the complications of threatened abortion?

The woman is at higher risk of being infected, which may sometimes be fulminant and life-threatening. It may progress to inevitable abortion, resulting in incomplete fetal expulsion.

SOURCE: THE PUNCH

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