Monique Rainford, Contributor

One of the more-difficult parts of my role as an obstetrician and gynaecologist is being the bearer of bad news. One such sad time is informing a woman or a couple that they have lost their baby. This can occur at any point in pregnancy but the most common time for loss of a pregnancy is within the first 12 weeks. (Pregnancy is dated from the first day of a woman's last menstrual period).

What makes this news even more heart wrenching to deliver is knowing that no matter what I may say, the woman often blames herself for the loss. However, I must emphasise that, with very few exceptions, first-trimester losses or miscarriages are unpreventable events and any intervention either on the part of the patient or doctor cannot change the outcome.

Miscarriage risk factors

A miscarriage is the loss of a pregnancy before 20 weeks. About 15-20 per cent of women will have a miscarriage or spontaneous abortion. However, it is estimated that a much larger percentage of women have miscarriages before they are even aware that they are pregnant.

The risk of a miscarriage increases with the age of the woman, the age of the man, the number of babies a woman has had and if a woman gets pregnant within the first three months of having a full-term baby. About half of miscarriages occur by the eighth week of pregnancy. There is also an increased risk in a woman who has had a miscarriage before but the likelihood of having a baby is greater than her risk of another miscarriage.

Most women have miscarriages because of an abnormality of the chromosomes or genes of the foetus. These abnormalities are not usually inherited from the parents and most occur randomly. In most cases, couples who have had even two or more miscarriages have normal genes.

Coffee drinking

Smoking and drinking alcohol increase the risk of losing a normal foetus. There may also be a slight, increased risk in women who drink more than four cups of coffee per day. Other factors that may cause miscarriages include certain infections including HIV, syphilis and acquiring an infection with herpes simplex virus early in pregnancy.

Other causes include abnormalities in the structure of the womb. Fibroids may cause spontaneous abortions if they are located in the lining of a woman's womb. Some women may have a condition called incompetent cervix which is a weakness of the cervix or the neck of the womb. Women with diabetes who have poor control of their blood sugars also have an increased risk. Certain antibodies in a woman's blood can lead to losses.

It's nature's way

As many as one in four or one in five women may have bleeding in early pregnancy but only half of these pregnancies will result in a miscarriage. This is much more likely if she has pain with the bleeding. However, if she has an ultrasound which shows the developing baby with heart activity, the risk of her miscarrying is much lower.

There is no proven treatment to prevent miscarriages early in pregnancy. However, for women with the condition incompetent cervix, which may lead to miscarriage later in pregnancy (after about 15 weeks), a stitch called a cerclage can be placed around the cervix to prevent the loss.

Although having a miscarriage can be a very sad occurrence in a woman's or couple's life, it may help if she view's this as nature's way of protecting her body from a pregnancy that might lead to a child that could not survive.

Dr. Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.