Miscarriage/ Interview with Dr Dédé Benedicta Améwoui, Obstetrician Gynaecologist, Head of the Group Medical Clinic

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Extract from the article: Miscarriage is a phenomenon that is often accompanied by feelings of guilt and shame. However, it is a very common event: some pregnancies do not reach term. Couples expecting a child often wonder about the risk factors and consequences of spontaneou

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« You should not hesitate to go to the nearest hospital emergency room, even during the night. A miscarriage is considered an obstetric emergency. »

Miscarriage is a phenomenon that is often accompanied by feelings of guilt and shame. However, it is a very common event: some pregnancies do not reach term. Couples expecting a child often wonder about the risk factors and consequences of spontaneous abortions. Here are some clarifications given by Dr Dédé Bénedicta Améwoui, Obstetrician Gynecologist, in this interview.

Santé-Education: What is a miscarriage?

Dr. Dédé Benedicta Améwoui: A miscarriage (or spontaneous abortion) occurs when an intrauterine pregnancy ends before the embryo or fetus is viable, i.e. before 22 weeks of amenorrhea in the West and 28 weeks of amenorrhea in developing countries.

At what point in the pregnancy is the risk greater?

The vast majority of miscarriages (80-90%) occur in the first trimester of pregnancy and are related to problems in the embryo. Sometimes a pregnancy can end after the 12th week of amenorrhoea, and this is known as a late miscarriage.

What are the symptoms?

The symptoms of miscarriage are usually bleeding and pain in the lower abdomen. These pains may resemble premenstrual pains or labour pains for those women who know them. But it is quite possible to have no symptoms at all. A very early miscarriage, also known as a "chemical pregnancy", is often equated with a late period.  It is also possible for a pregnancy to end abruptly without any particular symptoms and without the woman noticing. It is the ultrasound that indicates that the heart of the foetus has stopped beating.

When should you seek help?

Any woman who experiences bleeding or pain during pregnancy should seek professional help as soon as possible. You should not hesitate to go to the nearest hospital emergency room, even at night. A miscarriage is considered an obstetric emergency.

What management and treatment do you offer?

If the ultrasound scan indicates that the miscarriage has already occurred or is in progress, we ensure that the expulsion of the embryo is complete and that everything has gone well with a second ultrasound scan 7 to 10 days later. In specific cases we also monitor the level of beta hCG (the pregnancy hormone). We explain to our patients that in case of fever or foul-smelling vaginal discharge, they should seek immediate attention because of the risk of infection.

If the ultrasound shows that the miscarriage is incomplete or that the pregnancy has stopped, we can treat it with medication or surgically, by aspiration and/or curettage.

What to do in case of repeated miscarriages? 

When a woman has three consecutive miscarriages, we call it a "repeat miscarriage", she is asked to undergo a series of tests to try to determine the causes of the problem, if there is one, in order to provide appropriate treatment.

What are the risks?

Haemorrhage, dead egg retention, placental retention, anaemia, infection and even death, if not properly managed. An early intrauterine pregnancy with lower abdominal pain and bleeding should not be underestimated.

What causes a miscarriage?

The earlier the miscarriage, the more likely it is to be due to a chromosomal abnormality of the embryo. On the other hand, spontaneous abortions that occur in the second trimester are usually related to a health problem in the mother (placentation, anatomical abnormalities of the uterus, endocrine problems, infectious diseases, environmental factors, etc.).

Is the mother's age a determining factor?

Yes, it is. The risk of abortion increases with the mother's age.  A 20-year-old woman has only a 10% chance of miscarriage, whereas at 40 the risk of miscarriage rises to 40-50% and even to 80% after 45.

Are there any behaviours to avoid in order to limit the risk of miscarriage?

The vast majority of early miscarriages are caused by chromosomal abnormalities of the embryo. That said, it is important that the mother avoids tobacco, alcohol and of course any drugs, as it is impossible to say what serum level is harmful to the foetus. It is recommended to lead a healthy life and to continue to have good habits in terms of diet and physical activity or sport.

Are there any physical consequences of a miscarriage?

In the event of a miscarriage there are generally no physical consequences. However, there is a risk of infection of the endometrium (endometritis), which is why it is important to follow up. This is because the cervix remains slightly open even during a spontaneous miscarriage. Bacteria can travel up from the vagina and cause an infection. In the case of a miscarriage requiring one or more curettages, it is sometimes the case that poor healing of the uterus creates uterine synechiae, making it more difficult for the egg to implant in future pregnancies. It is therefore possible to have cases of secondary infertility linked to a miscarriage followed by complications.

What are the chances of getting pregnant again after a miscarriage?

After an uncomplicated miscarriage, the chances of conceiving and carrying a pregnancy to term are the same as for any other woman. Repeated miscarriages may, however, be a sign of an infertility problem that requires further investigation.

What about the emotional impact?

Experiencing a miscarriage is never an easy experience, especially as the subject remains a real taboo. Each woman is unique and so are her experiences. Some women want to get pregnant again as soon as possible. Others need time to mourn the loss. Then there is a small minority of women who experience the miscarriage as a relief, because they did not dare to take the decision to terminate the pregnancy voluntarily.

In your opinion, is miscarriage still a taboo subject?

Yes, in addition to the grief of the loss, the mother is often overcome by a great sense of guilt and shame. She feels like the guardian of the baby she is carrying. If something goes wrong, she feels entirely responsible. This is an irrational but natural feeling.

Do you offer psychological support at your clinic?

Yes, we try to identify vulnerable patients and offer them psychological support: midwife counsellors and psychologists can help them at any time. Sometimes it is easier to confide in a professional, but it can also be artificial. That's why I always advise my patients to seek support from their relatives as well.

Is it common to fall into depression after a miscarriage?

Many women experience this as a personal failure. The question that often comes up is "What did I do wrong? The answer is 'nothing, absolutely nothing'. I always try to remove the guilt from patients who feel responsible or ashamed. I remind them that this is a biological phenomenon that is completely beyond their control. There is absolutely nothing they can do about it, although it is difficult to accept.

What advice would you give to a woman who has just experienced a miscarriage?

It is important to take into account the individual experience of each woman and each couple. It is difficult to put yourself in their shoes and give advice. I try to reassure my patients that they will be followed up to make sure that everything is going well. It is important that they can confide in their close circle of friends and family and talk about their experience without shame or guilt. It is essential to find support to overcome this ordeal.

Interview by Abel OZIH