MISCARRIAGE

What is a miscarriage?

A miscarriage is the spontaneous loss of a pregnancy from conception to 20 weeks' gestation. The term stillbirth refers to the death of a fetus after 20 weeks' gestation. Miscarriage is sometimes referred to as spontaneous abortion, because the medical term abortion means the ending of a pregnancy, whether intentional or unintentional. Most miscarriages occur in the first trimester of pregnancy, between the 7th and 12th weeks of pregnancy.

How common is miscarriage?

Miscarriage is very common. Because many or even most miscarriages occur so early in pregnancy that a woman might not have known that she was pregnant, it is difficult to estimate how many miscarriages occur. Some experts believe that about half of all fertilized eggs die before implantation or are miscarried. Of known pregnancies (in which a woman misses a period or has a positive pregnancy test), about 10% to 20% end in miscarriage.

What causes miscarriage?

The majority of miscarriages are believed to be caused by genetic problems in the embryo that would prevent a baby from developing normally and surviving. These fatal genetic errors typically are not related to genetic problems in the mother.

In other cases, certain illnesses or medical conditions can cause miscarriage and may increase the risk of miscarriage. Mothers who have diabetes or thyroid disease are at increased risk of miscarriage. Infections that spread to the placenta, including some viral infections, can also increase the risk of miscarriage.

In general, risk factors for miscarriage include the following:

• Older maternal age
• Cigarette smoking (>10 cigarettes/day)
• Moderate to high alcohol consumption
• Trauma to the uterus
• Radiation exposure
• Previous miscarriage
• Maternal weight extremes (BMI either below 18.5 or above 25 kg/m2)
• Anatomical abnormalities of the uterus
• Illicit drug use
• Use of non-steroidal anti-inflammatory drugs (NSAIDs) around the time of conception may increase the risk of miscarriage

Women who had one miscarriage have an incidence of miscarriage of about 20%, whereas women who have three or more consecutive miscarriages may have a risk as high as 43%

What are the types of miscarriage?

Miscarriages are sometimes referred to by specific names to reflect the clinical findings or the type of miscarriage. Examples include:

• Threatened abortion: a woman may experience vaginal bleeding or others signs of miscarriage (see below), but miscarriage has not occurred
• Incomplete abortion: some of the products of conception (fetal and placental tissues) have been expelled from the uterus, but some remain within the uterus
• Complete abortion: all of the tissue from the pregnancy has been expelled
• Missed abortion: the fetus has not developed, so there is no viable pregnancy, but there is placental tissue contained within the uterus
• Septic abortion: a miscarriage in which there is infection in the fetal and pregnancy material before or after a miscarriage

What are signs and symptoms of a miscarriage?

Vaginal bleeding and pelvic pain are the hallmark symptoms of miscarriage. All vaginal bleeding during pregnancy should be investigated, although not all instances of bleeding result from a miscarriage. Bleeding in the first trimester of pregnancy is very common and does not typically signify a miscarriage. The pain tends to be dull and cramping, and it may come and go or be present constantly. Sometimes, there is passage of fetal or placental tissue. This material may appear whitish and covered with blood. Blood clots may also be present in the vaginal bleeding. The degree of bleeding does not necessarily correlate with the severity of the situation, and miscarriage may be associated with bleeding that ranges from mild to severe.

How is miscarriage diagnosed?

An ultrasound examination is typically performed if a woman has symptoms of a miscarriage. The ultrasound can determine if the pregnancy is intact and if a fetal heartbeat is present. Ultrasound examination can also reveal whether the pregnancy is an ectopic pregnancy (located outside of the uterus, typically in the Fallopian tube), which may have similar symptoms and signs as miscarriage. Other tests that may be performed include blood tests for pregnancy hormones, blood counts to determine the degree of blood loss or to see whether infection is present, and a pelvic examination. The mother's blood type will also be checked at the time of a miscarriage, so that Rh-negative women can receive an injection of rho-D immune globulin (RhoGam) to prevent problems in future pregnancies.

What happens after a miscarriage?

There are no specific treatments that can stop a miscarriage, although women who are at risk and have not yet miscarried may be advised to rest in bed, abstain from sexual activity, and restrict all activity until any warning signs are no longer present. Once a miscarriage occurs, there is no treatment available. In many cases, the miscarriage will take its course, and unless there is severe pain and cramping or severe blood loss, no treatment is required. If a miscarriage does not completely clear the pregnancy tissue from the uterus, a procedure known as a dilatation and curettage (D&C) can be performed to remove the remaining pregnancy material. This treatment is used in the case of a missed abortion, for example, when the pregnancy material is not expelled from the uterus.
As mentioned above, women who are Rh-negative will receive a dose of rho-D immune globulin to prevent complications in future pregnancies.
If a miscarriage is due to infection, antibiotic treatment will be given.
Miscarriage is such a common occurrence that typically, unless known risk factors are present, no special testing is performed. For couples who have experienced more than two miscarriages, diagnostic studies to detect genetic, hormonal, or anatomical problems may be recommended. Some doctors recommend evaluation of the couple after the second miscarriage, particularly if the woman is over 35 years of age

What is the outlook for future pregnancies after a miscarriage?

Most women who miscarry go on to have a successful pregnancy. The likelihood of a miscarriage in a future pregnancy increases with the number of miscarriages a woman has had. In general, the risk of a second miscarriage in women who have had a previous miscarriage is about 15%. The risk is about 30% in women who have had two miscarriages. Most women will have their menstrual period within 4 to 6 weeks after a miscarriage. Your doctor can advise you when you may start trying to conceive again. While it is possible to conceive again after your menstrual period has returned, some doctors advise waiting a bit longer, such as another menstrual cycle or more, to provide enough time for physical and emotional recovery.

Can miscarriage be prevented?

There is no evidence that bed rest can help prevent miscarriage, but women who have vaginal bleeding during pregnancy are often advised to rest and limit sexual activity until there are no more potential signs of miscarriage. It is possible that some risk factors for miscarriage can be minimized by maintaining a healthy weight and avoiding the use of alcohol, illicit drugs, or tobacco. Screening for and treatment of any sexually-transmitted diseases (STDs) can also reduce the risk of a miscarriage. Avoidance of sports such as horseback riding or skiing can reduce your risk of trauma to the uterus. In most instances, however, the cause of a miscarriage is outside of the woman's control
                                                           

THANKS FOR YOUR RAPT ATTENTION……..

                                                            .

COMMON BREASTFEEDING CHALLENGES

                                     COMMON BREASTFEEDING CHALLENGES

• Many women have no problems breastfeeding, while others will experience some challenges. These challenges can often be overcome.
• Developing a good latch is important to prevent sore nipples.
• Checking a baby's weight and growth is the best way to make sure he or she is getting enough milk.
• Engorgement refers to the feeling of pain or fullness in the lactating breasts.
• Clogged or plugged ducts are relatively common and can be relieved by massage, warm compresses, and frequent breastfeeding.
• A plugged duct feels like a tender, sore lump in the breast.
• Mastitis is an inflammation or infection of the breasts that can be accompanied by fever.
• Breast infections that do not heal within 24 to 48 hours may need treatment with antibiotics.
• Most mothers are able to make enough milk for twins, and some fully breastfeed triplets or quadruplets.
• Breastfeeding after breast surgery is usually possible; the extent depends upon the type of surgery and the reasons it was performed.
• Some health problems in babies can make breastfeeding more difficult.

Common breastfeeding challenges overview

Breastfeeding can be challenging at times, especially in the early days. But it is important to remember that you are not alone. Lactation consultants are trained to help you find ways to make breastfeeding work for you. And while many women are faced with one or more of the challenges listed here, many women do not struggle at all! Also, many women may have certain problems with one baby that they don't have with their second or third babies. Read on for ways to troubleshoot problems.

Sore nipples

Many moms report that nipples can be tender at first. Breastfeeding should be comfortable once you have found some positions that work and a good latch is established. Yet it is possible to still have pain from an abrasion you already have. You may also have pain if your baby is sucking on only the nipples.
Ask a lactation consultant for help to improve your baby's latch. Talk to your doctor if your pain does not go away or if you suddenly get sore nipples after several weeks of pain-free breastfeeding. Sore nipples may lead to a breast infection, which needs to be treated by a doctor.

What you can do

• A good latch is key, so visit the Bringing your baby to the breast to latch section for detailed instructions. If your baby is sucking only on the nipple, gently break your baby's suction to your breast by placing a clean finger in the corner of your baby's mouth and try again. (Your nipple should not look flat or compressed when it comes out of your baby's mouth. It should look round and long, or the same shape as it was before the feeding.)
• If you find yourself wanting to delay feedings because of pain, get help from a lactation consultant. Delaying feedings can cause more pain and harm your supply.
• Try changing positions each time you breastfeed. This puts the pressure on a different part of the breast.
• After breastfeeding, express a few drops of milk and gently rub it on your nipples with clean hands. Human milk has natural healing properties and emollients that soothe. Also try letting your nipples air-dry after feeding, or wear a soft cotton shirt.
• If you are thinking about using creams, hydrogel pads, or a nipple shield, get help from a health care provider first.
• Avoid wearing bras or clothes that are too tight and put pressure on your nipples.
• Change nursing pads often to avoid trapping in moisture.
• Avoid using soap or ointments that contain astringents or other chemicals on your nipples. Make sure to avoid products that must be removed before breastfeeding. Washing with clean water is all that is needed to keep your nipples and breasts clean.
• If you have very sore nipples, you can ask your doctor about using non-aspirin pain relievers.

 Low milk supply

• Most mothers can make plenty of milk for their babies. But many mothers are concerned about having enough.
  Checking your baby's weight and growth is the best way to make sure he or she is getting enough milk. Let the doctor know if you are concerned. For more ways to tell if your baby is getting enough milk, visit the How to know your baby is getting enough milk section.
  There may be times when you think your supply is low, but it is actually just fine:
  When your baby is around 6 weeks to 2 months old, your breasts may no longer feel full. This is normal. At the same time, your baby may nurse for only five minutes at a time. This can mean that you and baby are just adjusting to the breastfeeding process -  and getting good at it!
  Growth spurts can cause your baby to want to nurse longer and more often. These growth spurts can happen around 2 to 3 weeks, 6 weeks, and 3 months of age. They can also happen at any time. Don't be alarmed that your supply is too low to satisfy your baby. Follow your baby's lead - nursing more and more often will help build up your milk supply. Once your supply increases, you will likely be back to your usual routine.
  

  What you can do

• Make sure your baby is latched on and positioned well.
• Breastfeed often and let your baby decide when to end the feeding.
• Offer both breasts at each feeding. Have your baby stay at the first breast as long as he or she is still sucking and swallowing. Offer the second breast when the baby slows down or stops.
• Try to avoid giving your baby formula or cereal as it may lead to less interest in breast milk. This will decrease your milk supply. Your baby doesn't need solid foods until he or she is at least 6 months old. If you need to supplement the baby's feedings, try using a spoon, cup, or a dropper.
• Limit or stop pacifier use while trying the above tips at the same time.

Ask for help! Let your baby's doctor know if you think the baby is not getting enough milk.

Oversupply of milk

Some mothers are concerned about having an oversupply of milk. Having an overfull breast can make feedings stressful and uncomfortable for both mother and baby.

What you can do

1. Breastfeed on one side for each feeding. Continue to offer that same side for at least two hours until the next full feeding, gradually increasing the length of time per feeding.
2. If the other breast feels unbearably full before you are ready to breastfeed on it, hand express for a few moments to relieve some of the pressure. You can also use a cold compress or washcloth to reduce discomfort and swelling.
3. Feed your baby before he or she becomes overly hungry to prevent aggressive sucking. (Learn about hunger signs in the Tips for making it work section.)
4. Try positions that don't allow the force of gravity to help as much with milk ejection, such as the side-lying position or the football hold.
5. Burp your baby frequently if he or she is gassy.

Some women have a strong milk ejection reflex or let-down. This can happen along with an oversupply of milk. If you have a rush of milk, try the following:

1. Hold your nipple between your forefinger and middle finger or with the side of your hand to lightly compress milk ducts to reduce the force of the milk ejection.
2. If baby chokes or sputters, unlatch him or her and let the excess milk spray into a towel or cloth.
3. Allow your baby to come on and off the breast at will.

Ask for help! Ask a lactation consultant for help if you are unable to manage an oversupply of milk on your own.

Engorgement

It is normal for your breasts to become larger, heavier, and a little tender when they begin making more milk. Sometimes this fullness may turn into engorgement, when your breasts feel very hard and painful. You also may have breast swelling, tenderness, warmth, redness, throbbing, and flattening of the nipple. Engorgement sometimes also causes a low-grade fever and can be confused with a breast infection. Engorgement is the result of the milk building up. It usually happens during the third to fifth day after birth, but it can happen at any time.
Engorgement can lead to plugged ducts or a breast infection, so it is important to try to prevent it before this happens. If treated properly, engorgement should resolve.

What you can do

1. Breastfeed often after birth, allowing the baby to feed as long as he or she likes, as long as he or she is latched on well and sucking effectively. In the early weeks after birth, you should wake your baby to feed if four hours have passed since the beginning of the last feeding.
2. Work with a lactation consultant to improve the baby's latch.
3. Breastfeed often on the affected side to remove the milk, keep it moving freely, and prevent the breast from becoming overly full.
4. Avoid overusing pacifiers and using bottles to supplement feedings.
5. Hand express or pump a little milk to first soften the breast, areola, and nipple before breastfeeding.
6. Massage the breast.
7. Use cold compresses in between feedings to help ease pain.
8. If you are returning to work, try to pump your milk on the same schedule that the baby breastfed at home. Or, you can pump at least every four hours.
9. Get enough rest, proper nutrition, and fluids.
10. Wear a well-fitting, supportive bra that is not too tight.

Plugged ducts

It is common for many women to have a plugged duct at some point breastfeeding. A plugged milk duct feels like a tender and sore lump in the breast. It is not accompanied by a fever or other symptoms. It happens when a milk duct does not properly drain and becomes inflamed. Then, pressure builds up behind the plug, and surrounding tissue becomes inflamed. A plugged duct usually only occurs in one breast at a time.

What you can do

• Breastfeed often on the affected side, as often as every two hours. This helps loosen the plug, and keeps the milk moving freely.
• Massage the area, starting behind the sore spot.
• Use your fingers in a circular motion and massage toward the nipple. Use a warm compress on the sore area.
• Get extra sleep or relax with your feet up to help speed healing. Often a plugged duct is the first sign that a mother is doing too much.
• Wear a well-fitting supportive bra that is not too tight, since this can constrict milk ducts. Consider trying a bra without underwear.

Ask for help! If your plugged duct doesn't loosen up, ask for help from a lactation consultant. Plugged ducts can lead to a breast infection.

Breast infection (mastitis)

Even if you are taking medicine, continue to breastfeed during treatment. This is best for both you and your baby. Ask a lactation consultant for help if needed.
Mastitis (mast-EYE-tiss) is soreness or a lump in the breast that can be accompanied by a fever and/or flu-like symptoms, such as feeling run down or very achy. Some women with a breast infection also have nausea and vomiting. You also may have yellowish discharge from the nipple that looks like colostrum. Or, the breasts may feel warm or hot to the touch and appear pink or red. A breast infection can occur when other family members have a cold or the flu. It usually only occurs in one breast. It is not always easy to tell the difference between a breast infection and a plugged duct because both have similar symptoms and can improve within 24 to 48 hours. Most breast infections that do not improve on their own within this time period need to be treated with medicine given by a doctor.

What you can do

1. Breastfeed often on the affected side, as often as every two hours. This keeps the milk moving freely, and keeps the breast from becoming overly full.
2. Massage the area, starting behind the sore spot. Use your fingers in a circular motion and massage toward the nipple.
3. Apply heat to the sore area with a warm compress.
4. Get extra sleep or relax with your feet up to help speed healing. Often a breast infection is the first sign that a mother is doing too much and becoming overly tired.
5. Wear a well-fitting supportive bra that is not too tight, since this can constrict milk ducts.