The term abortion refers to the expulsion of the foetus from the uterus before the complete formation of the placenta. It is also commonly known as miscarriage. This may occur any time before 28 weeks of gestation but is most common during the first 12 weeks of pregnancy. Once in five to ten pregnancies terminates in this way.
When miscarriage occurs repeatedly at a certain period of pregnancy, it is termed " habitual abortion ". It is one of the most perplexing problems of gyanaecology and a major cause of maternal mortality. A woman who has suffered two or more terminations of this sort consecutively is said to be a case of habitual abortion.
Pains of the same character as labour pains and bleedings are the two main symptoms of possible abortion. Bleeding may lead to the detachment of the ovum from the uterus. It now acts as a foreign body in the uterus which stimulates uterine contraction. This generates a lot of pain and the foetus is thrown out of the body. In later weeks when the foetus is well developed, if it dies in the uterus, it leads to maceration of the body. The abdomen is filled with blood and the skin colour appears red. Sometime after a few more days, the foetus gets dehydrated and the fluid surrounding the foetus gets dried away.
One of the most important cause of habitual abortion is a congenital malformation of the uterus.
A hysterogram, before the woman becomes pregnant, will be useful in detecting any abormality, so that she is made aware of her case. Deficient functioning of the thyroid is another important cause of habitual abortion.
Most cases of habitual abortion, however, result from an inadequate secretion of the female hormone progesterone. This hormone is responsible for the development of the placenta. In the early stage of pregnancy, the gonadotrophin secreted by the cytotrophoblast of the chorion, one of the foetal membranes, stimulates the corpus lotemum to produce more oestrogen and progesterone, both essential female hormones. At a later stage, by about the 12th week of pregnancy, the placenta takes over the production and secretion of the hormones. Any deficiency of these hormones at this stage is detrimental to the growth of the foetus. It is, therefore, during this critical period,when habitual abortion mostly occurs. Lack of progesterone is especially instrumental in expelling the fertilised ovum and it results in an abortion.
Another important cause of habitual abortion may be chronic constipation which leads to putrefaction of morbid matter and wastes in the large intestines. This in turn causes auto-intoxication and inflammation of the reproductive organs, which can lead to a miscarriage.
Abortion may result from the excessive use of certain drugs. Drugs enter the foetus through the placenta. They may act quite differently on the foetus from the mother. Drugs which have adverse effects on the foetus are called " tera-togenestic drugs " and may include painkillers, antibiotics, tranquillisers and hormones. A high dosage of such drugs may produce contraction in the uterus and induce abortion.
Other cause of habitual abortion are excessive physical exercise, mental excitement, sexual intercourse, syphilis infections fibroid tumours, blood incompatibly of husband and wife, systemic disorders in the mother like hypertension, chronic nephritis, diabetes and even her mental condition.
Thorough examination of the pregnant woman's blood, urine, blood pressure and their related parameters help in detecting maternal disorders. Serological tests, for example, prove the presence or absence of syphilis infection. Pelvic examinations help to diagnose uterine displacements , fibroids or ovarian tumours. A hysterogram also helps to detect uterine malfunctions. The exact cause must be ascertained for prescribing correct treatment.
Conditions such as hormonal imbalance, infections of the uterus and chronic constipation can be remedied by natural methods of treatment . For congenital uterine malformation, however, recourse may have to be taken to surgery.
On appearance of the first symptoms of possible abortion, the patient should be put to bedimmediately and the bottom end of the bed raised. Cold compresses at 60 o F temperature should be applied continuously to the inner portion of the thighs, the perinium, the vagina and the lumbar region. Compresses should be changed every 15 to 20 minutes. When the compress is removed for renewing, the surface should be rubbed with a warm dry flannel for half a minute or until reddened, before applying the compress again. Simultaneously, a hot application should be made to the feet.
A neutral or warm water enema is an effective remedy for a constipated colon which is a major cause for the toxaemic condition of the uterus. This will relieve the bowels and thus reduce any excessive pressure on the uterus and other pelvic organs. A regular cold hip bath for a duration of 10 minutes twice every day is very helpful in relieving congestion and inflammation of the uterus. Wet girdle packs, twice every day, on an empty stomach, also relieve congestion's and infections in the uterus and other pelvic organs. It is advisable that women with a history of repeated abortions should adopt these techniques before conception and continue them during the first two months of pregnancy.
Hormonal imbalances can be set right by practicing yogic exercise. Yogic asanas such as sarvangasana, vajrasana, bhujan-gasana, shalabhsana, dhanurasana, paschimottashana, and trikonasana are especially useful in improving thyroid, pituitary, adrenal and gonaidal endocrine functions and should be practised regularly by women who suffer from imbalances of this sort, upto the first two months of pregnancy.
Dietary control is of utmost importance in the prevention of habitual abortion. Pregnant women should avoid refined carbo- hydrates, sugars, non-vegetarian food, coffee and tea. They should also avoid oily and fried foods as such foods lead to constipation, which is very detrimental to pregnancy. Smoking or chewing tobacco and drinking alcohol must be strictly avoided.
The pregnant woman's diet chart should be on the following lines : Breakfast : Fresh fruits and a glass of milk mixed with a teaspoonful of honey.
Lunch : Steamed vegetables, boiled rice or whole wheat chappatis and soup or buttermilk.
Midafternoon : A glass of fruit juice or a whole fruit.
Dinner : Cooked diet similar to the afternoon meal may be taken till the seventh month. After that, fruits, nuts, germinated seeds and sprouts, milk, buttermilk and soups must form her diet because they reduce the workload on the digestive system and thus help avoid indigestion, constipation and related disorders.
Indian gooseberry, known as amla in the vernancular, is considered useful in preventing abortion. A teaspoonful of fresh amla juice and honey mixed together should be taken every morning during the period of pregnancy. It will also prevent infections and help in the absorption of iron. A brew made from safflower foliage is also said to prevent abortion.
Pregnant women with a history of repeated abortions should take all other precautions necessary to prevent miscarriage. They should avoid sexual intercourse, during early pregnancy. They should go to bed early and rise early and take regular exercise, but avoid fatigue. They should sleep on a hard mattress with their heads low, and remain calm and cool.
All these measures will greatly help in correcting the phenomenon of habitual abortion.
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