REMEMBER the old wives' tale about not eating pineapples when you are expecting? Or about avoiding sex when you are pregnant? Well, all the old superstitions came flooding back during a recent forum on Miscarriage - Spontaneous Abortion held at the Pantai Medical Centre in Kuala Lumpur recently.
For the 40-odd participants who attended the session, it was an eye- opener in many respects. Warnings against having sex during the first three months of pregnancy apparently have a ring of truth to them as a substance called prostaglandin is present in the semen and can induce uterine activity.
If she cannot avoid sex, it is best for the woman to avoid reaching orgasm as this results in intense uterine activity.
Eating too much pineapple (especially the green, young ones) may also induce uterine activity and jeopardise the stability of the pregnancy.
Dr H.C. Ong, consultant obstetrician and gynaecologist elaborated at length during the forum on all the do's and don'ts of pregnancies and how miscarriages happen.
Miscarriage, or spontaneous abortion, occurs in about 60 per cent of all conceptions. Often, many miscarriages take place even before a woman misses her period or before she knows she is pregnant. That may be surprising, but true.
We always tend to associate miscarriage with a pregnancy of over three months (12 weeks) but, in fact, it happens even before some mothers are aware of it.
For example, over half of miscarriages in the first 12 weeks of pregnancy are caused by problems with the chromosomes of the foetus. If something is not right with the number or structure of the chromosomes or with the genes it carries, it can lead to a miscarriage.
There are many causes of miscarriage, the more common being high fever, rubella, chlamydia (infection of the body system), diabetes mellitus, severe asthma, congenital heart disease (due to the high carbon dioxide level, blood supply to the baby is lowered) and kidney conditions, especially when associated with severe hypertension.
In all of these, treatment can improve the chances of the pregnancy. In some cases, however, special care needs to be taken to prevent a miscarriage.
Other reasons are an incompetent cervix, abnormal endometrium and abnormalities of the uterus such as the uterus being divided in two.
For instance, fibroids can be a cause of miscarriages, not because of the abnormal shape of the uterus but the abnormal contractions that the uterus undergoes.
An incompetent cervix is simply a condition in which the cervix can widen and open too early, perhaps in the middle of pregnancy, leading to a miscarriage.
There are usually no signs of labour. What happens is that the water bag will burst without warning, leading to abdominal pain, and the baby is pushed out very quickly. To correct this condition, the gynaecologist normally puts in a suture at the cervix area when the pregnancy is 12 weeks old.
The danger with this type of condition is that there is almost no way of knowing whether the mother has an incompetent cervix in the first pregnancy.
Of course, lifestyles such as smoking, consumption of alcohol and hard drugs all have a part to play in miscarriages.
Doctors will normally also advise their patient who are already eight months into their pregnancy not to travel by air, although short journeys are permissible to some. Trans-Atlantic flights are out of the question, the reason being that the high atmospheric pressure will aggravate the condition especially if the mother is prone to miscarriages.
If a woman suffers a few miscarriages in a row, for example, three or more consecutively, then she is termed as having habitual miscarriages. About 50 per cent of such cases go without treatment, that is, the sufferers do not seek expert opinion or help.
Others who seek help will have to undergo investigation before the cause is found.
Usually, a complete history of the woman's medical condition and past pregnancies needs to be taken into account. This is followed by blood tests (for possible hormonal problems), genital tract cultures for presence of infection, blood tests, chromosomal testing for both partners, and chromosome analysis.
There may also be surgical procedures like hysteroscopy (where the doctor inserts a hysteroscope into the uterine cavity to look for fibroids or malformations), ultrasound or laparascopy (to examine the pelvis for other physical abnormalities that can lead to miscarriage).
Finally, if a woman has experienced recurrent miscarriage, she may feel hopeless and confused.
Coping with a miscarriage is difficult, especially if it is sudden. In early pregnancy the mother has already formed an attachment to the foetus and the miscarriage causes severe grief. In such cases it is important that the woman gets counselling to cope with her feelings of guilt and inadequacy.
The amount of emotional support she gets and the attitude of others important to her, as well as her age, also matter. If she is denied her grieving period, it may present problems later on and lead to depression.