Causes

Why?
The moment after the shock has registered that you are losing, or have lost, your baby, the million dollar question pops into your head. Why? Why did this happen to me, to us?

While we seek a reason, a cause, or someone or something to blame, the fact is that there often is no reason. While medical science has made giant leaps since the Middle Ages, doctors will be the first to admit that fertility, pregnancy and the death of a baby are still largely in the realms of mystery, wonder and awe.

Doctors can tell you what to do to increase your chance of falling pregnant, but they cannot explain why a man with deformed sperm or a low sperm count and a woman with a uterus that is supposedly incapable of growing a baby can suddenly fall pregnant and go on to produce a beautiful, healthy baby. 

Likewise, while they can tell you how to reduce your risk of losing a baby, oftentimes they can't actually tell you why you lost your baby. More often than not, a diagnosis of the reason for your loss is a process of elimination. This means that the doctor will be able to tell you what has NOT caused your loss, but will be unable to say what HAS caused your loss (none of which makes it any easier to go through what you are experiencing).

Looking at the lists below, there seem to be so many possible reasons. In the light of this, the fact that about half of deaths are still unexplained is incredible. What is even more incredible is that the number of unexplained deaths has remained constant since the early 1980s, despite advances in medical science. Before then, the number decreased steadily through a combination of improved ante-natal care and advances in scanning technologies. In order to make sense of the lists, there are a few definitions you need to know.

Definitions

Every country has its own way of defining when the death of an infant is a miscarriage and when it is a stillbirth. Some define stillbirths by the weight of the infant (over 500g or over 1000g), while others define it based on the infant's gestation (over 20 weeks, over 24 weeks, over 28 weeks).

In South Africa, a stillbirth is termed as the perinatal death of an infant over 1000g. (For statistical reporting, a miscarriage is termed as taking place only after 24 weeks gestation.) Both miscarriage and stillbirth are termed as perinatal deaths.

Neonatal deaths are more standardised across nations, and are defined as deaths between birth and 28 days of life.

Premature birth is any birth earlier than 37 weeks gestation. The earlier a baby is born, the more premature it is, and the less likely it is to survive. Babies born before 24 weeks have less than a 50% chance of survival, even with proper medical treatment.

High risk pregnancies

Women who are classified as 'high risk' pregnancies are at a much greater risk of losing their pregnancy. These are women who:

  • are over 35 years of age
  • smoke, drink or use any drug
  • are obese
  • suffer from an existing medical condition (e.g. diabetes, hypertension)
  • are pregnant with twins, or more
  • have had recurrent miscarriages/ stillbirths
  • have a past history of other obstetric problems

Causes of miscarriage & stillbirth

Even if you do not have a high risk pregnancy, there are other factors that may cause a miscarriage or stillbirth. These include:

  • genetic disorders (ie chromosomal disorders) in the baby
  • hormonal imbalances of insulin or prolactin, or the malfunctioning of the thyroid gland
  • Antiphospholipid Syndrome (blood clotting disorder) in the mother
  • hereditary thrombophilias (blood clotting disorders) in either the mother or the baby, e.g. Factor V Leiden
  • fibroids (benign tumours inside the uterus)
  • cervical insufficiency/ incompetence (a cervix that is weak, so starts to dilate too early on in the pregnancy - any time after about 4 months)
  • congenital uterine problems (when the uterus grows incorrectly so has the wrong structure or shape, or has two chambers instead of just the one)
  • scarring inside the uterus from a D&C, caesarian section scars or from treatment for fibroids
  • an excess of amniotic fluid (though this usually only causes premature births)
  • undetected ectopic pregnancy (embryo implants itself into the Fallopian tubes or inside the abdomen onto the outside of one of the mother's organs, rather than in the uterus)
  • taking contra-indicated drugs (always ask a doctor before taking any drugs during a pregnancy)
  • untreated syphilis in the mother
  • Rubella (German Measles) infection in the mother
  • pre-eclampsia (pregnancy-induced hypertension)
  • any chronic illness or infection that causes the mother to have an extremely high fever
  • infection introduced into the uterus via an amniocentesis (unlikely, but possible)
  • umbilical cord twisted or wrapped around the baby's neck, preventing oxygen and nutrients from reaching the baby and waste products from being removed to the mother
  • tremendous stress events
  • physical trauma (e.g. car accident)

About half of all recurrent miscarriages and stillbirths are unexplained. However, 70% of couples who have recurrent miscarriages or stillbirths go on to produce a healthy baby, which is very good news.

Causes of neonatal deaths

Any baby who manages to survive birth still has a major battle on its hands to live. Most neonatal deaths occur within the first week of life. The longer a baby lives, the greater its chances of surviving are. Common causes for a neonatal death are:

  • Sudden Infant Death Syndrome (SIDS) (can occur up to about 2 years old)
  • genetic disorders
  • low birth weights (e.g. if the infant was from a multiple pregnancy)
  • birth defects (which are very strongly associated with premature or preterm birth), also termed congenital abnormalities
  • premature birth
  • complications during labour
  • post-birth infection (e.g. pneumonia - common in preterm babies because their lungs are not properly developed and their immune systems are also immature)
  • pre-birth infection may have been introduced into the uterus during an amniocentesis

Whatever the reason for our loss, losing our babies makes us think that we did something wrong, that somehow we have failed in our duty as parents. While this is a natural reaction to grief, it is not our fault, and believing that only complicates and prolongs our grieving.

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