Rima was expecting and was advised bed rest as she had a miscarriage earlier. One night she woke up with stomach cramps in the seventh week of pregnancy and began bleeding. It was happening again despite all that rest.

An abortion is caused by:

• Malformation: Many spontaneous early abortions are caused by defective development of the fertilised ovum. This is due to chromosomal abnormalities, for which either parent may be responsible. Probably this is nature's way of reducing the number of abnormal babies born on earth. Luckily, most abortions of this type are not recurrent, so that prognosis in later pregnancies is good.

• Uterine abnormalities: A congenital problem like a septet uterus or a double uterus, or the presence of uterine tumours like fibromyoma cause abortions. A loose cervix caused by an injury during a previous delivery or abortion could lead to a late abortion if the membrane of the sac bulges through the cervix and gets ruptured.

• General diseases of the mother: Any acute illness with high fever, maternal infections like Rubella and Syphillis may lead to miscarriages. Sometimes, these infections may cause intrauterine foetal death during a later stage of pregnancy. A diabetic or a woman with hypertension will also have to be treated to ensure a safe pregnancy and childbirth. Sudden emotional disturbances could also lead to abortion, presumably because of strong uterine contractions.

• Hormonal imbalance: Pregnancy is maintained in the early stages by a hormone called progesterone before the placenta is fully developed to take over. Inadequate production of progesterone may also lead to an abortion. A deficiency or surplus of the thyroid hormone may also terminate the foetus.

• Drugs: Certain anti-cancer drugs, oxytocic drugs and prostaglandin (used to induce uterine pain), quinine and lead poisoning may cause abortion.

• Trauma: Severe uterine trauma may cause partial detachment of the embryo leading to an abortion. If the woman has a previous history of miscarriages, it is unwise to have intercourse regularly.