Pregnancy

Miscarriage (spontaneous abortion)

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a - in the uterus all the shells, b - in the uterus remnants of the ovum

When miscarriage in the course of the later period of heavy bleeding, as a rule, does not happen. Therefore, in the later stages of pregnancy, it is advisable to wait for the independent birth of the fetus and afterbirth, and then make a digital or instrumental examination of the uterus.

When spontaneous miscarriage, especially early term, the ovum rarely completely separated from the walls of the uterus. Usually, a part of the ovum is exfoliated and born, and a part remains in the uterus (Fig. 6). Such an incomplete miscarriage is accompanied by profuse bleeding with clots. If a small portion of the hairy membrane lingers in the uterus, the bleeding may not be very intense, but prolonged. The remains of the ovum in the uterus can cause not only bleeding that threatens the health, and sometimes the life of a woman, but also a serious infectious disease. Therefore, the diagnosis of incomplete miscarriage should be timely. The diagnosis of incomplete abortion is established on the basis of subjective and objective data. Collecting the history of the disease of women, it is necessary to find out the date of the last normal menstruation, the duration of amenorrhea, when and in connection with which there was bloody discharge when a miscarriage occurred. When vaginal examination is determined by the open cervical canal, freely passing a finger over the inner throat. The uterus in size does not correspond to the duration of pregnancy, its size is smaller, since part of the ovum has already been born. The texture of the uterus is soft.

After examining the patient and having established the diagnosis of incomplete miscarriage, the midwife should immediately refer the patient to the hospital, as with incomplete miscarriage, instrumental removal of the remnants of the ovum is shown.

Causes of Miscarriage

The causes of abortion are many, ranging from banal stress and ending with serious endocrine disorders. In some cases, the cause of the miscarriage can not be established.

The main causes of miscarriages include:

- genetic (chromosomal) developmental abnormalities of the fetus, incompatible with life. As a result, the nonviable fetus dies and miscarriage occurs,
- hormonal disorders: progesterone hormone deficiency, hyperandrogenism, hyperprolactinemia, thyroid disease and diabetes,
- sexually transmitted infections (chlamydia, trichomoniasis, ureaplasmosis, mycoplasmosis, HPV, HSV, TsMV) and TORCH infections (rubella, herpes, toxoplasmosis, cytomegalovirus infection),
- anatomical anomalies: malformations of the uterus (single-horned, two-horned and saddle-headed uterus, the presence of an intrauterine septum), uterine myoma with submucous localization of the node, intrauterine synechia,
- cervical insufficiency (insufficiency of the muscular layer of the cervix, leading to its disclosure),
- Rhesus-conflict between mother and fetus.

Other factors that can also trigger a miscarriage include abortion in the past, smoking, drinking alcohol, drug use, stress, acute respiratory infections, taking analgesics and hormonal contraceptives.

How to recognize the symptoms of a beginning miscarriage?

As a rule, miscarriage begins with pulling pain in the lower abdomen. Feels like these pains resemble the first day of menstruation. This condition indicates an increase in uterine contractility, that is, the threat of miscarriage. The fruit does not suffer.

As the process progresses, the pain takes on a cramping character and blood discharge from the genital tract appears. Discharges may be slimming or moderate. This indicates a miscarriage has begun.

With detachment of the ovum from the uterus wall, a “complete” or “incomplete miscarriage” occurs. In either case, pregnancy cannot be saved. With complete miscarriage, bleeding from the genital tract increases - the discharge becomes abundant with clots. Fetal egg independently comes out of the uterus. After which the uterus is independently reduced, and the bleeding stops.

When incomplete miscarriage due to the fact that the fetus is not fully out of the uterus, the bleeding can be very long and abundant.

All the above symptoms at any stage of pregnancy require immediate treatment to the gynecologist.

Diagnosis of miscarriage threat

Diagnosis of spontaneous abortion is not difficult. When viewed on a chair, the gynecologist checks the size of the uterus to the expected duration of pregnancy, checks whether the tone of the uterus, whether or not the cervix is ​​open, determines the nature of the discharge - mucous, blood, with or without the remnants of the ovum.

To assess the condition of the fetus, an ultrasound of the pelvic and fetal organs is performed. At the same time determine the location of the ovum (if available), look, whether there is detachment. With the help of ultrasound, you can determine the hypertonicity of the uterus, that is, its excessive tension, which is a sign of the threat of miscarriage.

Based on the inspection and ultrasound is determined tactics for pregnant. All pregnant women with threatened abortion are to be hospitalized.

Treatment of pregnant women with threatened abortion

Tactics of treatment is determined depending on the ultrasound data, examination and clinical manifestations.

With threatened abortion or miscarriage that has begun, therapy is aimed at prolonging the pregnancy, provided that there is no detachment of the ovum. With partial detachment of the ovum, if the blood discharge is not very abundant, as happens when the miscarriage begins, they also carry out treatment aimed at preserving pregnancy.

But if the fertilized egg has already peeled off and the bleeding is abundant, then the treatment is already ineffective. In this case, curettage of the uterine cavity is performed with the removal of the remnants of the ovum. The resulting scraping is sent for cytogenetic research.

In late abortions, after removal of the remnants of the ovum, intravenous drugs are prescribed to reduce the uterus (Oxytocin). After scraping, antibiotics are prescribed.

Anti-Rh immunoglobulin is administered to women with a negative blood group for the prevention of Rh-conflict after curettage.

For better contraction of the uterus and to reduce blood loss, a bladder with cold water or ice is applied to the abdomen after scraping.

At discharge, the woman is recommended to undergo an outpatient examination by a gynecologist to determine the cause of the miscarriage, which includes: pelvic ultrasound, a urogenital infection test and TORCH infection, a blood test for hormones (DHEA, prolactin, 17-OH progesterone, progesterone, estradiol, LH, FSH, cortisol, testosterone), the study of thyroid hormones (TSH, St. T3, St. T4), coagulogram, hemostasiogram, cytogenetic study of the remnants of the ovum.

This is the main checklist. At the initiative of the doctor, it can be expanded. In addition, for 6 months, a woman is recommended to be protected from pregnancy with hormonal contraceptives to regulate hormonal levels.

If everything is normal with the fetus, then to prolong pregnancy use the following groups of drugs:

- progestins (Duphaston or Utrozhestan) for the correction of progesterone deficiency. They are prescribed up to 16 weeks gestation,
- glucocorticoids (Dexamethasone, Metipred) are prescribed for the correction of hyperandrogenism,
- sedatives (motherwort or Valerian tinctures),
- spasmolytics (No-shpa, Papaverin, Baralgin) to relax the muscles of the uterus,
- vitamins and trace elements (Magne B6, folic acid, vitamin E).

If the pregnancy has been maintained, then at discharge, the pregnant woman is recommended to continue taking the drugs prescribed in the hospital. This is especially true of gestagens and glucocorticoids, which should be used in continuous mode. If you abruptly stop using the drugs, you may again face the threat of miscarriage.

In addition, the pregnant woman needs physical and emotional rest, sexual abstinence.

To reduce the risk of miscarriage in the future, it is recommended to increase the consumption of complex carbohydrates (bread, pasta), fruits and vegetables rich in fiber, dairy products, fish, meat, vegetable oil and legumes.

Prevention of spontaneous abortions:

- healthy lifestyle,
- timely examination and treatment of gynecological and endocrine diseases,
- refusal of abortion.

Consultation of an obstetrician-gynecologist on the topic of miscarriage:

1. Can I get pregnant after a miscarriage?
Yes.

2. Does the doctor have the right to make scraping without prior ultrasound?
In emergency situations, if a woman enters the hospital with abundant bleeding, then there is no question of any preservation of pregnancy and curettage is carried out on an emergency basis without ultrasound. In other cases, ultrasound do necessarily.

3. I had a miscarriage and discharge stopped. Tell me, is it necessary to do scraping? Can the remains of the fetus remain in the uterus?
If there is no discharge, then most likely, everything has already happened and there is no need for curettage.

4. After a monthly delay, I had abundant blood discharge with clots. What is it? Miscarriage? Pregnancy test is negative.
According to the clinical picture is very similar to a miscarriage. Pregnancy tests sometimes give false results. Go to the gynecologist for an ultrasound.

5. Can sex provoke a miscarriage?
If the pregnancy is normal and there are no other causes of miscarriage, then sexual intercourse is safe.

6. After a miscarriage at 20 weeks, I had light yellow discharge from the nipples. Is this normal or necessary treatment?
This is a variant of the norm. Allocation will be held independently after the restoration of menstrual function.

7. Is it possible to use tampons during miscarriage?
It is impossible, they can contribute to infection of the genital tract. Use pads.

8. I have lower back pain. Could this indicate a threatened miscarriage?
Low back pain can be at risk of miscarriage. But normally, it is also possible the appearance of back pain due to the growth of the uterus. For an objective assessment of the condition, it is necessary to consult a gynecologist.

9. What can be done at home if during pregnancy abundant bleeding from the genital tract suddenly appeared?
Immediately call an ambulance and put an ice pack on your stomach.

10. How long do you need to be protected after a miscarriage?
Not less than 6 months.

Late miscarriage

Late spontaneous abortion (miscarriage) occurs in 2-4% of women with a clinically confirmed pregnancy, which is about 1/5 of all cases of its premature termination. The key difference in late miscarriage from preterm labor is the unviability of the fetus, which weighs up to 500 g during abortion and cannot develop on its own outside the uterus, which roughly corresponds to the 22nd week of gestation. There is a certain difference in the approaches of domestic and foreign obstetricians to the management of pregnant women with the threat of miscarriage. While waiting tactics are practiced abroad, in Russia, patients with threatened abortions are prescribed medication.

Causes of late miscarriage

In contrast to early spontaneous abortion, premature termination of pregnancy at 13-22 weeks in extremely rare cases caused by genetic abnormalities. By this time, the main organs of the fetus are already formed, and therefore they usually result in miscarriage:

  • Cervical insufficiency. Cervical failure of the cervix cause genetic abnormalities, hormonal disorders or mechanical damage in previous births. The omission of the fetal bladder and the opening of its membranes provokes a premature onset of labor. CI is detected in 15-40% of patients with recurrent miscarriage.
  • Pathology of the uterus. Abnormal development (single-horned, double-horned, saddle-shaped uterus), inflammatory processes, adenomyosis, submucosal fibroids, other benign and malignant neoplasms prevent the normal course of pregnancy.
  • Pathology of the placenta and umbilical cord. Late miscarriage may occur due to delayed maturation or hypoplasia of the placenta, the presence of cysts and areas of calcification in its tissues, inflammation and premature detachment. True nodes and umbilical cord thrombosis also lead to the death of the fetus.
  • Immunological factors. Spontaneous late abortion can be a consequence of the incompatibility of the blood of the mother and the fetus in the Rh or AB0 system.

In addition to the immediate causes leading to late abortion, there are a number of predisposing factors. Thus, pregnancy is often spontaneously terminated in patients with genital infections, dyshormonal conditions, concomitant somatic diseases (diabetes, arterial hypertension), gestosis. The risk of miscarriage increases in women who have previously undergone artificial abortion, gynecological surgery, invasive diagnostic procedures and complicated labor with cervical damage. Late abortion can also provoke injuries, intoxication, infectious diseases, significant physical and psychological stress.

The mechanism of late spontaneous interruption of the gestational period is determined by the reasons that caused it. At the same time, the uterus tone usually increases first and the contractile activity of the myometrium increases, which leads to shortening and opening of the cervix, rejection of the ovum from the uterine wall, followed by death and expulsion. Sometimes fetal death precedes late abortion. At the beginning of the second trimester, the shells are usually not opened during the miscarriage, the egg of the egg comes out entirely. After completion of the expulsion of all parts of the ovum, the myometrium is reduced, the bleeding stops.

Classification

Determining the form (stage) of late miscarriage is based on the symptoms and reversibility of the pathological process. Domestic specialists in the field of obstetrics and gynecology identify the following types of spontaneous late abortions:

  • Threatened miscarriage. It is characterized by an increase in the tone of the muscular layer of the uterus with the safety of the placenta, fetus and membranes.
  • Miscarriage. Against the background of ajar or open cervix, fetal rejection begins.
  • Abortion in progress. The fetus and its surrounding membranes are partially or completely expelled from the uterus. Respectively distinguish incomplete and complete miscarriage.
  • Missed abortion (missed abortion). Observed with fetal death and failure of the contractile function of the myometrium.

Foreign experts offer a slightly different approach. In the WHO classification, a late abortion and miscarriage in progress are a common category - an inevitable miscarriage, in which the pregnancy cannot be maintained.

Symptoms of a late miscarriage

Clinical manifestations depend on the stage of abortion. Patients with the threat of late miscarriage complain of pulling pain in the lower abdomen and lower back. Vaginal discharge is usually absent, rarely smearing bloody. At the beginning of miscarriage, the painful sensations increase, the discharge with blood admixture appears or amplifies. At the stage of abortion in the course of the uterine muscles is reduced regularly, which is subjectively perceived by the patient as cramping pain, there are abundant bleeding, the fertilized egg departs completely or partially. After the expulsion of the fetus, the placenta and the membranes, the pain disappears, the bleeding stops, and for some time there may be a scant discharge.

In case of late miscarriage, characteristic pain and bleeding are absent. In the expected period does not appear movement of the fetus, and if such movements were noted earlier, they stop. The patient notes the disappearance of subjective signs of a previously diagnosed pregnancy and the softening of the mammary glands. 3-4 weeks after the death of the fetus, there may be signs of general malaise with weakness, dizziness, fever to subfebrile numbers. In some cases, it is during this period that the typical symptoms of miscarriage develop.

Complications

Delay in the uterine cavity of the fetus, its membranes or placenta causes massive bleeding, leading to significant blood loss and can cause hypovolemic shock. Adherence to the miscarriage of the inflammatory process is manifested by the clinic of an infected abortion - a serious condition characterized by chills, fever, general malaise, bloody or pussy vaginal discharge, severe pain in the lower abdomen. Subsequently, these patients increase the risk of developing inflammatory and dyshormonal gynecological diseases. The long-term consequence of late miscarriage is an increased likelihood of spontaneous termination of subsequent pregnancies. In addition, the stress experienced by a woman sometimes provokes the development of depression and psychological problems.

Treatment of late miscarriage

Therapeutic tactics for spontaneous abortion depends on its form. При наличии угрозы выкидыша рекомендовано медикаментозное лечение и охранительный режим с отказом от физической активности и половых отношений. Пациентке назначают:

  • Гормональные препараты. Особенно эффективно применение гестагенов в сочетании с витамином Е.
  • Antispasmodics. Drugs can reduce the tone of the myometrium and, accordingly, reduce pain.
  • Methylxanthines. Medications of this group relax the myometrium, reduce the risk of thrombosis, improve blood circulation in the tissues of the uterus and the placenta.
  • Sedatives. To reduce the psychological stress experienced by a pregnant woman, use magnesium preparations, motherwort broth or valerian.

After eliminating the threat of late termination of pregnancy, further management of the patient depends on the reasons that provoked this condition. At detection of isthmic-cervical insufficiency, sutures are imposed on the cervix, or an unloading obstetric pessary (Meyer's ring) is installed in the vagina. The tactics of treatment of identified gynecological and associated diseases should take into account the specifics of the appointment of various groups of drugs during pregnancy. Maintaining a pregnant woman in the diagnosis of intrauterine infection of the fetus or chromosomal aberrations is determined by the type of pathogen and genetic abnormalities.

Late incomplete abortion is a direct indication for the provision of emergency surgical care, to avoid significant blood loss. In such cases, the remnants of the ovum are removed with fingers, a curette or a vacuum aspirator. In parallel, a dropper with oxytocin is prescribed. With a likely complete abortion at 13-16 weeks of pregnancy, ultrasound control and curettage of the uterus are recommended when decidual tissue and elements of the ovum are detected in its cavity. If the miscarriage occurred at a later gestational period, and the uterus is well reduced, you can do without curettage.

The tactics of the patient with failed miscarriage and the dead fetus depends on the duration of pregnancy. Until the 16th week, the fertilized egg is removed by instrumental methods, with a longer period of labor, labor is stimulated with medication. For this purpose, sodium chloride solution is administered intraamnially, antiprogestagens and prostaglandins are prescribed. After a spontaneous abortion, antianemic and preventive antibiotic therapy is indicated. Patients with Rh negative blood are advised to administer anti-Rh immunoglobulin.

Prognosis and prevention

The prognosis for the fetus and the pregnant woman is determined by the reasons that provoked a late miscarriage. In the absence of developmental abnormalities and gross anatomical changes of the uterus, the timely appointment of a protective regimen and drug treatment in most cases allows you to save the pregnancy. With the beginning, incomplete, complete and failed abortion, the preservation of pregnancy is impossible, and the main efforts of obstetrician-gynecologists are aimed at helping the woman. After a miscarriage, the risk of repeated spontaneous abortion increases by 3-5%. For preventive purposes, planning for conception, preventive treatment of female inflammatory diseases of the female genitalia, timely registration and regular follow-up at antenatal clinics are recommended for women with the potential threat of termination of pregnancy.

Psychological symptoms Edit

Despite the fact that a woman physically recovers quickly after a miscarriage, psychological rehabilitation can take a long time. Much depends on the individual characteristics: for some, several months are enough to move on, while others may take more than a year. Questioning (GHQ-12 General Health Questionnaire (General Health Questionnaire)), in which women with abortive pregnancies were surveyed, showed that half (55%) of them experienced a significant psychological disorder immediately after abortion, 25% within 3 x months, 18% - 6 months, and 11% for a year after a miscarriage. [9]

The sense of loss, lack of understanding from others is of great importance. People who have not experienced a miscarriage, it is difficult to empathize with those who had it. Pregnancy and miscarriage are often not mentioned in communication, because this topic is too painful. This can make a woman feel more isolated from everyone. The interaction of pregnant women with newborn children is painful for parents who have experienced a miscarriage. Sometimes it makes it difficult to communicate with friends, acquaintances and family. [ten]

Miscarriage can occur for various reasons, not all of which can be detected in time. Main reasons:

  • Genetic disorders
  • Hormonal imbalance,
  • Infectious diseases of women
  • Chronic diseases
  • Abnormalities in the structure of the genitals and postponed abortions,
  • Immunological reasons
  • Heavy physical exertion. [eleven]

Most clinical miscarriages (two thirds or three quarters in different studies) occur during the first trimester. [12] [13] Chromosomal abnormalities occur in more than half of the embryos after a miscarriage in the first 13 weeks. [14] A pregnancy with a genetic problem with a 95% chance ends in miscarriage. Most chromosomal problems occur by chance, have nothing to do with their parents and are unlikely to recur. Chromosomal problems associated with parental genes, however, are possible. In the case of repeated miscarriages, there is a possibility of genetic disorders in one of the parents of the child. Also, this reason should be considered if the parents have children or close relatives with disabilities or defects. Genetic problems are more likely to occur with older parents. [15]

Another cause of early miscarriage may be progesterone deficiency. For women with low progesterone levels in the second half of the menstrual cycle (luteal phase), progesterone support may be recommended in the first trimester. However, no study has shown that drug progesterone support reduces the risk of miscarriage (when the mother may have already lost the child). [16] Even the connection between the luteal phase problem and miscarriage is questionable. [17]

Up to 15% of second-trimester pregnancy losses may be associated with uterine malformation, a neoplasm in the uterus (myoma), or problems with the cervix. These conditions can also lead to preterm labor.
One study found that 19% of second-trimester pregnancy losses were caused by cord problems. Problems with the placenta can be a significant number of late miscarriages.

  • The age of the pregnant.
  • Multiple pregnancy.
  • Diabetes mellitus in the stage of decompensation (uncontrolled). Since diabetes can develop during pregnancy (gestational diabetes), an important part of antenatal care is monitoring the signs of the disease.
  • Polycystic ovary syndrome.
  • Increased blood pressure (pre-eclampsia).
  • Severe hypothyroidism. The presence of antithyroid autoantibodies is associated with an increased risk of miscarriage.
  • Some infectious diseases: measles, rubella, chlamydia, etc.
  • Smoking. Increased risk of miscarriage is also associated with the father smoker. In one study [source not specified 1161 days] It was noted that the risk for husbands who smoke less than 20 cigarettes per day increased by 4%, and 81% for husbands who smoke more than 20 cigarettes a day.
  • Drug addiction.
  • Physical injuries, exposure to environmental toxins.
  • The use of the Navy at the time of conception.
  • Antidepressants paroxetine and venlafaxine can lead to spontaneous abortion.

Several factors have been associated with a higher frequency of miscarriages, but it remains to be seen if they are causes of miscarriages.

Some studies suggest that autoimmune diseases are a possible cause of recurrent or late miscarriage. Such diseases occur when the immune system acts "against the host organism." Thus, it destroys the growing fetus or interferes with the normal progression of pregnancy. Further studies have also shown that autoimmune diseases can cause genetic disorders in embryos, which in turn can lead to miscarriage.

Pregnant nausea and vomiting are associated with a reduced risk of miscarriage.

One of the risk factors are exercise. The study (which one? –– Ed.) Showed that most types of exercise (with the exception of swimming) are associated with an increased risk of miscarriage up to 18 weeks. Shock-resistant (what is it. –– Ed.) Exercises are especially associated with an increased risk of miscarriage. No relationship was found between exercise and miscarriage after 18 weeks of gestation.

Miscarriage can be detected using special ultrasound equipment. When searching for microscopic abnormal symptoms of miscarriage, you should look at the picture. Microscopic include villi, trophoblast, part of the fetus. You can also perform genetic tests to look for abnormal chromosomes. The role in morphological research is to identify and study the morphological changes in the material obtained during spontaneous abortions.

Blood loss during early pregnancy is the most common symptom. In case of blood loss and / or pain, transvaginal ultrasound is performed. If ultrasound does not establish the viability of an intrauterine pregnancy, certain tests must be performed to rule out an ectopic pregnancy, which is life threatening.
If the bleeding is not strong, then it is recommended to go to the doctor, and if the bleeding is heavy, there is significant pain or there is a fever, then it is imperative to consult a doctor.
In case of incomplete abortion, empty bag or missed abortion, there are three treatment options:

  • If untreated (wait-and-see tactics), everything will naturally occur within two to six weeks. This way avoids the side effects caused by medications and surgeries.
  • Drug treatment usually involves the use of misoprostol and contributes to the completion of the miscarriage.
  • Surgical treatment (most often vacuum aspiration) is the fastest way to complete a miscarriage. It also reduces the duration and severity of bleeding, and also helps to avoid the physical pain associated with miscarriage. In the case of re-miscarriage, vacuum aspiration is also the most convenient way to obtain tissue samples for karyotype analysis. However, this operation also has a high risk of complications, including the risk of damage to the cervix and the uterus itself, perforation of the uterus, scars and potential intrauterine lining. This is an important factor for those women who would like to have children in the future, to maintain their fertility and reduce the likelihood of future obstetric complications.

There is currently no way to prevent miscarriage. Nevertheless, experts believe that identifying the causes of miscarriage can help prevent its recurrence in subsequent pregnancies.

Determining the prevalence of miscarriage is difficult. Many miscarriages occur at the very beginning of a pregnancy, before a woman finds out that she is pregnant. Prospective studies using tests of very early pregnancies showed that 26% of miscarriages occur for up to six weeks from the date of the beginning of the last menstruation of a woman. However, there are other sources claiming something else:

  • University of Ottawa: "The frequency of spontaneous abortions is 50% of all pregnancies due to the fact that many terminate the pregnancy spontaneously and without clinical intervention.
  • NIH reports: "Up to half of all fertilized eggs die before the woman finds out she is pregnant. Among those women who know about their pregnancy, miscarriage is about 15-20%. Clinical miscarriages occur in 8% of pregnancies.

The risk of miscarriage falls sharply after 10 weeks from the last menstruation of a woman.

The prevalence of miscarriage increases significantly with the age of the parents. Pregnancy at age 25 has a 60% lower risk of miscarriage than pregnancy at age 40.

Miscarriage occurs in all animals. There are a number of known risk factors for miscarriage in non-human animals. In sheep, for example, this may be due to a crowd of people or due to a dog chase. In cows, miscarriage can occur due to an infectious disease, but can often be controlled by vaccination. [ source not specified 1161 days ]

How often is pregnancy terminated?

It is believed that at least 20% of all conceptions end in spontaneous abortion. It is possible that this figure is undervalued. After all, many women are not even aware of the terminated pregnancy, when it occurs at week 4, taking it for the delayed periods. The percentage of such events increases with the age of the woman.

  • 80% of all sudden abortions are 1 trimester loss
  • 90% loss in the first trimester and about 30% in the second - a consequence of random chromosomal abnormalities, which most likely will not recur
  • more than half of all women with threatened miscarriages successfully bear pregnancy to 40 weeks
  • At age 40, a woman has a 50% risk of spontaneous abortion.

Probable causes of abortion

  • Disruption of the development of the embryo (chromosomal and genetic damage, deformities)
  • Immune failures
  • Abnormalities of the uterus and its tumors
  • Neck failure
  • Hormonal causes
  • Maternal infection
  • Mother's systemic illness
  • Poisoning, injuries
  • Other

Unfortunately, it is not always possible to establish the exact cause of such an event. This involves most of the anxieties of parents planning a new pregnancy after a failure.

Immune failures

The phrase "antiphospholipid syndrome" in recent years has been feared by all women who have lost their pregnancy at least once. It is this diagnosis that they are trying in vain to find in case of a spontaneous abortion up to 12 weeks, passing unnecessary tests.

APS is a syndrome in which antibodies to its own proteins are formed in the body. As a result, there are thrombosis, thromboembolism in the absence of visible causes of miscarriage in the early stages of 10 weeks. In addition, the risk of fetal growth retardation and severe pre-eclampsia is increased. True APS requires treatment for all subsequent pregnancies.

In addition to the detection of antiphospholipid antibodies, certain symptoms are needed for the diagnosis of the syndrome (unexplained miscarriage of pregnancy, thrombosis). Therefore, it makes no sense to be checked for APS during the first pregnancy or after a single loss in the early periods.

Cervical (isthmic-cervical) insufficiency

In the second trimester, the role of cervical failure increases in the structure of spontaneous miscarriages. In this case, the cervix prematurely softens and shortens, which leads to the discharge of amniotic fluid and the beginning of labor. The cause of this condition can be trauma during gynecological manipulations, anatomical features, frequent artificial abortions. Most often, this process is asymptomatic, only occasionally discharge or pain may occur. Therefore, absolutely all women in the period of 19-21 weeks need to undergo cervicometry - measurement of the length of the cervix using an intravaginal ultrasound probe.

Hormonal causes

There is some evidence that low progesterone levels can cause miscarriage. The lack of the luteal phase is the manifestation of progesterone deficiency. In reality, this condition is less common than the diagnosis. Sometimes NLF is combined with changes in the ovaries, pituitary, and other endocrine organs. Very often, low progesterone is successfully combined with a normal pregnancy.

High fever and severe intoxication of the maternal organism can stimulate contractions of the uterus and cause termination of pregnancy. Therefore, any infection is potentially dangerous. However, some diseases are especially often threatened with miscarriage. This is rubella, toxoplasmosis, listeriosis, brucellosis (see the causes of intrauterine infection in newborns). Other infections are not associated with increased abortion rates. It is important to note that in the case of repeated abortions, the role of the infection is sharply reduced.

Mother's systemic illness

There are diseases that not only complicate the course of pregnancy, but may increase the incidence of spontaneous abortions. These include:

  • Diabetes mellitus (with poor glucose control)
  • Diseases of the thyroid gland
  • Blood clotting disorder
  • Autoimmune diseases

Poisoning and injuries

A clear link between toxic substances and abortion has not been established. It is believed that working with organic solvents and narcotic gases can trigger an abortion. The same effect has smoking, large doses of alcohol and drugs.

Abdominal accidents, as well as surgery on the ovaries and intestines can be dangerous during pregnancy. But the embryo in the uterus has good protection, so most of these interventions end safely.

Myths about the causes of early pregnancy loss

Up to 13 weeks, abortion is almost never associated with the following factors:

  • Airplane flight
  • Mild blunt abdominal trauma
  • Sports (adequate)
  • One previous miscarriage up to 12 weeks
  • Sexual activity
  • Stress

How to recognize an abortion?

There are several major symptoms of miscarriage:

  • Bleeding of varying intensity

Выделение крови объясняется частичной или полной отслойкой хориона (будущей плаценты). Если эта отслойка произошла в верхних отделах матки, то кровь может не выходить наружу, а образовывать ретрохориальную гематому. With a threatened abortion, there may be mild bleeding that goes on independently and without consequences, and with abortion in the course of bleeding can be quite abundant.

Pain sensations are usually localized above the pubis, can give in the groin, lower back and have different intensity. They may be permanent or cramped. It is important that most pregnant women during all the 9 months can experience various unpleasant and unusual sensations in the abdomen area, which in no way threaten the baby. All doubts about the nature of pain can dispel the doctor of female consultation.

  • The exit of parts of the embryo from the genital tract

Most abortions end on their own after all parts of the embryo exit. This symptom is a definitive confirmation of the diagnosis, but sometimes a woman confuses blood clots with an embryo.

  • Amniotic fluid outpouring

In the second trimester, the outpouring of the amniotic fluid always speaks of imminent abortion. Following the rupture of the membranes followed by contractions and the exit of the fetus. Sometimes during pregnancy, urinary incontinence or abundant vaginal discharge may occur. When in doubt about the nature of the liquid, it is better to immediately consult a doctor for special tests. Available in pharmacies test pads for amniotic fluid can give a false positive result.

When do I need to see a doctor urgently?

  • Bleeding at any time.
  • Severe cramping pain in the lower abdomen
  • Pain or discomfort in the groin area that appeared for the first time.
  • Isolation of large amounts of colorless fluid from the vagina.
  • Temperature increase, deterioration of the general condition.

Diagnosis for symptoms of miscarriage

With the help of an ultrasound sensor, it is possible to detect the ovum from 3-4 weeks of gestation, and at a later date it is possible to find the heartbeat of the embryo. It is believed that if with a minor bleeding and a closed cervix, the doctor detects the heartbeat of the fetus, then the probability of making this pregnancy before the period is 97%. If the blood from the genital tract is combined with a strongly deformed fetal egg, too small an embryo or lack of a heartbeat, then an abortion is considered inevitable.

Often, with bleeding or severe lower abdominal pain, an ultrasound hematoma can be detected on an ultrasound. With small sizes, it is not dangerous and requires only observation. With significant detachment and large hematoma, there is a high risk of abortion and severe bleeding.

The determination of chorionic gonadotropin is advisable to carry out only in very early periods, when the viability of the embryo cannot be determined by ultrasound. With a high-quality ultrasound study, this is no longer necessary. If the gestation period is 3-4 weeks, and the fertilized egg is not found, then it makes sense to determine HCG twice, with an interval of 48 hours. Depending on the results, ultrasound is repeated or a miscarriage is ascertained.

Oddly enough, sometimes when bleeding do smear oncocytology. This is necessary if there is a living embryo on the ultrasound, there is no visible hematoma in the chorion, and the bleeding continues. In this case, a swab eliminates cervical cancer.

Treatment of threatened abortion

depends on its intended reason. Directly affect the course of events in the early stages (up to 12 weeks) is almost impossible. Usually prescribed tranexam (to stop bleeding) and utrozhestan (with unsuccessful previous pregnancies). In the second trimester, it is possible to slow the shortening of the cervix in the ICN (by stitching and pessary). This treatment methods are exhausted. In many countries, early miscarriages do not even try to treat due to the high frequency of chromosomal abnormalities. Recently, studies have appeared that Utrozhestan in candles does not prevent the release of an abnormal embryo, and therefore can be used for short periods.

what NOT NECESSARY with bleeding in early pregnancy (threatened abortion):

All of the above tools and measures are ineffective, and therefore are not recommended by leading Russian and foreign associations of obstetricians and gynecologists. Some old treatments, such as bed rest, can even harm a pregnant woman. With limited mobility increases the risk of constipation, thrombosis, stress, which leads to various complications.

Complete abortion

This condition usually does not require treatment or even observation. Usually, doctors recommend testing for hCG 3 weeks after the end of the pregnancy. If he returns to normal, then you can safely live on. If hCG has not decreased or has fallen inadequately, then blistering can be suspected - a dangerous condition requiring treatment.

Abortion in progress

If, when examined by a doctor, the bleeding still continues, and the egg of the gestation or the dead embryo has not yet left the uterus, then three approaches are used:

  • waiting (wait for an independent resolution of the situation within 7 days)
  • medication completion (taking misoprostol to reduce the uterus and expulsion of the ovum)
  • vacuum aspiration or curettage (cleaning) of the uterine cavity (with severe bleeding or the failure of other methods)

The question of how to complete the abortion is decided by the doctor. Therefore, it is extremely important to consult a specialist and be observed with him before the end of the process. When life-threatening bleeding is prescribed hemostatic agents, and sometimes have to transfuse blood components in a hospital.

When is progesterone prescribed?

Hormonal support (utrozhestan in candles intravaginally) is appointed in the following cases:

  • two or more spontaneous abortions for periods of less than 20 weeks
  • one miscarriage in the period of 20 weeks in women over 35 years old or with past infertility
  • proven deficiency of the luteal phase of the cycle
  • threatened miscarriage in case of cervical insufficiency (arbitrary shortening of the cervix is ​​less than 25 mm)

In the first two cases, Utrogestan (micronized progesterone) is used for prophylaxis, starting from preparing for pregnancy and up to 10-12 weeks. With the existing threat of abortion up to 20 weeks, the drug is prescribed until the symptoms disappear.

How to recover from a miscarriage?

Losing a desired pregnancy is always stressful for a woman. To him is added concern about the success of future pregnancies. Therefore, it is extremely important to rehabilitate your health and mood before planning offspring (see also the effects of abortion and rehabilitation).

  • When infection of the genital tract (if the bleeding is prolonged, for example), the doctor prescribes antibiotics. It makes no sense to take them only for preventive purposes with independent abortion. If its completion was stimulated by misoprostol, then the fever on the first day will be due to the medication, not the infection, so do not worry. During surgery, a single prophylactic antibacterial drug is usually prescribed.
  • If the loss of pregnancy was accompanied by significant bleeding, then iron supplements may be needed to treat anemia.
  • Under certain circumstances, a gynecologist may recommend the use of contraceptives. But with uncomplicated spontaneous abortion at different times, you can start planning for pregnancy, as soon as there is a psychological mood.
  • With habitual miscarriage (3 or more spontaneous abortions in a row), you must go through additional procedures and pass tests.

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