Any manifestations of pain and bleeding during pregnancy require immediate medical attention. This may be a signal for the onset of a miscarriage. The first question of any woman who is threatened with a miscarriage during pregnancy is what to do? The answer is - do not panic ahead of time! If everything is done correctly, miscarriage can be avoided, having subsequently given birth to a healthy child.
Miscarriage is a complication of pregnancy with spontaneous rejection of the fetus in a period in which the child is not viable outside the uterus. The difference between miscarriage and premature birth is simple: after childbirth the child can be saved, as his organs are viable and developed, after a miscarriage - the survival of the fetus is impossible. Thanks to the achievements of modern medicine, the ability to maintain life outside the mother's womb, even in the most immature fetus, has been maximally increased. In developed countries, babies born on the 25th week of pregnancy are already safely nursed. In this case, premature infants subsequently do not lose the ability to grow and it is normal to develop.
Specialists distinguish spontaneous miscarriages, are caused by natural causes, as well as artificial (abortion or abortion). The latter can be provoked, for example, for medical reasons. Next we will talk about spontaneous miscarriages.
Causes of miscarriages
They can be different, depending on the woman's health, her history of previous pregnancies, the presence of abortions and so on. More than 60% of miscarriages are caused by blastocyst pathology, and sometimes maternal factors and other causes play a decisive role. In 10-15% of pregnancies, miscarriages are accidental, with no apparent predispositions.
Blastotcystosis is the most common cause of the threat of miscarriage in pregnancy. It entails anomalies in the formation of the fetus, which do not indicate the possibility of its maturation. Blastocystosis most often occurs by the fusion of "bad" sex cells of the mother and father. In these cases, miscarriage usually occurs at the beginning of 6-7 weeks of pregnancy. To do with this, almost nothing can. And it is not worth it, because the child as a result of blastocystosis is not normal. In a consequence, if the mother is healthy and there are no contraindications, you can immediately plan the next pregnancy. The likelihood of recurrence of miscarriage for the same reason is negligible.
The causes of miscarriage in the development of the fetus:
- pathology of germ cells (oocytes and spermatozoa) - often with recurrent miscarriages;
- serological conflict;
- chromosomal defects of the fetus;
- developmental defects (defects of the nervous system, heart disease, biochemical defects, etc.)
- defects in the development of the umbilical cord;
- Defect caused by anterograde chorionic fetal death
Causes of miscarriage in the mother's state:
- local changes in the reproductive organs, such as uterine malformations, its retardation, tumors, uterine fibroids, cervical lesions. Also, miscarriage is affected by erosion (often causes ectopic pregnancy), polyps, cervical cancer, adhesions after inflammatory lesions. The threat of miscarriage during pregnancy can be caused by abnormalities in the development of the placenta. Women who had similar anomalies should be under strict medical supervision during the year. Pregnant during this period is strictly contraindicated.
- the maximum age of the mother. The late arrival of the first pregnancy after 38 years is considered to be late.
- illness in the mother. These include: acute common diseases, viral diseases that are due to high fever, chronic diseases (such as syphilis or toxoplasmosis), endocrine function pathology (eg, diabetes), mechanical trauma, shock, mental and hormonal disorders, e.
- rupture of membranes and intrauterine infection.
- complications due to diagnostic procedures (occur in rare cases): when examining the fetus with a special endoscope, with an amniocentesis test, with a fetal biopsy (stretching the outer layer of the fetal membranes of the embryo - puncture of the umbilical vein).
- eating disorders.
- mental and emotional factors, such as fear of pregnancy, mental agitation.
An increased risk of miscarriage in women occurs after infertility treatment, in multiple pregnancy and in women who drink alcohol and smoke during pregnancy. Often, the threat of miscarriage occurs after an abortion - develops miscarriage (loss of 3 or more pregnancies in a row).
It is worth to clarify that myoma does not always entail a miscarriage. It in general is rarely seen in young women (more common in 40-year-olds). Many women with uterine myoma without problems become pregnant, but in the second or third trimester of pregnancy may have problems. With the observation of doctors, the opportunity to give birth to a healthy child is great enough. In addition, myoma rarely causes repeated miscarriages.
Symptoms of miscarriage
Signs of impending miscarriage are painless vaginal bleeding occurring in the first trimester of pregnancy (until the end of the 16th week). Symptoms of miscarriage often fall on the period of regular menstruation for 4, 8 and 12 weeks of pregnancy. Also, miscarriages often occur around the 14th week of pregnancy, at a time when the placenta is being formed, and the production of hormones in the yellow body is significantly reduced.
First the bleeding is weak, then the blood turns dark, becomes brown. Sometimes it mixes with mucus. Bleeding can be short-lived and insignificant. It also happens that it resembles a normal menstrual cycle. Vaginal bleeding in early pregnancy is common and usually occurs once in four confirmed pregnancies. It's always the mother's blood, not the fruit. It happens that the bleeding is insignificant and resolved spontaneously in a short time. However, if the bleeding grows and is accompanied by dull pain in the lower abdomen - this is definitely the beginning of the miscarriage. If there is further intensification of these symptoms, rejection of blastocysts or parts of the cervix uteri - a miscarriage is already under way.
Incomplete, complete, erroneous miscarriage
When a miscarriage is already under way and the tissues of the placenta or fetal sac (possibly with the embryo) fall into the vagina - we are dealing with incomplete miscarriage. In this case, miscarriage threatens the condition of the uterus, the size of which corresponds to the development of pregnancy and the cervical canal is open. With incomplete miscarriage, part of the tissue is excluded, and part of the blastocysts and small fragments of the chorion biopsy remain in the uterus. Remains cause bleeding, which can persist for a long time. In this case, the cleaning of the uterus is required, because otherwise a woman is threatened with intrauterine bleeding or infection. Cleaning is done under anesthesia.
If all parts of the fetus with the placenta were expelled from the uterus - a miscarriage is complete. Usually it happens very early - in the seventh week. The uterus is empty and does not require additional cleaning.
Miscarriage is a frozen pregnancy. In this case, the embryo is dead, but the pregnancy continues. A dead fetus can remain in the uterus for several weeks, even months. The uterus ceases to grow, but its neck is tightly closed. The results of pregnancy tests may be uncertain within a few weeks after the fetal death. The best way to determine whether the embryo is alive is by ultrasound. At the fifth week of pregnancy, you can already see the heartbeat of the fetus. If your doctor decides that the pregnancy is frozen, the fetus should be removed as soon as possible.
The cause of bleeding may be partial separation of the placenta or membranes from the uterine wall. Sometimes the death of the embryo and, consequently, miscarriage occurs even with scarce and short-term bleeding. Pregnant women who have begun to bleed should always keep blood samples on a piece of tissue so that the doctor can study them.
Treatment and prevention of miscarriages
In some cases, miscarriage can be effectively prevented. In this case, treatment depends on the cause and nature of complications of pregnancy. So different are the consequences of the threat of miscarriage during pregnancy, that conclusions can not be drawn in advance. Sometimes you can give birth to a healthy child and in the future not have any problems with pregnancy.
To begin with, when a miscarriage threatens, conservative treatment is used, during which the woman should immediately undergo a medical examination and take medication as prescribed by the doctor. Typically, these diastolic drugs, sedatives, painkillers, and sometimes hormonal (including drugs that block the production of prostaglandins). Sometimes a woman simply needs to provide a friendly atmosphere at this difficult time for her to avoid taking sedatives. The patient must always lie in bed.
For any, even the slightest spotting during pregnancy, you should consult your doctor in the near future. He may perform an ultrasound scan to determine on this basis whether the embryo is alive. If so, the woman usually goes to the department of pregnancy pathology in order to maintain pregnancy. In 90% of cases it passes successfully, and the pregnancy ends with the birth of a healthy child, usually on time. However, since there is a risk of premature birth, pregnancy should be carefully checked. It happens that a woman "lives" in the ward for several weeks, and sometimes for several months.
With cervical defects in the second trimester of pregnancy, overlapping of the circumferential seams on the cervix is performed. This reduces the degree of its failure. The neck must be closed during pregnancy, otherwise the egg can fall out of the uterus. Such treatment is effective in 80% of cases. It is very important that when the pregnant woman is admitted to the birth the doctor announced that he had created such a seam!
If during pregnancy there is a rapid outflow of amniotic fluid or a woman noticed a constant flowing trickle - this can lead to rupture of the membrane. In such a situation, a woman should be immediately hospitalized. The spontaneous onset of labor is very difficult to stop. In prenatal infection, induction of labor is necessary. Sometimes the membrane heals independently and pregnancy proceeds correctly.
To prevent loss of pregnancy due to serological conflict (which is now rarely the cause of miscarriage), sometimes an exchange transfusion is performed during pregnancy. It is designed to remove damaged cells, antibodies and excess bilirubin. In the course of exchange transfusion, 75% of the child's blood changes. This does not change his blood in fact, because the baby will continue to produce blood cells with its own antigens. Patients also receive supportive therapy that includes intravenous administration of the albumin solution to reduce the risk of free bilirubin entering the brain.
Patients for the prevention of incompatibility are administered immunoglobulin Rh D 72 hours after childbirth, miscarriages and abortions. The product contains a large amount of anti-Rh. It works by eliminating Rh-positive fetal blood cells that have penetrated the mother's bloodstream. The use of this drug protects against disease, and also protects the child during subsequent pregnancy. This procedure should be repeated after each birth and miscarriage.
If, however, the serological conflict occurs in the second trimester of pregnancy, then, as a rule, the process precedes the fetal death, and then the miscarriage. Subsequent pregnancy in such situations, as a rule, is very carefully monitored and usually ends with the successful birth of a healthy child.
After a miscarriage
First of all, you should wait with the introduction of sexual intercourse for at least 2 weeks (do not also apply tampons during this period). Some women resume sexual activity only after the first menstruation after a miscarriage, which usually appears 4-6 weeks after losing pregnancy.
Ovulation usually precedes menstruation, so that after a miscarriage, there is a risk of rapid subsequent pregnancy. Experts recommend using contraceptive methods at least three, four months after the miscarriage. It should be recognized that there are known risks associated with the rapid onset of the next pregnancy after miscarriage. But wait is preferable not for medical reasons, but for psychological reasons. A woman after a pregnancy loss is concerned about what will happen next. She feels fear and constantly asks herself if she will be able to conceive again and give birth to a child. This is an abnormal mental state that does not contribute to the orderly development of pregnancy.
Miscarriages usually do not cause each other. The first miscarriage does not mean that with the next pregnancy will be the same. After three consecutive miscarriages, the chances of having a baby are 70%, four - 50%. If you lost your first pregnancy in the first three months, then the risk of losing another pregnancy is only slightly higher than that of the rest. Thus, although there is no guarantee that another pregnancy will take place without any interference, miscarriage does not cancel the chance of a happy motherhood.
How often do miscarriages occur?
It is believed that one of the seven confirmed pregnancies results in miscarriage. For example, in the UK, a pregnancy loses 100,000 women a year. This means hundreds of miscarriages per day. This scale is significantly increased when considering unconfirmed pregnancies. That is, in cases in which a woman had a miscarriage, before she realized that she was pregnant. This is three quarters of all embryo losses.
At 20% of pregnant women at the beginning of pregnancy there is a bleeding, half of which is evidence of miscarriage. 1 out of 10 pregnancies ends with a spontaneous miscarriage. 75% of miscarriages occur in the first trimester of pregnancy, i.e. up to 12 weeks from its inception. The incidence of miscarriages is higher in young women (under the age of 25) and only before the onset of menopause.