How an early miscarriage occurs. Early miscarriage: treatment and its effectiveness. Is it worth keeping the pregnancy? Spontaneous miscarriage in early pregnancy

03.07.2019

Unfortunately, quite often in the modern world, an early miscarriage occurs (symptoms up to 2 weeks with the photo will be lower). The most common and unpleasant phenomenon is spontaneous abortion in the first trimester. It is extremely important, before planning a pregnancy, to bypass the factors that can cause such a bitter result of such a short pregnancy.

What causes a miscarriage?

Before studying the symptoms, you should find out why the baby's development process was interrupted. In fact, there are many reasons for the interruption of fetal development at an early stage.

Basically, an unpleasant phenomenon occurs due to certain abnormalities in the development of the fetus. This situation is caused by viruses entering the body, bad habits, poor ecology and taking medications. Many in the early stages try to leave closer to the sea in order to breathe fresh air. It is impossible to prevent an early miscarriage (we will describe symptoms up to 2 weeks with a photo) caused by a genetic disorder in the fetus.
Another reason can be hormonal disruption. In other words, a lack, or excessive production of hormones, leads to abnormal development of the baby. Basically, there is a lack of progesterone in the body of a pregnant woman. If you take action in time, you can prevent unwanted interruption in the development of the embryo. The hormones of the adrenal glands and the thyroid gland have a strong effect on the formation of the embryo.
Few people know, but termination of pregnancy can occur due to the mismatch of the Rh factors of both partners. In this case, specialists prescribe the necessary therapy to protect the fetus.
Another reason can be sexually transmitted infections. Bacteria infect the embryo and membranes, resulting in spontaneous embryo rejection. This can be prevented by being cured before conception.
Abortion also contributes to the interruption of fetal development. It is better not to practice such an intervention, because the consequences can be the most dire. You can read onforum about early miscarriages, symptoms up to 2 weeks and see photos.
Taking certain medications can also cause abrupt termination of pregnancy. During pregnancy, it is better to refuse any medication.
It is strictly forbidden for a pregnant woman to be nervous. This can cause abnormalities in the development of the fetus.
You also need to give up bad habits. If there is a risk of termination of pregnancy, it is better to refrain from intercourse at the initial stage.

As a result of fetal death, placental abruption occurs, which provokes an interruption in the development of the embryo.

Symptoms of an early miscarriage

What are the symptoms of rejection of the fetus up to 2 weeks? Sometimes a pregnant woman confuses this process with the onset of PMS, as spotting appears. This happens in the early stages, when she does not yet know that an embryo has already begun. But a little later, fetal rejection can be recognized by various factors.

Spontaneous termination of pregnancy can be manifested by bleeding. They can be long and plentiful. If too much blood has flowed out, then it will no longer be possible to save the child. At the first sign of such a phenomenon, you should immediately consult a doctor!
A woman may feel a sharp pain in the lower abdomen. But not everyone has a painful sensation, so you may not even understand that there was an early miscarriage (symptoms up to 2 weeks with a photo).
You can feel how the uterus has become "stone", and the stomach has become hard. All of this can be accompanied by pain.

Some may have a high pain threshold, while others may have a low pain threshold. For this reason, they may not recognize the termination of pregnancy. Often bloody discharge with impurities serves as a signal to this unpleasant process.

What to do?

Knowing everything symptoms up to 2 weeks, failed to preventearly miscarriagethen some recovery measures should be taken.

If there is a complete rejection of the embryo, then the victim will not need any treatment. In a month, her body will recover on its own.
After the fetus has been rejected, the doctor may prescribe medications to complete the removal of the remaining parts of the embryo.
If complications appear after interrupting the development of the embryo, then surgical intervention will be required.

In some cases, abortion can be done with medication. After a day, you can feel the contractions of the uterus, after which there will be a complete rejection of the embryo. At the end of the procedure, an ultrasound scan is done. Through the screen, you will see how the uterus has cleared.

If for some reason there is a partial rejection of the fetus, then cleaning will be required. This is a very serious procedure that leads to the development of inflammation in many women. After cleaning, there is a risk of not getting pregnant in the future.

At the beginning of the procedure, a woman is removed hair from an intimate place and an enema is given. Then the required type of anesthesia is selected. The pain reliever is selected by the doctor depending on the individual characteristics of the victim. The doctor takes the mirrors and dilators and pushes the cervix back, and with the help of a hook, pulls out the contents. To recover, a woman will need to follow all the doctor's prescriptions. After this procedure, sexual relations should be excluded for a couple of months. Treatment must be carried out psychologically as well. For this, a course of psychotherapy by a specialist is prescribed. The woman is prescribed special medications.

After full recovery, a married couple may think about conception again. Usually, steps begin to be taken a year after unsuccessful gestation. But this does not happen for everyone. Many people are still afraid to repeat fertilization attempts.

An early miscarriage (symptoms up to 2 weeks from the photo, see above) is an extremely unpleasant event for both the mother and the father. It is necessary to carry out preventive measures at an early stage of embryo development. They should be based on anti-inflammatory therapy, elimination of physiological and mental trauma, and the fight against toxicosis is also carried out. The doctor may prescribe the intake of a complex of vitamins. In such a serious matter, it is strictly forbidden to self-medicate, it is better to seek qualified help.

An early miscarriage is able to quickly put an end to all the happy plans of future parents. It is not always possible to avoid such a development of events, but the expectant mother has the opportunity to reduce the threat of spontaneous abortion to a minimum.

Spontaneous abortion in the first trimester is the most painless in terms of physiology and for the mental state of a woman. Often, a failed mother finds out about an interesting situation after a spontaneous abortion.

A miscarriage in early pregnancy occurs as follows. Rejection of the ovum begins with pain in the lower abdomen, comparable to the condition during menstruation. Bleeding develops gradually. The discharge is much more abundant than during normal menstruation. At the final stage, a large clot comes out, similar to a bubble of blood.

Even the rapid cessation of bleeding and the absence of pain are the reason for immediate medical attention. Such measures will help to avoid possible complications. If some of the exfoliated tissue remains in the uterus, the patient needs to be cleaned.

Types of pathology

Depending on the moment when, after conception, a spontaneous abortion occurred, there are four types of miscarriage:

Interruption of biochemical pregnancy. The embryo, which is only a clot of cells, is separated from the surface of the uterine epithelium. The patient begins bloody discharge, which differs from the typical menstruation in that it begins with a slight delay. Usually the phenomenon occurs before the third week after the implantation of a fertilized egg in the uterus.
Early miscarriage occurring before 12 weeks. At this time, the forming ovum is small and leaves the woman's body with practically no consequences.
Late miscarriage occurring between 12 and 22 weeks. Despite the fact that the limbs and most of the internal organs are practically formed, there is no chance of saving the baby.
Premature birth. Starting from the sixth month, if the child was able to gain at least 0.5 kg of weight, there is a chance to save a small life. Premature newborns usually require resuscitation and long-term rehabilitation.

Fetal cessation is not necessarily due to spontaneous rejection. Sometimes a pregnant woman needs help to provoke an early miscarriage. Such a measure is necessary when the child is obviously not viable, but the patient's body, for some reason, did not perform the abortive function. There are several main indications for medical termination of pregnancy:

Chorionadenoma is a violation of the normal development of the embryo, when the fertilized egg does not develop into a full-fledged organism. As a result, a clot of undifferentiated cells forms in the uterus, gradually increasing in size like a tumor.
Anembryonia. Pregnancy actually ends before the formation of the embryo, in the early stages. The process usually ends with the death of the fetus in the first month, but sometimes the help of doctors is required.
Frozen pregnancy (miscarriage). It is asymptomatic and is diagnosed only by ultrasound. Without the help of a surgeon, there is a serious danger to the life of the mother.

Causes of poor outcome

There are many reasons for spontaneous embryo death in the first trimester, but not everything can be controlled and prevented. Often, a woman only has to put up with it and try to get pregnant again.

A whole complex of causes of miscarriage in early pregnancy is predetermined by genetics. This includes congenital disorders of the mother's organ systems, leading to the inability to bear the child normally, and hormonal imbalance, which provokes the rejection of the ovum from the uterus.

The father's genetics have a significant impact on the outcome of an event. If, in the process of joining the germ cells, a defective gene is found in one of the 23 chromosomes, an incompatibility arises between the DNA strands of the parents, and the mother's body sometimes decides to interrupt the development of the embryo.

A similar situation is possible in the event of a conflict of the Rh factor in the blood. A negative protein in the mother and positive in the father forces the woman's immunity to identify the embryo as a foreign body / tumor and actively fight against it. In such a case, solely the intervention of doctors will help preserve the life of the fetus.

External factors that can provoke a miscarriage adversely affect the health of the mother and the unborn child:

Infections. They provoke the termination of the vital activity of the embryo, even if the reproductive system is not affected. If the mother's body temperature rises above 38 ° C, the risk of rejection of the ovum increases significantly. Toxoplasmosis, rubella, chickenpox, a number of genital infections and other diseases, in the event of a certain set of circumstances, do not leave the fetus a chance of survival.
Pathology and damage to the uterus. The presence of scars and sutures on the surface of the epithelium of the internal genital organs can lead to the rejection of the ovum. This condition of the reproductive system is often the result of numerous abortions and a number of diseases.
Treatment with methods contraindicated during the period of gestation. Usually, bleeding and rejection of the ovum begins in cases where the woman is unaware of her position.
Lifestyle. Many pregnant women constantly have to deal with high physical and psychological stress. These events do not go unnoticed and often lead to spontaneous abortion. The presence of bad habits greatly aggravates the situation.

At later stages, most of the listed factors also play a significant role in the development of an unfavorable outcome. But spontaneous abortions soon after conception are dangerous - the girl does not know about her situation and does not have time to register with the antenatal clinic. Symptoms of miscarriage in early pregnancy go unnoticed, and treatment is prescribed when it is no longer possible to change the situation.

Symptoms of spontaneous abortion

In order to respond in time to alarming symptoms and save the life of the unborn child, the pregnant woman must closely monitor her health. The beginning of the process of embryo rejection is easiest to determine by spotting from the vagina. Weak smears without pain in the first weeks after conception are the norm in most cases. But if the blood is getting stronger, accompanied by pain in the lower abdomen, you cannot do without consulting a doctor.

The process takes place in four stages. Each of them is accompanied by certain signs and symptoms, which are a wake-up call for the mother and a reason to contact the antenatal clinic as soon as possible:

The threat of death of the embryo. This is the first stage, which begins with mild pain in the lower back. It is often accompanied by a fever, as in inflammatory conditions, and mild bleeding. Timely provision of medical care and the implementation of medical recommendations gives a chance to save the life of the baby.
The beginning of rejection. The pain and bleeding are worse. Signs of miscarriage in early pregnancy are especially pronounced during active physical activity. Gradually, the pain takes on the character of contractions, resembling the process of childbirth. The pregnant woman feels weak and dizzy due to profuse bleeding. This moment is the last chance to prevent the death of the baby.
Miscarriage in progress. The fruit dies. Due to severe hemorrhage, it leaves the uterus partially or completely.
Completed miscarriage. The patient's body returns to the state prior to fertilization. The uterus contracts and the menstrual cycle resumes.

At the end of the fourth stage, the patient is assigned an ultrasound scan in order to exclude the likelihood of preserving the membranes in the uterine cavity. If the symptoms of pathology were ignored, in the future a woman risks facing its consequences: chronic inflammatory diseases and infertility.

Useful materials on the topic:

A spontaneous abortion is not only an event that weighs on the psyche and a collapse of hopes, but also a signal that there are problems in the body of a woman or her partner. The patient needs to undergo a mandatory examination for two reasons:

Every tenth case of miscarriage is accompanied by serious consequences for the health of the failed mother. In addition to possible inflammation due to the decomposition of the remains of the ovum inside the uterus, the patient sometimes has a high body temperature, convulsions and nausea for several days.
Examination of fetal tissue will help determine the cause of death and help prevent it during subsequent conception. Knowing who is to blame and what to do in a given situation makes it easier to cope with the feeling of loss and move on.

Usually, in the first trimester, the process proceeds without serious consequences and does not require specialized assistance. But if pains in the lower abdomen begin to bother or your periods are especially strong and unpleasant, you must definitely consult a doctor in order to prevent the development of complications.

In the absence of contraindications, some time after treatment and restoration of reproductive function, it is allowed to continue trying to get pregnant. It is necessary to remember about the danger of repeated miscarriage and take the necessary preventive measures in accordance with the doctor's recommendations.

Rehabilitation

The loss of a long-awaited baby negatively affects not only reproductive functions, but also the patient's mental state, leading to depression and fear of repeated failure. The best way out in this situation is to seek help from a qualified psychologist. The specialist will help you sort out your feelings and go through the situation, bypassing long-term consequences.

But the rehabilitation procedures do not end there. After passing the examination, it is important to identify the cause of the poor outcome. Depending on it, a further set of measures is predetermined to prevent a similar situation in the future:

Congenital pathologies. Miscarriage is a consequence of the weakened state of the female genital organs, including the cervix. The reason for this development of events is one of the structural features of the urogenital system of a pregnant woman. Pathology must be eliminated and corrected by any available methods, if a complete cure is impossible.
Genetic factor. Some combinations of parental genes are considered by the pregnant woman to be incapable of development due to the large number of mutated DNA regions. Often it is required to carry out artificial insemination, the search for a new sexual partner. In such cases, it is said about the genetic incompatibility of the failed parents.
Immunological causes. Given the sensitivity of the body after fertilization to the effects of bacteria, fungi and viruses, it is better to undergo a full examination in advance and get rid of diseases. In the future, it is worthwhile to prepare in advance for the war against infections, observing hygiene standards, strengthening the immune system and using drugs that are extremely safe for the embryo at the first signs of a new life.
Lifestyle. The developing fetus is sensitive to the state of the mother. Nervous and mental fatigue, bad habits that lead to spontaneous miscarriage at an early stage, can provoke the second. The only decision is to make a choice between a career and having a baby. The expectant mother needs to rest, change jobs, sometimes she needs the help of a psychologist.

Once the root cause has been identified and resolved, the symptoms of the problem usually no longer bother the woman. But it is better to worry about your own health and take up prevention, as the test will show the cherished two strips.

Prevention of pathology

Prevention of spontaneous abortion is organized around two basic principles: strengthening the body and eliminating external factors that provoke a threat. One of the best recommendations for girls is not to practice unnecessary termination of pregnancy with the help of doctors and medicines. Such artificial interference in the activity of the reproductive system has a detrimental effect on the reproduction of offspring in the future.

It is necessary to prepare for the second conception in advance, it usually takes about six months. During this time, it is recommended to restore health and take care of getting rid of bad habits. Do not forget about a healthy, balanced diet, a correct diet will reduce the unpleasant manifestations of toxicosis in the first trimester.

It is equally important to think about the emotional side of the issue in advance. Mood swings, stress, chronic fatigue and hormonal imbalances should not have a detrimental effect on bearing a long-awaited baby. Knowledge of the basic nuances of the process and a conscious choice in favor of conception strengthen the mother's calmness and increase the chances of a successful bearing of the fetus.

For the rest, a woman must choose those measures that will help prevent miscarriage. The main helpers in such a situation should be a loving husband and a competent specialist in antenatal clinics, who will be able to notice the danger in time and suggest how to save the life of the baby.

One in five pregnancies ends in miscarriage; more than 80% of miscarriages occur in the first 3 months of pregnancy. However, their actual number may be underestimated, since most occur in the early stages, when pregnancy has not yet been diagnosed. It doesn't matter when the miscarriage occurs, you may feel shock, despair, and anger. A sharp decrease in estrogen can cause a depression of mood, although most women already fall into depression. Best friends or even family members sometimes refer to it as a "bad period" or "pregnancy that was not meant to be," which only adds to your grief. Many women feel guilty thinking that something wrong was the cause of the miscarriage. What if it's because of the weights you lifted in the gym? Because of the computer at work? Or a glass of wine at dinner? No. Remember that the vast majority of miscarriages are due to chromosomal abnormalities. Only a small proportion of women (4%) with a history of more than one miscarriage suffer from some kind of disease that requires diagnosis and treatment. It is important to find moral support after the incident. Give yourself time to go through all 4 stages of grief — denial, anger, depression, and acceptance — before trying to get pregnant again. Understand that this is a disease and share your pain with someone you trust. Your partner is grieving the loss as much as you are, now is the time to support each other. Finally, remember that in most cases, even women who have miscarriages will have healthy children in the future.

Miscarriage classification

Spontaneous miscarriages can be classified according to many characteristics.

Of practical interest are classifications based on differences in gestational age, the degree of miscarriage (pathogenetic sign) and clinical course.

Spontaneous - miscarriages are distinguished:

By gestational age: a) early - in the first 12-16 weeks of pregnancy, b) late - in 16-28 weeks of pregnancy.
According to the degree of development: a) threatening, b) beginning, c) in progress, d) incomplete, e) complete, f) failed. If spontaneous miscarriages are repeated during subsequent pregnancies one after another, they speak of a habitual miscarriage.
According to the clinical course: a) uninfected (non-febrile), b) infected (febrile).

At the heart of pathogenesis spontaneous miscarriage may be the primary death of the ovum during toxicosis of pregnancy, acute and chronic infections, cystic drift, etc. In such cases, reactive changes in the body of a pregnant woman usually occur, entailing contractions of the uterus with the subsequent expulsion of the dead ovum. In other cases, reflex uterine contractions occur primarily and precede the death of the ovum (secondary death of the ovum), which occurs from a disruption in the connection of the ovum with the maternal body due to detachment of the placenta from its bed. Finally, both of these factors, i.e., uterine contractions and egg death, can be observed simultaneously.

Until 4 weeks of gestation, the ovum is still so small that it occupies an insignificant place in the total mass of the falling off shell. By contractions of the uterus from its cavity, the falling membrane can be completely or partially removed. If that part of the membrane in which the egg is implanted is removed from the uterine cavity, a spontaneous miscarriage occurs, which the pregnant woman either does not notice at all, or takes it for heavy menstrual bleeding. When a part of the falling membrane that does not contain the ovum is removed, the egg can continue its development after the cessation of contractions. In such cases, a small amount of bleeding from the pregnant uterus can even be mistaken for menstruation, especially since a small amount of discharge, like menstruation, sometimes occurs in the first month of pregnancy. Further observation of the pregnant woman reveals the true picture.

If the contractions of the uterus precede the death of the ovum and cause it to detach from the bed in the decidua basalis area, where a rich vascular system is developed, there is a short, but severe bleeding, quickly exsanguinating the patient, especially if half or rion has exfoliated.

The closer the implanted egg is to the inner os of the uterus, the more bleeding. This is explained by the lesser contractility of the isthmus of the uterus in comparison with its body.
Sometimes the ovum of early pregnancy exfoliates completely and, having overcome the obstacle from the internal uterine pharynx, descends into the cervical canal. If at the same time the external pharynx turns out to be impassable for the egg, it seems to get stuck in the canal of the cervix and stretches its walls, and the cervix takes a barrel-shaped appearance. This form of miscarriage is called a cervical abortion (abortus cervicalis).

A miscarriage in late pregnancy (after 16 weeks) proceeds in the same way as premature birth: first, the uterine pharynx opens with a wedging of the fetal bladder into it, then the fetal bladder is opened, the birth of the fetus and, finally, the detachment and birth of the placenta. In multiparous women, the membranes often remain intact, and after the opening of the uterine pharynx, the entire ovum is born entirely at the same time.

Types of miscarriage

Depending on what was found during the examination, your doctor may name the type of miscarriage you have:

Risk of miscarriage. If you are bleeding, but the cervix has not begun to open, then this is only a threat of miscarriage. After rest, these pregnancies often continue without further problems.
Inevitable miscarriage (abortion in progress). If you are bleeding, the uterus contracts and the cervix is dilated, a miscarriage is inevitable.
Incomplete miscarriage. If some of the tissues of the fetus or placenta have come out, and some remain in the uterus, this is an incomplete miscarriage.
Failed miscarriage. The tissues of the placenta and embryo remain in the uterus, but the fetus has died or did not form at all.
Complete miscarriage. If all the tissues associated with pregnancy have come out, this is a complete miscarriage. This is common for miscarriages occurring earlier than 12 weeks.
Septic miscarriage. If you develop a uterine infection, it is a septic miscarriage. Urgent treatment may be required.

Causes of miscarriage

Most miscarriages occur because the fetus does not develop normally. Abnormalities in the genes and chromosomes of the child are usually the result of accidental errors during the division and growth of the embryo - not inherited from the parents.

Some examples of anomalies:

Dead egg (anembryonia). This is a fairly common occurrence and is responsible for nearly half of miscarriages in the first 12 weeks of pregnancy. Occurs when only the placenta and membranes develop from the fertilized egg, but no embryo.
Intrauterine fetal death (frozen pregnancy). In this situation, the embryo is there, but it dies before any symptoms of miscarriage appear. This also happens due to genetic abnormalities in the fetus.
Bubble drift. Bladder motility, also called trophoblastic pregnancy disease, is uncommon. This is an abnormality of the placenta associated with abnormalities at the time of fertilization. In doing so, the placenta develops into a rapidly growing cystic mass in the uterus, which may or may not contain an embryo. If the embryo is still there, it will not reach maturity.

In some cases, a woman's health condition can play a role. Untreated diabetes, thyroid disease, infections, hormonal imbalances can sometimes lead to miscarriage. Other factors that increase the risk of miscarriage are as follows:

Age. Women over 35 have a higher risk of miscarriage than young women. At 35, the risk is about 20%. At 40, about 40%. At 45 - about 80%. The age of the father may also play a role.

There are all sorts of reasons for miscarriages:

Chromosomal abnormalities. During fertilization, the sperm and the egg are brought into the future zygote by 23 chromosomes and a set of 23 carefully selected pairs of chromosomes is created. This is a complex process, and the slightest disruption can lead to a genetic abnormality that will stop the growth of the embryo. Research has shown that most miscarriages are genetically based. The older the woman, the more likely such anomalies are.

Hormonal imbalance... About 15% of miscarriages are mediated by hormonal imbalances. For example, insufficient progesterone levels can prevent the embryo from implanting into the uterine wall. Your doctor can diagnose the imbalance with an endometrial biopsy, this procedure is usually done at the end of the menstrual cycle to assess ovulation and development of the lining of the uterus. As a treatment, hormonal drugs are used that stimulate the development of the embryo.

Diseases of the uterus... Fibroids in the uterus can cause miscarriage; such tumors tend to grow on the outer wall of the uterus and are not dangerous. If they are located inside the uterus, they can interfere with the implantation of the embryo or blood flow to the fetus. Some women are born with a uterine septum, a rare defect that can lead to miscarriage. The septum is a tissue wall that divides the uterus in two. Another reason may be scarring on the surface of the uterus, as a result of surgery or abortion. This extra tissue can interfere with the implantation of the embryo and also obstruct blood flow to the placenta. A doctor can detect these scars with X-rays, and most of them are healed.

Chronic diseases... Autoimmune diseases, heart disease, kidney disease or liver disease, diabetes are examples of disorders that result in approximately 6% of miscarriages. If you have a chronic medical condition, find an obstetrician / gynecologist who specializes in managing pregnancy for these women.

Heat... No matter how healthy a woman is normally, if you have a high fever (above 39 ° C) in the early stages, this pregnancy may end in miscarriage. An elevated temperature is especially dangerous for an embryo up to 6 weeks of age.

Miscarriage in the 1st trimester

During this period, miscarriages are very common, in about 15-20% of cases. In most cases, they are caused by an abnormality of fertilization, which causes an abnormality in the chromosomes of the fetus, making it unviable. This is a natural selection mechanism that does not imply anomalies on either the mother or the father.

Physical activity has nothing to do with it. Therefore, you should not blame yourself for the fact that, for example, you did not get enough rest, nor should you feel responsible for it. A miscarriage that occurs in the first trimester of pregnancy does not require further special examination, except in cases of two or three consecutive spontaneous abortions.

Miscarriage in the 2nd trimester

From 13 to 24 weeks of amenorrhea, miscarriages occur much less often - about 0.5%) and, as a rule, are triggered by an infection or abnormal opening (gaping) of the cervix. For prevention purposes, cerclage can be done, and in case of infection, antibiotics can be drunk.

What does not cause a miscarriage

Such daily activities do not provoke a miscarriage:

Physical exercises.
Lifting loads or physical exertion.
Having sex.
Substance-free work: Some studies show that the risk of miscarriage increases when the partner is over 35, and the older the father, the greater.
More than two previous miscarriages. The risk of miscarriage is higher if the woman has had two or more miscarriages. After one miscarriage, the risk is the same as if you haven't had a miscarriage yet.
Smoking, alcohol, drugs. Women who smoke and drink alcohol during pregnancy have a greater risk of miscarriage than nonsmokers and non-alcohol users. Drugs also increase the risk of miscarriage.
Invasive antenatal examinations. Certain prenatal genetic tests, such as chorionic villi or amniotic fluid, may increase the risk of miscarriage.

Symptoms and signs of a spontaneous miscarriage

Metrorrhagia (vaginal bleeding that occurs outside of menstruation) or palpable contractions of the pelvic muscles are often the first signs of miscarriage. However, bleeding is not always a symptom of a miscarriage: it is often a disorder in the 1st trimester (it affects one woman in four); in most cases, pregnancy continues unhindered.

Threatened miscarriage (abortus imminens) begins either with the destruction of the falling membrane, followed by cramping contractions of the uterus, or with the onset of contractions, followed by bloody discharge from the uterus - a sign of incipient detachment of the ovum from its bed. The initial symptom of a threatening miscarriage is, in the first of these options, a slight bleeding, in the second - cramping contractions of the uterus. If the process that has begun does not stop, it goes on to the next stage - to the state of incipient miscarriage.

Thus, the diagnosis of threatened miscarriage is made if there is a sign in pregnancy based on one of the mentioned symptoms - minor cramping pains in the lower abdomen and sacrum and minor bleeding from the uterus (or both symptoms together), provided that there is no shortening of the cervix uterus and dilatation of the uterine pharynx. In a two-handed study performed during contractions, the uterus is indurated, and the induration is retained for some time after the subject has ceased to feel pain from contractions.

Incipient miscarriage (abortus incipiens) .. At this stage of miscarriage, cramping pains in the abdomen and sacrum and blood discharge from the uterus are simultaneously observed; both of these symptoms are more pronounced than in the stage of threatened miscarriage. As with a threatened miscarriage, the cervix is preserved, the external pharynx is closed. Compaction of the uterus during labor is more pronounced than with a threatened miscarriage. If the connection with the uterus is broken only on a small surface of the ovum, for example, in less than one third, its development can continue and the pregnancy is sometimes carried to the end.

As the process progresses, the contractions intensify and become painful, as in childbirth; bleeding also increases. The cervix is shortened, the pharynx gradually opens, up to the size necessary for the passage of the ovum. With a vaginal examination, due to the opening of the cervical canal, an examining finger can be introduced into it, which gropes here for parts of the exfoliated ovum. This stage in the development of miscarriage is called abortion in progress (abortus progrediens). The fertilized egg in such cases is born in part or in whole.

When expelled from the uterine cavity, only a part of the ovum speaks of incomplete miscarriage (abortus incom-pletus). In such cases, the main symptoms are: profuse bleeding with large clots, which can lead to acute and severe exsanguination of the patient, and painful contractions. With a two-handed gynecological examination, blood clots are found, often filling the entire vagina, a shortened and softened cervix, patency of the cervical canal along its entire length for one or two fingers; the presence of parts of a detached ovum in the vagina, in the cervical canal and in the lower part of the uterine cavity, if it was not expelled from the uterus before the study, an increase in the body of the uterus, some softening (uneven), roundness and soreness, a short contraction of the uterus under the influence of the study and dr.

Complete miscarriage (abortus completus) is said in the case of expulsion of the entire fetal egg from the uterus. With a vaginal examination, it turns out that the uterus has decreased in volume, is dense, although the cervical canal is open, the bleeding has stopped, only scant spotting is observed; after 1-2 days, the cervix is restored and the cervical canal is closed. However, although the ovum is expelled from the uterus as if entirely, in the cavity of the latter, fragments of a falling membrane and villi that have not lost contact with the uterus, etc., usually remain. repeated two-handed gynecological examination. In all other cases, it is more correct to clinically consider each miscarriage as incomplete.

Failed miscarriage is recognized after clinical observation on the basis of the cessation of the growth of the uterus, which had previously increased in accordance with the gestational age, and then its decrease, the appearance of milk instead of colostrum in the mammary glands, a negative Ashheim-Tsondek reaction (appears no earlier than 1-2 weeks after death of the ovum), minor bloody discharge from the uterus, and sometimes their absence.

One or another stage of miscarriage development (which is of great practical importance) is established on the basis of the mentioned signs of each of them.

The following pathological processes can be complications of a miscarriage.

Acute anemia, which often requires urgent intervention. If a woman who has a miscarriage is healthy in all other respects, especially if the body's compensatory ability is full, then with timely and appropriate measures to combat acute anemia, death from the latter is very rare.
Infection. With miscarriage, a number of conditions are created that favor the development of the septic process. These include: an open uterine pharynx, which makes it possible for microorganisms to enter the uterine cavity from the cervical canal and vagina; blood clots and remnants of the ovum located in the uterine cavity, which serve as a good breeding ground for microorganisms; the naked placental platform, which is an entrance gate that is easily permeable to microorganisms; the exsanguinated state of the patient, which reduces the body's resistance to infection. In each case, it is necessary to establish whether there is an infected (febrile) or uninfected (non-febrile) miscarriage. An infected miscarriage will be indicated by the presence of at least one of the following signs: high fever, palpation or percussion soreness of the abdomen, soreness of the uterus not associated with its contractions, as well as soreness of its appendages and vaults, admixture of pus to the blood flowing from the uterus, general intoxication organism (frequent pulse, depressed or agitated state of the patient, etc.), if they are not caused by other reasons, etc.
Placental polyp. The formation of such a polyp is usually observed in cases where a small part of the placental tissue is retained in the uterine cavity. The blood oozing from the uterine vessels due to insufficient contraction of the uterus gradually permeates the remaining placental tissue, then layers on it, organizes and takes the form of a polyp. The lower pole of the polyp can reach the internal pharynx, which does not completely contract due to the presence of a placental polyp in the uterus (a kind of foreign body). This process is accompanied by a slight bleeding from the uterus, which can last up to several weeks or even months, periodically increasing. The entire uterus contracts poorly. When the polyp reaches a size that irritates the uterus, contractions begin and the bleeding increases.
Malignant degeneration of the epithelium of the chorionic villi retained in the uterus - chorionepithelioma.

Spontaneous miscarriage treatment

The main question that should be resolved at the first examination of a pregnant woman with signs of miscarriage is the possibility of maintaining the pregnancy. With proper care and treatment of a patient with a threatened miscarriage, and somewhat less often with an onset miscarriage, pregnancy can be saved; with the developed picture of miscarriage, pregnancy cannot be saved. Hence follows the doctor's tactics in treating a patient with a spontaneous miscarriage.

Having established the presence of a threatening and incipient miscarriage, the pregnant woman is immediately placed in the maternity hospital, where a medical and protective regime should be organized. The necessary elements of it are bed keeping, physical and mental rest, strengthening faith in maintaining pregnancy (psychotherapy, hypnosis), normal or, if necessary, extended sleep, etc.

Drug treatment is carried out taking into account the identified etiological factors that caused the miscarriage. But since it is in most cases difficult to establish, the drug measures are aimed at increasing the viability of the ovum and eliminating the increased excitability of the uterus. Prescribe sodium bromide (1-2% solution inside, 1 tablespoon 3 times a day), glucose (20 ml of 40% solution intravenously once a day), it is useful for the patient to stay outdoors (in winter, frequent inhalation of oxygen); for infectious etiology, penicillin injections are used (50,000 units every 3 hours) and other drugs; in the presence of contractions - opium preparations (opium tincture 5-10 drops 2-3 times a day by mouth or opium extract 0.015 g in candles - 2-3 candles a day); effective injections of progesterone (5-10 mg daily for 10 days). After that, take a break and, if necessary, repeat the course after 5-10 days. Continuous injections of large doses of progesterone for a long time sometimes have an adverse effect on the course of pregnancy, in particular on the viability of the fetus.

Vitamins A, B 2, C, D, E are also useful. They are prescribed in pure form or products containing these vitamins are recommended: fish oil, brewer's yeast, etc.

The appointment of ergot, ergotine, quinine, pituitrin and other similar hemostatic agents is strictly contraindicated and is a gross medical error, since they increase the contraction of the uterus, and at the same time contribute to further detachment of the ovum.

If these measures do not give the desired effect, bleeding and contractions intensify and the miscarriage proceeds to the next stage - abortion is in progress, it is not possible to maintain the pregnancy. In such cases, in the first 3 months of pregnancy, if there are no contraindications (infected miscarriage), they resort to instrumental emptying of the uterine cavity - removal of the ovum or its remnants from the uterus cavity, followed by curettage.

After 3 months of pregnancy, the patient is prescribed conservative treatment: cold to the lower abdomen, quinine (0.15 g orally every 30-40 minutes, only 4-6 times) and, alternating with it, 0.25 ml pituitrin injections every 30-45 minutes, 4-6 times in total. After the birth of the fetus, the afterbirth, if it is not born on its own, is removed with a finger inserted into the uterine cavity, and its remnants - with the help of curettes.

In the postoperative period, bed maintenance is prescribed, application of cold to the suprapubic area, uterine-reducing agents: liquid ergot extract - 25 drops 2 times a day, ergotine 1 ml intramuscularly 2 times a day, etc. and the patient's health can be discharged 3-5 days after the operation. Before discharge, a thorough general and necessarily special - gynecological (two-handed) - examination should be performed.

Treatment of patients with a syphilized, febrile miscarriage is carried out either strictly conservatively (medications), or actively (operation), or actively and expectantly (elimination of the infection followed by instrumental removal of the remains of the ovum). When choosing a method of patient management, one should be guided by her general condition and the severity of the infectious process.

In this case, a distinction is made between:

uncomplicated infected miscarriage, when only the ovum or ovum is infected with the uterus, but the infection has not gone beyond the uterus;
complicated infected miscarriage, when the infection has gone beyond the uterus, but the process has not yet been generalized;
septic miscarriage, when the infection is generalized.

Complicated infectious and septic miscarriage is commonly seen in the case of delinquent fertility intervention.

When treating patients with infected uncomplicated miscarriage, some obstetricians prefer immediate instrumental emptying of the uterine cavity. Another, large, part of obstetricians adheres to an active wait-and-see method: for 3-4 days the patient is prescribed bed rest and drugs that tone the muscles of the uterus (cold on the lower abdomen, inside quinine, pituitrin, ergot preparations, etc.) and aimed at eliminating the infection ( sulfa drugs, antibiotics). After the signs of infection disappear, the uterine cavity is gently emptied by surgery.

Finally, a number of obstetricians prefer strictly conservative management of patients, without any intrauterine intervention. To this end, the above means are supplemented with injections of estrogen hormone, pituitrin or thymophysin, injection of castor oil, etc., in order to stimulate uterine contractions and promote spontaneous expulsion of the remains of the ovum from the uterus. Instrumental emptying of the uterus is resorted to only with severe bleeding that threatens the patient's life.

With any of the listed methods of managing patients with an infected uncomplicated miscarriage, measures are taken to raise the defenses of the patient's body, its tone. This is achieved by good care, a rational diet, easily digestible, high-calorie, containing a sufficient amount of vitamins, and other activities.

Having tested over the years each of the listed methods of treating patients with uncomplicated infectious miscarriage - incomplete and complete, we were convinced of the advantages of the active expectant method. We resort to urgent instrumental emptying of the uterus only in exceptional cases when heavy bleeding from the uterus threatens the patient's life and it is necessary to stop it immediately.

Treatment of patients with complicated infected miscarriage, that is, when the infection has gone beyond the uterus, should only be conservative, since surgical intervention in such cases leads, almost as a rule, to the occurrence of peritonitis or sepsis. Surgical intervention may be necessary only in those exceptional cases when a sharp exsanguination of the patient and incessant bleeding from the uterus pose an immediate threat to the patient's life.

In the treatment of patients with miscarriage, the competing methods are expectant-observational and active - simultaneous instrumental emptying of the uterine cavity.

Given the danger that threatens a pregnant woman with a delay in the uterus of a dead ovum, caused by infection, intoxication, malignant degeneration of villi, etc., one should strive to empty the uterine cavity as soon as the diagnosis of the disease is established with certainty. If miscarriage does not take place, treatment begins with the appointment of agents that stimulate contractions of the uterus and thereby provoke the onset of miscarriage: for 2-3 days, 10,000 units of estrogen is injected daily. After that, 60 g of castor oil is given inside, and after half an hour, hydrochloric quinine 6 times, 0.2 every 30 minutes; after taking the fourth quinine powder, 4 injections of 0.25 ml pituitrin are made every 15 minutes. Then a hot vaginal shower is prescribed, and the temperature of the liquid should not exceed 38 ° for the first time; in the future, it is gradually increased within the patient's endurance. Often, the fetus lingering in the uterus is expelled completely or partially without instrumental intervention, which is resorted to in the future to remove the remnants of the ovum.

Even in those cases when this method of treatment does not lead to the goal, that is, to the expulsion of the fetal egg that has lingered in the uterus, it is useful, since it increases the tone of the muscles of the uterus. This creates favorable conditions for the subsequent surgical removal of the ovum: with a well-contracted uterus, bleeding rarely occurs during and after the operation and there is no perforation of the uterus during the operation.

Treatment for a placental polyp consists in its instrumental removal (curettage).

Prevention of spontaneous miscarriage

Prevention of spontaneous miscarriage should precede or begin with the appearance of its first symptoms. In the antenatal clinic, at the first visit of a pregnant woman, they take on a special account those women who have a history of spontaneous miscarriages or premature births, especially when there were several of them ("habitual miscarriage", "habitual premature birth"), and women with various pathological conditions, which can be the cause of spontaneous miscarriage. Preventive measures include prescribing anti-inflammatory treatment, correcting the wrong position of the uterus, combating pregnancy toxicosis, hypovitaminosis, eliminating and preventing mental and physical trauma; in appropriate cases - prohibition of sexual intercourse during pregnancy, transfer to a lighter type of work, etc.

Pregnant women with a "habitual miscarriage", as well as a threatening miscarriage that has begun, should be placed in a maternity hospital, in a pregnant ward. It is of great importance to strengthen the patient's faith in the possibility of maintaining pregnancy, as well as carrying out therapeutic measures: maintaining rest, prolonged sleep, prescribing progesterone, pain relievers, drugs that reduce the excitability of the uterus, multivitamins, especially vitamin E, etc.

If during childbirth there were deep ruptures of the cervix, its integrity must be restored immediately after childbirth. If this has not been done, then in order to prevent spontaneous miscarriage in the future, plastic surgery on the cervix should be performed before the onset of the next pregnancy - to restore its integrity.

In most cases, a woman loses a child at a very early stage, when she is not even aware of the onset of pregnancy. The absence of menstruation is recorded as an ordinary delay, and after a few days critical days come - stronger and more painful than usual. Bleeding quickly returns to normal, the pain disappears, and the woman does not go to the gynecologist to find out the cause. If profuse discharge and painful sensations last more than 2-3 days, then you just need to see a doctor.

Spontaneous abortion can be diagnosed with one hundred percent probability when, on one of the days of painful and profuse bleeding, a large blood clot comes out of the vagina. Usually, such a clot looks more like a blood bubble, which can be whole or burst. In this case, the visit to the gynecologist cannot be postponed. It is necessary to find out exactly whether it was a miscarriage, or something else. If the fact of spontaneous miscarriage is confirmed, then the doctor must find out whether it is necessary to carry out additional cleaning of the uterus from the remnants of the embryo tissue.

Most often, a miscarriage in early pregnancy can go completely unnoticed by a woman. However, for those planning to become a mother and looking forward to getting pregnant, it can be extremely difficult to cope with the loss of a fetus. A woman's body is not always ready to bear a healthy child, and any living organism is programmed to get rid of genetically unhealthy offspring.

Causes of early miscarriage

The main reasons for miscarriage are many and most of them can seriously undermine both the physical and psycho-emotional health of both parents.

Congenital, genetic defects. In the process of fusion of two sex cells of the parents, a zygote is formed, which should contain 44 somatic and 2 sex chromosomes - 46 in total. , the maternal body gets rid of the wrong set of cells. Thus, natural selection begins to take place in the womb.
Hormonal disbalance. For the entire life of a person, special biologically active substances are responsible, which are produced by the body in a given situation. Hormones are always in a certain balance, shaping the appearance and mood of a person, affecting metabolism and general health. A constant violation or frequent jumps in hormonal levels can provoke a spontaneous termination of pregnancy by the body. For example, when the expectant mother experiences constant stress, the body produces adrenaline, which negatively affects the blood circulation and tone of the pregnant uterus, which can provoke a miscarriage. This happens because a woman's own life is more important for a woman's body than an unformed fetus. In addition, there are a number of hormonal diseases that do not allow a child to be carried out normally.
Mismatch of the Rh factor of the mother and the child. It is very rare for a person to have a negative Rh factor. Even less often, women with similar blood can bear and give birth to a healthy child. Most people on the planet have a positive Rh factor, and if the father of the child has such a mark in his medical record, then the baby, most likely, too. The maternal organism with a negative factor will perceive the fetal tissues as foreign, and the fetus will be rejected. The modern level of medicine allows us to overcome this problem, and an increasing percentage of women with a similar problem give birth to healthy babies.
Parental infectious diseases. Any disease, acute or chronic, can negatively affect both conception and an already forming embryo. It is necessary to get rid of any disease, especially an infectious one, even before the onset of pregnancy. It is necessary to undergo treatment for both parents, since often the fetus also becomes infected from sexually transmitted diseases of one of the partners. In addition, you should be carefully checked for the presence of inflammatory diseases in the pelvic organs. Any temperature above 37 degrees can cause spontaneous abortion.
Previous abortions. Any interference with the natural course of the body's life is stressful and can cause various problems in the future. This can be not only a surgical abortion, but also a special drug, a traditional method and other home methods of abortion that the attending physician may not know about. With a high probability, such an intervention can result in subsequent negative pregnancy outcomes and even infertility.
Taking medicines that are contraindicated in bearing a fetus. Most drugs are not recommended for pregnant and lactating women unless the risk is justified. Very often, the drugs themselves can cause the malformation of organ systems, and this will provoke spontaneous abortion.

There are many more reasons that can lead to a miscarriage. The lifestyle of the expectant mother, her psycho-emotional state, physical activity and much more, has a very large impact on the favorable course of pregnancy.

Miscarriage symptoms

Harbingers of fetal rejection at all stages of pregnancy are acute pain in the lower abdomen and bleeding. In the early stages, women often mistake such symptoms for periods that began a little later. But if it was already known about pregnancy, you must immediately seek medical help.

The main symptoms of a miscarriage are:

acute pain in the lower abdomen, it will probably be given to the lower back;
vaginal discharge (bloody or slightly brownish, profuse);
increasing the tone of the smooth muscles of the uterus;
signs of general intoxication of the body (temperature, headache, weakness, nausea).

An increased tone of the uterus is usually impossible to diagnose on its own. However, other signs should alert a woman in position. They may indicate not only miscarriage, but also other pathologies.

Discharge may be mild, but with an admixture of blood. In this case, the chances of saving the fetus increase significantly.

What to do if you have symptoms of miscarriage

All gynecologists recommend, at the first sign of a possible miscarriage, to take a comfortable horizontal position, calm down and call an ambulance. In some cases, a woman is completely forbidden to get out of bed. Naturally, any physical activity at this moment is fatal for the baby.

Calming practices and breathing exercises are often recommended to reduce the anxiety level of the expectant mother. Excessive experiences can only aggravate the condition, as they provoke the release of unwanted hormones in the mother's body. It is important to think about something pleasant and good. For example, how to finally see the baby and take him on the arms for the first time, how he will grow up smart and healthy. A positive attitude and the right emotions will not only reduce the level of anxiety, but also distract from painful sensations, help you relax and calmly wait for the ambulance crew.

Early miscarriage prevention

If both partners have made a serious and balanced decision to become parents, then they must definitely prepare not only for the birth of a child, but also for the pregnancy itself. Both parents-to-be must be physically healthy, free from serious chronic diseases and bad habits. In addition, it is recommended to undergo a number of additional studies:

genetic examination - allows you to identify the risks of developing congenital pathologies;
endocrinological examination;
gynecological examination;
urological examination;
tests for the presence of viral sexually transmitted infections.

However, if the pregnancy came unexpectedly, but is quite acceptable, then the woman needs to completely rebuild her entire rhythm of life. It is important to stop taking medications that are contraindicated for pregnant and lactating women, get rid of all bad habits and start leading a healthier and more measured lifestyle. In this case, the risk of spontaneous abortion is significantly reduced.

The doctor will most likely do an ultrasound scan so that the presence of a fetus in the uterus can be seen. If you are pregnant, the ultrasound will also allow your doctor to see if the fetus is developing properly. In addition, the doctor can check the fetal heartbeat for longer periods.
The obstetrician-gynecologist will examine the vagina so that he can see if the cervix has opened.
The blood test results will allow the doctor to assess your hormonal levels.
If you have brought tissue with you in an airtight container that you believe may be fetal tissue, your doctor will do the necessary tests to confirm or refute your concerns.

Find out about the possible diagnoses your doctor might give you. These include:

Risk of miscarriage. This diagnosis can be made if symptoms of a possible miscarriage are present. But do not worry ahead of time, because the threat of miscarriage does not always lead directly to miscarriage. If you are having seizures or bleeding but your cervix is closed, your doctor may diagnose you at risk of miscarriage.
If it is impossible to prevent a miscarriage, then, unfortunately, the doctor will diagnose you with a miscarriage. The doctor will make this diagnosis if the uterus contracts and the cervix is dilated. In this case, a miscarriage is inevitable.
A complete miscarriage is characterized by the complete release of all tissues of the fetus and ovum from the uterus.
An incomplete miscarriage occurs when the tissue has come out, but some parts of the fetus or placenta have not yet exited the vagina.
A frozen pregnancy occurs when the fetus dies for any reason.

Follow your doctor's recommendations if you have been diagnosed with threatened miscarriage. The threat of miscarriage does not always lead directly to miscarriage. However, in some situations, a miscarriage is inevitable. However, often, your doctor may recommend the following to prevent miscarriage:

rest until symptoms have subsided;
do not exercise;
refrain from intimacy;
refuse to travel to places where you will not be able to provide fast and high-quality medical care, if necessary.

If a miscarriage occurs, but not all tissues of the ovum have come out, follow the recommendations of the obstetrician-gynecologist. However, your doctor will take your opinion into account when prescribing treatment.

You can wait for the remaining tissue to be torn away. In this case, it will take about one month.
You may be taking medications that will reject any remaining tissue. This usually happens during the day. The drugs can be taken orally or used as suppositories inserted into the vagina.
If you show signs of infection, the doctor will remove the remaining tissue.

Take enough time to physically recover from your miscarriage. You will most likely only need a few days to feel healthy again.

Be prepared for your period to resume as early as next month. This means you can get pregnant again. If you don't want to, use contraception.
For two weeks, do not have sex or use tampons, as this can interfere with the repair of tissue in the vaginal walls.

Take time to restore your mental health. Research shows that a woman can experience intense sadness no matter how long she has lost her baby. So don't beat yourself up for your feelings, but rather surround yourself with people who can help you cope with your grief.

Get the support of trusted friends and family members.
Find a support group.
Most women who have miscarried in the past have been able to bear and give birth to a healthy baby. A miscarriage does not mean that you will not be able to have a baby in the future.