Why do you constantly miscarry. How does a miscarriage happen? Classification of miscarriage and associated symptoms

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. No matter when the miscarriage occurs, you may feel shock, despair, and anger. A sharp decrease in estrogen can cause a decline in mood, although most women become depressed without it. Best friends or even family members sometimes refer to what happened as a “bad period” or “pregnancy that was not meant to be,” which only deepens your grief. Many women experience guilt, thinking that something wrong was the cause of the miscarriage. What if it's because of the weights you lifted at the gym? Because of the computer at work? Or because of 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 what happened. Give yourself time to go through all 4 stages of grief—denial, anger, depression, and acceptance—before trying to conceive again. Understand that this is a disease and share your pain with someone you trust. Your partner is grieving the loss just like you, now is the time to support each other. Finally, remember that in most cases, even women who have had miscarriages have healthy children in the future.

Miscarriage classification

Spontaneous miscarriages can be classified in many ways.

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

Spontaneous - miscarriages are distinguished:

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

At the core pathogenesis Spontaneous miscarriage may be the primary death of the fetal egg during toxicosis of pregnancy, acute and chronic infections, cystic mole, etc. In such cases, reactive changes usually occur in the body of a pregnant woman, entailing uterine contractions, followed by expulsion of the dead fetal egg. In other cases, reflex uterine contractions occur primarily and precede the death of the fetal egg (secondary death of the fetal egg), which occurs from a violation of the connection between the fetal egg and the mother's 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 at the same time.

Up to 4 weeks of pregnancy, the fetal egg is still so small that it occupies an insignificant place in the total mass of the falling off shell. Contractions of the uterus from its cavity can completely or partially remove the falling shell. 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 removing a part of the falling off shell that does not contain a fetal egg, the egg, after the cessation of contractions, can continue its development. In such cases, a slight bleeding from the pregnant uterus may even be mistaken for menstruation, especially since a small amount of discharge, similar to menstruation, sometimes occurs in the first month of pregnancy. Further observation of the pregnant woman reveals the true picture.

If uterine contractions precede the death of the fetal egg and cause its detachment from the bed in the decidua basalis area, where a rich vascular system is developed, a short but severe bleeding occurs, quickly bleeding the patient, especially if half or rion exfoliated.

The closer to the internal os of the uterus the egg is implanted, the more bleeding. This is explained by the lower contractility of the isthmus of the uterus compared to its body.
Sometimes the fetal egg of the early stages of pregnancy exfoliates entirely and, having overcome the obstacle from the side of the internal uterine os, 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 cervical canal and stretches its walls, and the neck takes on a barrel-shaped appearance. This form of miscarriage is called cervical abortion (abortus cervicalis).

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

Varieties of miscarriage

Depending on what was found during the examination, your doctor may name the type of miscarriage that 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 resting, such pregnancies often continue without further problems.
• Inevitable miscarriage (abortion in progress). If you are bleeding, your uterus is contracting and your cervix is ​​dilated, a miscarriage is inevitable.
• Incomplete miscarriage. If part of the tissue of the fetus or placenta came out, and some remained in the uterus, this is an incomplete miscarriage.
• Failed miscarriage. The tissues of the placenta and embryo remain in the uterus, but the fetus died or did not form at all.
• Complete miscarriage. If all the tissues associated with the pregnancy have come out, it is a complete miscarriage. This is usually for miscarriages that occur before 12 weeks.
• Septic miscarriage. If you have 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. Violations in the genes and chromosomes of the child are usually the result of random errors in the division and growth of the embryo - not inherited from parents.

Some examples of anomalies:

• A dead egg (anembryony). This is a fairly common occurrence, causing almost half of the miscarriages in the first 12 weeks of pregnancy. Occurs if only the placenta and membranes develop from a fertilized egg, but there is no embryo.
• Intrauterine fetal death (missed pregnancy). In this situation, there is an embryo, but it dies before any symptoms of a miscarriage appear. This is also due to genetic abnormalities of the fetus.
• Bubble drift. A mole, also called trophoblastic disease of pregnancy, is uncommon. This is an anomaly of the placenta associated with disorders at the time of fertilization. In this case, 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 status may play a role. Untreated diabetes, thyroid disease, infections, and hormonal imbalances can sometimes lead to miscarriage. Other factors that increase the risk of miscarriage are:

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

Here are the various causes of miscarriages:

Chromosomal abnormalities. During fertilization, the sperm and egg each contribute 23 chromosomes to the future zygote and create a set of 23 carefully selected pairs of chromosomes. This is a complex process, and the slightest failure can lead to a genetic anomaly that stops the growth of the embryo. Studies have shown that most miscarriages have a genetic basis. The older the woman, the more likely such anomalies.

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

Diseases of the uterus. Fibrous tumor of the uterus can cause miscarriage; such tumors often grow on the outer wall of the uterus and are not dangerous. If they are located inside the uterus, they can interfere with implantation of the embryo or blood flow to the fetus. Some women are born with a uterine septum, a rare defect that causes miscarriage. The septum is a tissue wall that separates the uterus in two. Another cause may be scarring on the surface of the uterus, as a result of surgery or abortion. This excess tissue can disrupt the implantation of the fetus, as well as obstruct blood flow to the placenta. A doctor can detect these scars with an x-ray, and most of them can be treated.

chronic diseases. Autoimmune diseases, heart, kidney or liver disease, and diabetes are examples of disorders that cause about 6% of miscarriages. If you have any chronic medical condition, find an OB/GYN who specializes in pregnancy management for these women.

Heat. No matter how healthy a woman is in her normal state, if you have a high temperature (above 39 ° C) in the early stages, this pregnancy may end in a miscarriage. Elevated temperature is especially dangerous for an embryo up to 6 weeks.

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 anomaly of fertilization, which causes a deviation in the chromosomes of the fetus, making it unviable. We are talking about the mechanism of natural selection, which does not involve anomalies either on the part of the mother or on the part of the father.

Physical activity has nothing to do with it. Therefore, you should neither blame yourself for the fact that, for example, you did not have enough rest, nor feel responsible for this. 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 the 13th to the 24th week of amenorrhea, miscarriages occur much less frequently - about 0.5%) and are usually triggered by infection or abnormal opening (gaping) of the cervix. For prevention purposes, you can make a cervical cerclage, and in case of infection, drink antibiotics.

What doesn't cause a miscarriage

Such daily activities do not provoke a miscarriage:

• Physical exercises.
• Lifting loads or physical exertion.
• Having sex.
• Work that excludes contact with harmful substances. Some studies show that the risk of miscarriage increases if the partner is over 35 years old, and the older the father, the more.
• More than two previous miscarriages. The risk of miscarriage is higher if a woman has already had two or more miscarriages. After one miscarriage, the risk is the same as if there was no miscarriage yet.
• Smoking, alcohol, drugs. Women who smoke and drink alcohol during pregnancy have a higher risk of miscarriage than non-smokers and non-drinkers. Drugs also increase the risk of miscarriage.
• Invasive prenatal examinations. Some prenatal genetic testing, such as sampling of chorionic villi or amniotic fluid, may increase the risk of miscarriage.

Symptoms and signs of spontaneous miscarriage

Often the first sign of a miscarriage is metrorrhagia (vaginal bleeding that occurs outside of a period) or palpable contractions of the pelvic muscles. However, bleeding is not always a symptom of a miscarriage: it is often a 1st trimester disorder (affecting one in four women); in most cases, the pregnancy continues unhindered.

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

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

A miscarriage that has begun (abortus incipiens). In 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 os is closed. Consolidation of the uterus during contractions is more pronounced than with a threatened miscarriage. If the connection with the uterus is broken only on a small surface of the fetal egg, for example, less than one third, its development can continue and the pregnancy is sometimes carried to the end.

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

When expelled from the uterine cavity, only parts of the fetal egg speak of an incomplete miscarriage (abortus incompletus). In such cases, the main symptoms are: profuse bleeding with large clots, which can lead to acute and severe bleeding 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, the patency of the cervical canal throughout its entire length for one or two fingers; the presence in the vagina, in the cervical canal and in the lower part of the uterine cavity of parts of an exfoliated fetal egg, 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 others

A complete miscarriage (abortus completus) is said to occur when the entire fetal egg is expelled from the uterus. During 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 scanty spotting is observed; after 1-2 days, the cervix recovers and the cervical canal closes. However, although the fetal egg is expelled from the uterus as if entirely, fragments of the falling membrane and villi that have not lost contact with the uterus, etc., usually still remain in the cavity of the latter. repeated two-handed gynecological examination. In all other cases, it is more correct to clinically consider each miscarriage as incomplete.

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

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

Complications of miscarriage can be the following pathological processes.

1. Acute anemia, which often requires urgent intervention. If a woman who has a miscarriage is healthy in all other respects, especially if the compensatory ability of the body is full, then with timely and appropriate measures taken to combat acute anemia, death from the latter is very rare.
2. Infection. With a miscarriage, a number of conditions are created that favor the development of a septic process. These include: an open uterine os, which makes it possible for microorganisms to enter the uterine cavity from the cervical canal and vagina; blood clots and remnants of the fetal egg located in the uterine cavity, which serve as a good breeding ground for microorganisms; exposed placental platform, which is an entrance gate easily permeable to microorganisms; bleeding state of the patient, reducing the body's resistance to infection. In each case, it must be established whether there is an infected (febrile) or uninfected (non-febrile) miscarriage. The presence of at least one of the following signs will indicate an infected miscarriage: high fever, palpation or percussion tenderness 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 phenomena body (frequent pulse, depressed or excited state of the patient, etc.), if they are not caused by other reasons, etc.
3. placental polyp. The formation of such a polyp is usually observed in cases where a small part of the placental tissue has lingered in the uterine cavity. Oozing from the uterine vessels due to insufficient contraction of the uterus, the blood gradually impregnates the remaining placental tissue, then layers on it, organizes and takes on the appearance of a polyp. The lower pole of the polyp can reach the internal os, which is not completely reduced due to the presence of a placental polyp in the uterus (like a foreign body). This process is accompanied by a slight bleeding from the uterus, which can last up to several weeks and even months, periodically intensifying. The entire uterus is poorly reduced. When the polyp reaches a size that causes irritation of the uterus, contractions begin and bleeding increases.
4. Malignant degeneration of the epithelium of chorionic villi retained in the uterus - chorionepithelioma.

Treatment of spontaneous miscarriage

The main issue that should be resolved at the first examination of a pregnant woman with signs of a 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 a miscarriage that has begun, pregnancy can be saved; with the developed picture of a miscarriage, pregnancy cannot be saved. From this follows the doctor's tactics in the treatment of a patient with spontaneous miscarriage.

Having established the presence of a threatening and incipient miscarriage, the pregnant woman is immediately placed in a maternity hospital, where a medical and protective regime should be organized. Its necessary elements are bed content, physical and mental rest, strengthening of faith in the preservation of 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 this is in most cases difficult to establish, medical measures are aimed at increasing the viability of the fetal egg and eliminating the increased excitability of the uterus. Sodium bromide is prescribed (1-2% solution inside, 1 tablespoon 3 times a day), glucose (20 ml of a 40% solution intravenously once a day), it is useful for the patient to stay outdoors (in winter, frequent inhalation of oxygen); with infectious etiology, injections of penicillin (50,000 IU every 3 hours) and other drugs are used; in the presence of contractions - opium preparations (opium tincture 5-10 drops 2-3 times a day orally or opium extract 0.015 g in suppositories - 2-3 suppositories per day); progesterone injections are effective (5-10 mg daily for 10 days). After that, they 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 their 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, as they increase uterine contraction, and at the same time contribute to further detachment of the fetal egg.

If these measures do not give the desired effect, bleeding and contractions intensify and the miscarriage goes to the next stage - abortion 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 fetal egg or its remains from the uterine cavity, followed by curettage.

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

In the postoperative period, bed content is prescribed, application of cold to the suprapubic region, and means that reduce the uterus: liquid ergot extract - 25 drops 2 times a day, ergotine 1 ml intramuscularly 2 times a day, etc. With a non-febrile course of the postoperative period and good general condition and feeling the patient can be discharged 3-5 days after the operation. Before discharge, a thorough general and necessarily special - gynecological (two-handed) - examination should be carried out.

Treatment of patients with synfected, febrile miscarriage is carried out either strictly conservatively (drugs), or actively (surgery), or actively and expectantly (elimination of the infection followed by instrumental removal of the remnants of the fetal egg). When choosing a method of conducting a patient, one should be guided by its general condition and the severity of the infectious process.

At the same time, they distinguish:

1. uncomplicated infected miscarriage, when only the fetal egg or the fetal egg along with the uterus is infected, but the infection has not gone beyond the uterus;
2. complicated infected miscarriage, when the infection has gone beyond the uterus, but the process has not yet been generalized;
3. septic miscarriage, when the infection is generalized.

Complicated infected and septic miscarriage is usually observed with criminal intervention for the purpose of fetal expulsion.

When treating patients with an infected uncomplicated miscarriage, some obstetricians prefer immediate instrumental emptying of the uterine cavity. Another, large part of obstetricians adheres to the active-waiting 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 disappearance of signs of infection, the uterine cavity is carefully emptied by surgery.

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

With any of the listed methods of managing patients with an infected uncomplicated miscarriage, measures are taken to raise the patient's body's defenses and 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 for many years each of the listed methods of treating patients with uncomplicated infected miscarriage - incomplete and complete, we were convinced of the advantages of the active-waiting method. We resort to urgent instrumental emptying of the uterus only in exceptional cases, when severe bleeding from the uterus threatens the life of the patient and it is necessary to stop it immediately.

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

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

Considering the danger that threatens a pregnant woman when a dead ovum is retained in the uterus due to infection, intoxication, malignant degeneration of the villi, etc., one should strive to empty the uterine cavity as soon as the diagnosis of the disease is established with certainty. In case of a failed miscarriage, treatment begins with the appointment of drugs that stimulate uterine contractions and thereby provoke a miscarriage: within 2-3 days, estrogen hormone injections of 10,000 units are made daily. After that, 60 g of castor oil are given inside, and after half an hour, quinine hydrochloride is given 6 times, 0.2 every 30 minutes; after taking the fourth powder of quinine, 4 injections of pituitrin, 0.25 ml, 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 limits of the patient's endurance. Often, the fetus that is retained in the uterus is completely or partially expelled without instrumental intervention, which is later resorted to to remove the remnants of the fetal egg.

Even in those cases when this method of treatment does not lead to the goal, i.e., to the expulsion of the fetal egg that has lingered in the uterus, it is useful, as it increases the tone of the muscles of the uterus. This creates favorable conditions for the subsequent surgical removal of the fetal egg: 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, a special account is taken of 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 may be the cause of spontaneous miscarriage. Preventive measures consist in prescribing anti-inflammatory treatment, correcting the incorrect position of the uterus, combating toxicosis of pregnancy, 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 with a miscarriage threatening and begun, should be placed in the maternity hospital, in the ward of pregnant women. Of great importance is the strengthening of the patient's faith in the possibility of maintaining pregnancy, as well as the implementation of therapeutic measures: maintaining rest, prolonged sleep, prescribing progesterone, painkillers, 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 further spontaneous miscarriage, plastic surgery on the neck should be performed before the onset of the next pregnancy - restoring its integrity.

If the pregnancy was terminated spontaneously before the 22nd week of gestation, then we are talking about a miscarriage. Such miscarriage can be diagnosed for various reasons. There are many provoking factors, besides, today's statistics are not encouraging, because we are talking about 17-18% of all desired pregnancies.

Termination of pregnancy can be different, they distinguish: threatening abortion, as well as begun, complete, infected, habitual, failed and abortion in progress.

Miscarriage in early pregnancy

Scientists believe that early miscarriages are a kind of natural selection. Approximately 75% of all embryos that were examined after spontaneous abortion had chromosomal abnormalities.

Causes of miscarriage

Even experienced and competent doctors cannot always determine the causes of a miscarriage. The thing is that most often the reasons are mixed. Initially, it is worth highlighting social factors in the form of unfavorable working conditions and bad habits.

It has been proven that smoking and drinking alcohol negatively affects all systems of the human body. The same can be said about production reasons. Here it is worth noting constant vibrations, temperature changes, chemical influence, etc.

Among the causes of miscarriage, medical factors also play an important role. These are infectious diseases, uterine development disorders, malfunctions of the endocrine system, conception with the help of IVF, etc. Doctors also note such possible causes of miscarriage:

• genetic anomalies in the development of the embryo;
• hormonal imbalance (lack of progesterone, malfunction of the adrenal glands or ovaries, placental insufficiency);
• infectious diseases of the genital tract;
• neoplasms of the uterus;
• severe stress, constant nervous tension;
• trauma and even Rhesus conflict.

The age of the expectant mother also affects pregnancy. Too young girls and women over 35 years of age may experience difficulties with bearing.

A miscarriage can start in different ways. There are three main options for the outcome of events:

• the uterus contracts, then detachment of the fetal egg is observed;
• the fetal egg exfoliates from the wall of the uterus, then the organ contracts;
• detachment of the fetal egg and uterine contractions occur simultaneously.

The symptoms of a miscarriage can vary. Doctors distinguish a pain symptom in the lower abdomen and / or sacrum, spotting, which can be profuse or just spotty. If the warning signs are not pronounced, then it is possible that the situation can still be saved and the process of rejection has not yet begun. It is important to seek help from your gynecologist who is leading the pregnancy.

But emergency cases should also be taken into account, when the help of competent medical specialists is urgently needed. An ambulance should be called immediately if heavy bleeding and / or sharp pains begin. The task in this situation is to save the life and health of a woman, because an untimely response can lead to irreparable consequences.

Threatened abortion: threatened miscarriage

Considering the threatening spontaneous interruption, it should be noted increased contractile uterine activity. With such a threat of miscarriage, the embryo retains its connection with the uterine wall.

Signs of a threatened abortion are most often a minor pain symptom in the lower abdomen or in the lumbar region. There are no discharges with an admixture of blood. During a gynecological examination, an increased tone of the uterus is diagnosed, although the organ itself corresponds in size to the gestational age. The external os of the cervix in some cases can pass one finger, the internal os is closed.

Treatment for threatened abortion

With the threat of miscarriage, treatment is prescribed exclusively by the attending physician. Most often, therapy is aimed at maintaining pregnancy. A gynecologist may prescribe vitamin E, painkillers, and a sedative. Bed rest is also recommended, it is desirable to exclude any nervous tension.

If the threat of miscarriage begins after 20-21 weeks of pregnancy, b-agonists are often prescribed. In case of hormonal failure, medical correction is carried out.

If amniotic fluid leaks (if the problem is diagnosed in the first 12 weeks of pregnancy), it is not advisable to continue the pregnancy.

The process in which detachment of the fetal egg from the uterine wall is traced is called the abortion that has begun. Bloody discharge from the vagina appears, pain in the lumbar region or just above the pubis may disturb. The pain symptom often resembles contractions and appears with a certain frequency and intensity. At gynecological examination, as a rule, the uterus is not enlarged.

If you do a pregnancy test with a miscarriage that has begun, it will show a positive result. On ultrasound examination, the fetus is in the uterine cavity, detachment of the chorionic membrane is noticeable.

Treatment of an abortion

If the doctor diagnoses an abortion that has begun, then most often the therapy is directed to maintaining the pregnancy. Vitamin E, sedatives and antispasmodics are prescribed. As an addition, Ascorutin and Etamzilat are recommended.

If the doctor detects insufficiency of the corpus luteum in the first 12 weeks of pregnancy, then gestagens are prescribed. If a woman suffers from hyperandrogenism and there is a threat of miscarriage, then corticosteroid therapy is used.

Abortion in progress

With this diagnosis, a pregnant woman may complain of pain in the abdomen or lower back. The symptom is most often presented in the form of contractions and can have different intensity. Bleeding is usually profuse.

The picture is specific. The fetal egg exfoliates, is rejected from the wall of the uterus and moves to the lower part of the organ, sometimes even to the cervical canal. This condition can end in incomplete or complete miscarriage.

If the abortion is incomplete, then after the detachment of the fetal egg, its particles may remain in the uterine cavity, including elements of the placenta and fetal membranes. Residual particles are determined by ultrasound. In addition, a pregnancy test in such a situation can still remain positive.

When viewed on a gynecological chair, the cervix is ​​ajar and easily passes a finger. The uterus itself in size most often does not correspond to the gestational age, it is reduced. Bloody discharge can have different intensity.

Treatment for incomplete abortion

Incomplete spontaneous miscarriage is treated only with instrumental removal of the fetus. The mucous membrane of the uterus is scraped off.

Treatment of this kind is similar to artificial termination of pregnancy. During the operation, the cervical canal does not expand. Medical instruments are involved - a large curette, abortsang, as well as a small sharp curette No. 5 and No. 6.

If the bleeding is insignificant, then a vacuum aspirator is often used. Also, during the operation, therapy will be performed aimed at enhancing the contractile function of the uterus and stopping bleeding.

Complete abortion

A complete expulsion of the fetal egg from the uterine cavity is a complete abortion. This condition can be observed only after the formation of the placenta, that is, after approximately 12 weeks of pregnancy. If a spontaneous miscarriage occurred before the 12th week of pregnancy, then there is no certainty that the uterus has completely emptied.

If you suspect a spontaneous miscarriage, namely a complete abortion, a gynecological examination is performed on the armchair and ultrasound. The uterus may be slightly enlarged or have a normal size. Discharges with an admixture of blood are noticeable.

A failed miscarriage is a situation in which the fetus dies, but there are no signs of termination of pregnancy. An inanimate embryo can stay in the uterus even for 20-30 days or more, undergoing necrosis. Uterine contractions may not be observed due to failures in the neurohumoral regulation of the genital system.

The symptomatology of a missed miscarriage is special. Discharges with blood impurities may appear, the fetal heartbeat is not audible (on ultrasound), the uterus may have a dimensional discrepancy (reduced).

If a dead fetus has been in the uterine cavity for too long, it is important for doctors to examine the body's reactions that are aimed at stopping the bleeding. The blood group is determined. If the gestation period is short, up to about 12-14 weeks, then the fetus is removed using vacuum aspiration. This procedure allows you to remove the fetal egg at once.

If the terms are more significant, then a specific therapy is prescribed, consisting of Oxytocin, a prostaglandin. Recommend in the complex gel Dinoprostone.

habitual miscarriage

Habitual pregnancy loss (RPB) is an interruption, spontaneous miscarriage, recurrent undeveloped pregnancy. PPB is not common among pregnant women, however, this problem cannot be called too rare. Modern physicians distinguish the term "fetal loss syndrome", the clinical criteria of which are one or more spontaneous miscarriages for a period of 10 weeks or more; neonatal death of a morphologically normal newborn as a complication of premature birth due to severe preeclampsia or placental insufficiency; stillbirth, etc.

Fetal loss syndrome is considered a generalizing definition, since it is characteristic of all stages of pregnancy, including the latest ones. In the course of medical research, it was found that miscarriage is possible in subsequent pregnancies. Diagnosis is necessary to identify the causes of repeated fetal loss. Habitual miscarriage is based on violations of the reproductive function of the body. Among other factors of PPB, it should be noted:

• endocrine disruptions of the reproductive system;
• diseases of the uterus (synechia, endometritis);
• dysfunction of the immune system;
• complications of the gestational process (multiple pregnancies, uterine infections, premature birth);
• tissue damage to the endometrium.

The presence of chronic diseases such as diabetes mellitus, arterial hypertension or infectious lesions can also cause a habitual miscarriage. Chromosome pathology is another cause of PPB, but this phenomenon is extremely rare. Timely, well-chosen diagnostics increases the chances of eliminating influencing factors and maintaining pregnancy.

One of the important causes of PPB is age: women in their 20s and 30s are half as likely to have a miscarriage as women in their 40s. The causes of PPB are quite similar to the factors for the occurrence of sporadic disruption, but with PPB, an anomaly of the reproductive function is more pronounced.

For a healthy pregnancy (in the presence of any complications), it is necessary to constantly resort to examining the condition of the embryo and the reproductive organs of a woman, to drug therapy and some effective preventive methods. Such measures will increase the chances of having a healthy baby without complications.

As a rule, four groups of main factors provoking miscarriage are distinguished. A correct assessment of the risk factors for relapse is one of the components of the diagnosis, through which it is possible to establish the cause of the termination of pregnancy and determine the methodology that will be effective for preserving the fetus.

Socio-biological conditions of parents can cause miscarriage. It can be noted here:

• low financial income, which affects the nutrition of the expectant mother;
• stressful situations, constant depression;
• emotional and physical stress.

Maternal age younger than 18 years or older than 30 years also often affects the development of pregnancy, as a result of which there may be a risk of failure. A similar factor can cause premature birth, which will lead to complications during possible future pregnancies.

The presence of any chronic or extragenital pathologies, such as diabetes, viral infections or bacterial diseases, intoxication of the body as a result of taking alcohol, drugs, as well as chronic diseases (for example, bronchitis, asthma) can serve as a cause of fetal loss.

Complications during the gestational process are often the cause of premature birth, which in most cases leads to the complete loss of the fetus. Among these complications, multiple pregnancy, previous preterm birth, intrauterine infections, uterine diseases, breech presentation of the fetus, and violation of the structure of the placenta should be noted.

Although there are a number of reasons for miscarriage, in some cases it is not possible to determine which factors led to the loss of the fetus.

As a rule, examinations are carried out at later stages of pregnancy, which is sometimes the reason for the belated detection of existing pathologies. This often does not make it possible to establish and timely eliminate certain disorders, although pregravid therapy used in such cases is quite effective. As a result, in almost half of the cases, pregnancy has a fatal outcome for the fetus and early miscarriage.

Genetic Causes of Recurrent Pregnancy Loss

Thanks to modern methods of genetic research, specialists have a broader understanding of the causes of spontaneous abortion. There is a chance of relapse due to genetic factors, but it is very small and amounts to only 3-6%. Most genetic disorders are:

• a change in the proper number of chromosomes (usually the loss of a chromosome);
• trisomy (appearance of an extra chromosome);
• polyploidy (an increase in the number of chromosomes in a complete haploid set), which is formed as a result of the fertilization of one egg by a pair of sperm.

The genetic factor in miscarriages is usually trisomies. Less likely causes of miscarriage are polyploidy and Shereshevsky-Turner syndrome.

There are also structural genetic pathologies, among which intrachromosomal and interchromosomal are distinguished. Such changes are manifested in the structure of chromosomes when a segment of one is in place of a segment of another, non-homologous chromosome. In some cases, inversions and ring-shaped chromosomes are possible.

As a result of genetic abnormalities of this type, the fetus may be born unviable or with chromosomal abnormalities (Down syndrome, color blindness and other chromosomal diseases). Occasionally, when studying the chromosome set of parents, one can find genetic abnormalities in the form of rearrangement of chromosomes.

Genetic abnormalities can also appear after a recurrence of an interrupted gestational process, which often affects subsequent pregnancies. In such cases, the process of fertilization, bifurcation of chromosomes is difficult for parents, which as a result leads to a violation of the genetic structure of the fertilized gametes.

If parents have karyotype disorders, then there is a chance that the child will be born with chromosomal abnormalities. In the presence of genetic abnormalities in the mother or father, the objective possibility of having a child with such abnormalities does not reach 10%. And in subsequent pregnancies, the risk of chromosomal pathology is only 1%.

Diagnosis of genetic factors in the genesis of unreasonable disruption is the study of the karyotype (chromosomal set) of each of the parents, cytogenetic analysis, the study of the karyotype of a stillborn child or in cases of neonatal death.

There are several significant endocrine causes of miscarriage, including diabetes and thyroid disorders. These diseases can provoke repeated miscarriages, but in the case of diabetes, the situation is solved by its compensation. Several conditions caused by hormonal imbalances are not corrected therapeutically.

At the same time, a woman may experience polycystic ovaries, insufficient development of glands and blood vessels, lack of glycogen and proteins, dysplasia and other pathologies that provoke abnormal development of the fetal egg, which ultimately leads to miscarriage. Hormonal disorders that provoke a miscarriage can be different, but hyperandrogenism is the most common among them. This pathology is due to a change in androgen metabolism.

Hyperandrogenism may be polycystic ovary syndrome. This pathology is characterized by infertility, menstrual cycle disorders, obesity. Pathology affects not only the ovaries, but also the adrenal glands. Although the causes of the pathology are not fully understood, it is assumed that the disease begins during adrenarche. During this period, the adrenal glands are stimulated, which provokes an accelerated production of androgens and, as a result, an excessive accumulation of estrogens on the skin and fatty tissues.

From the adrenal glands, the pathological syndrome passes to the ovaries, which also begin to produce androgens in large quantities. As the process of disorders develops, the pathology, affecting the ovaries, leads to the appearance in them of various functional and structural disorders. This, in turn, causes even more complex mixed pathologies. The severity of the pathological process makes it very difficult to diagnose and, accordingly, treat and subsequently manage pregnancy in women.

Stress, a number of diseases, various infections and mechanical injuries are essential in the manifestation of such disorders, which become the initial cause of the pathology in women who have problems associated with the genetic background. There is evidence that women suffering from adrenal hyperandrogenism belong to the primary stage of this disease. Clinically, this is expressed by mild symptoms of androgenization and minor hormonal disorders. At this stage, it is easier to diagnose the problem, moreover, adequate treatment leads to complete rehabilitation.

infectious causes

Today there is no doubt that the infectious factor plays a significant role in miscarriage. If the gestational age at which the infection entered the body is still small, there is a risk of developing feto- and embryopathies that are not compatible with life and provoke a miscarriage. The likelihood that the infection will reactivate at such times and provoke repeated miscarriages tends to zero. Studies show that in most patients with PPB and chronic endometritis, the endometrium is dominated by 2 types of viruses and other harmful microorganisms.

Viral infections such as herpes simplex, Coxsackie (A and B), entero- and cytomegalovirus are observed in women with PPB much more often than in patients who do not have complications of a gynecological history. Bacteria and viruses that infect the endometrium lead to the fact that a woman's immunity loses the ability to adequately fight harmful microorganisms.

Diseases of a viral nature (influenza, measles, polio, rubella, mumps, hepatitis, parvovirus, and others) that develop during pregnancy often lead to fetal malformations and miscarriages. The gestational age at which infection occurred is of great importance. The smaller it is, the higher the probability of the above consequences becomes. Infection affecting the fetus in the later stages of its development, as a rule, does not lead to serious pathologies, but it can disrupt the normal functionality of tissues and cells.

The placenta protects the fetus. Being a physiological obstacle to infection getting to the fetus, it does not always cope with its task. In particular, in the early stages of pregnancy, a trophoblast is formed, with a rapid division of its cells and, accordingly, an acceleration of metabolic processes. This becomes an ideal environment for the spread of viruses. In turn, the replication of pathogens can damage the placenta, and it loses its protective abilities.

Viruses can penetrate the placenta to the fetus in the event of all kinds of damage to the placental tissue caused by the threat of disruption, autoimmune disorders, and toxicosis. A bacterial infection develops after the pathogen enters through the birth canal. This path is also characteristic of fungi such as Candida, chlamydia and mycoplasmas.

Before childbirth, amniotic fluid has antimicrobial properties, but they are not very pronounced and can only delay the spread of microorganisms, but not eliminate and suppress the pathogen. At the same time, the membrane remains permeable to a number of pathogens that can enter the amniotic fluid, after which they begin to actively multiply. As a result, an infected environment is formed in which the fetus is found. This leads to consequences such as:

• infection of the fetus;
• vasculitis (premature placenta);
• oligohydramnios and polyhydramnios;
• placental insufficiency (delayed fetal development);
• miscarriage;
• rupture of the membranes of the fetus;
• respiratory disorders in the newborn.

The most sensitive period to the influence of negative factors is the first 3-6 weeks of pregnancy. Infectious lesions of the fetus that occur during this period lead to deformity, since they affect tissues that are in the process of rapid formation. Since all the internal organs of the fetus are laid at different periods of pregnancy, the prevalence and severity of the lesion depends on the duration of the negative factor.

In the period from 13 to 27 weeks, the fetus acquires sensitivity to pathogenic microorganisms that provoke the development of intrauterine infections. In this case, there is also a possibility of developing pathologies. Negative processes provoke the narrowing of certain openings and channels, as a result of which the subsequent development of an already formed organ is disrupted. After 27 weeks, the fetus can already respond to the pathogen with various changes, which leads to a number of dysfunctions.

A bacterial and viral infection, often mixed and in a chronic form, observed in women with PPB, stays in the body for a long time without showing any symptoms, but subsequently leads to autoimmune and other problems, including the death of the fetal egg and its rejection, miscarriage .

The anatomical factors of PPB include the following pathologies:

• congenital defects in the development of the uterus (double uterus; two- or unicornuate, as well as a saddle uterus; the presence of a septum inside the uterus);
• acquired anomalies (sinechia, fibroids);
• cervical insufficiency.

Anatomical defects of the reproductive system in patients with PPB are rare (10 to 16% of cases). In most of these patients, uterine development anomalies are combined with hormonal disruptions, menstrual irregularities. The mechanism of miscarriage in the abnormal development of the uterus is the incorrect implantation of the fetal egg, malformations of the endometrium and other pathologies.

Often, pregnancy is interrupted due to uterine hypoplasia due to infantile genitalia. This is a private symptom of a severe pathological process, which is characterized by underdevelopment of the genital organs and all kinds of disorders of the uterus, ovaries, pituitary gland and hypothalamus.

The reasons why genital infantilism develops are not clearly defined. However, many complications are associated with this pathology, such as menstrual and reproductive disorders. When a pregnancy is terminated as a result of genital infantilism, the factor of uterine pathologies plays the main role:

• the endometrium is not prepared enough;
• the myometrium of the infantile uterus is excessively excitable;
• close relationships in the space of the uterus.

The threat of miscarriage in this case exists throughout the pregnancy. In the second third of pregnancy, such patients often have a complication in the form of cervical insufficiency. In the later stages, there is an increased tone of the uterus, placental insufficiency may develop. Simultaneously with these defects, the impact of other adverse factors leading to spontaneous miscarriage is often observed.

As for uterine fibroids, the reproduction of many women with this problem is absolutely normal, pregnancy, like childbirth, is not fraught with any complications. However, in these patients there is still a risk of abortion, often in cases where the size of the uterus is not suitable for healthy gestation. In addition, the location of large myomatous nodes can deform the uterine cavity and create negative conditions for the growth of the fetus and the formation of the placenta.

If a woman suffering from fibroids has any hormonal disorders, this becomes an additional negative factor that can lead to miscarriage even in early pregnancy. It is assumed that uterine fibroids are often accompanied by progesterone deficiency, which potentially contributes to spontaneous breakdown.

Often the threat of miscarriage is due to swelling, malnutrition of fibroids, tumor necrosis. The treatment recommended to maintain pregnancy in women with uterine fibroids is selected on a case-by-case basis. The doctor takes into account the age of the patient, the duration of the disease, hereditary factors, the presence of other defects.

Immunological causes

At the moment, it is known that approximately 80% of all PPB, which could not be explained before (with the exception of factors of a genetic, endocrine, anatomical and infectious nature), are caused by disorders of the immune system. There are two types of such disorders - autoimmune and alloimmune.

With autoimmune problems, the immune system directs aggression to the tissues of the mother's body, that is, antibodies begin to attack their own antigens. In this case, the fetus suffers doubly, as the tissues of the woman are damaged. With an alloimmune factor, the patient's immune response is directed against the antigens of the fetus, which are received from the father and are perceived by the mother's immunity as foreign.

Usually in patients with PPB there are such autoimmune disorders as the presence in the serum of autoimmune antibodies - antiphospholipid, antithyroid and antinuclear. The detection of these antibodies is the reason for a more thorough examination, which will detect the autoimmune process and formulate a diagnosis.

The most dangerous autoimmune problem leading to fetal death is Hughes syndrome, or antiphospholipid syndrome. Clinically, it is manifested by several criteria:

• miscarriage;
• thrombophilias resulting from genetic disorders;
• so-called sticky platelets and other anomalies.

Alloimmune disorders that provoke pregnancy loss appear as a result of a couple having an increased number of common antigens in the histocompatibility system, which often happens when marriage is between blood relatives. In addition, an insufficient content of blocking factors in the serum of a woman leads to alloimmune problems.

There is no definitive therapy for this problem. To date, progesterone is considered the most effective immunomodulatory drug used in early pregnancy.

Several miscarriages or two or more preterm births in a woman's history can be considered habitual miscarriage. There can be many reasons for the development of such a problem. In particular, experts in the medical field highlight disruptions in the endocrine system, infectious diseases, uterine pathologies, genetic and autoimmune factors.

Before pregnancy, a woman with habitual miscarriage must undergo a thorough examination. The hormonal background, the virological status of the woman, the karyotype of the future mother and father are taken into account. It is necessary to carry out ultrasound diagnostics of the genital internal organs, salpingography (assessment of the patency of the uterine tubes) and hysteroscopy (examination of the uterine cavity).

Therapy for habitual miscarriage should be prescribed before the moment of conception. In addition, the emphasis is on exactly the cause of the problem.

If the reproductive system refuses to fully function against the background of endocrine disorders, then hormonal drugs are prescribed. A complete hormonal correction is carried out.

• If an excess of androgens is formed by the adrenal glands, then the attending physician will prescribe individual treatment with the use of glucocorticoids. Most often it is Dexamethasone.
• If androgens were produced in excess by the ovaries, then medications with an antiandrogenic effect are recommended. It could be Diane-35 and Androkur. Each drug is prescribed according to a strict scheme. So, for example, Androcur must be taken for several months (starting from the first and ending with the tenth day of the menstrual cycle). If therapy does not give the desired result after 3-4 months of treatment, then Clostilbegid or Clomiphencitrate is used to artificially stimulate ovulation.
• If in the body of a woman androgens are produced in excess by both the adrenal glands and the ovaries, then this form of the disease is considered mixed. In such a situation, before the desired pregnancy, the patient should get rid of excess weight. The doctor will try to normalize carbohydrate and lipid metabolism before conception. If insulin and glucose are normal, then in the second phase of menstruation, Dufaston or Utrozhestan is prescribed along with Dexamethasone. Ovulation is stimulated by Clostilbegid.

In the event that a woman with recurrent miscarriage has problems with the luteal phase, hormonal combined medications are prescribed that combine progestogen and estrogen. It can be Femostan, Silest and others. They are taken for 2-3 months in a certain period of time, or rather 20 days, starting from the fifth day of the onset of the menstrual cycle.

During therapy, ovulation slows down, but after the treatment is canceled, the process of the release of the egg from the follicle resumes, as well as the development of the corpus luteum. If the effect is not observed, then Clostilbegid 50 mg is most often prescribed.

If in the blood of a woman who is diagnosed with habitual miscarriage (permanent miscarriage or premature birth), the level of prolactin is increased, then Bromkriptin is prescribed. The treatment regimen is determined on an individual basis. Moreover, the entire period of therapy is controlled by analyzes that determine the level of prolactin.

If a woman cannot bear a fetus, she has a history of 2 or more miscarriages, and the causes of this pathology are associated with an infection, then treatment may include antibiotic therapy. Also, eubiotics, immunomodulators (Viferon) and antimycotics, for example, Diflucan, can be prescribed in the complex.

If the cause of miscarriage is a viral infection of the body, then the treatment regimen will depend on the type of process. If the viral infection is active and often relapses, then the attending physician may prescribe chemotherapy (up to 10 days) with Acyclovir and Valaciclovir.

If persistent miscarriages are a consequence of autoimmune disorders, then Metipred (glucocorticosteroid hormones) may be prescribed in small doses shortly before the planned conception. If autoimmune disorders are traced in combination with the preserved activity of the virus, then antiviral drugs and immunomodulators are recommended.

If the pregnancy is terminated on its own due to uterine adhesions, septa or other pathologies of the uterus, then surgery is prescribed. In any case, only a competent doctor can prescribe adequate treatment for habitual miscarriage. The specialist will take into account the age of the patient, her obstetric portrait, the presence of chronic systemic diseases and other nuances that may be important. Any self-medication is fraught with negative consequences, especially since they don’t joke with health, even if you are sure of the diagnosis.

If a woman has a diagnosis - habitual miscarriage, then during a subsequent pregnancy she must undergo a standard examination scheme. As an addition to the diagnosis of the condition is prescribed:

• Tests to determine the level of hormones in the first 12 weeks after conception. Including chorionic gonadotropin, testosterone, progesterone, estradiol, etc.
• Culture for bacteria from the cervical canal, which connects the vagina and the uterine cavity.
• Laboratory analysis of the mucus of the cervical canal for the detection of pathogens of an infectious nature.
• Ultrasound diagnosis of the state of the cervix (starting from the second trimester).
• Cardiotocography to monitor uterine contractions and the heartbeat of the unborn child (every week, one month before the expected date of birth).
• Dopplerometry (according to individual medical indications).

A pregnant woman who has had several miscarriages in her history should be constantly under the supervision of the attending (leading) gynecologist. Any changes in well-being should be the reason for an urgent visit to a specialist. In no case should you experiment with medications, change the prescribed treatment regimen, it is undesirable to miss scheduled visits to the gynecologist or endure the symptoms of any disorders.

Therapeutic measures

Even if a woman diagnosed with recurrent miscarriage does not have any health problems during a subsequent pregnancy, treatment can be prescribed according to the indications of the attending (leading) doctor. A therapeutic bias can be made in the following areas:

• Symptomatic treatment of threatened miscarriage.
• Treatment aimed at preventing fetal hypoxia and placental insufficiency.
• Drug effects, for example, aimed at normalizing metabolism, increasing the reactivity of the immune system, as well as correcting malfunctions in the internal organs.

This kind of treatment should be applied only according to the indications of the attending physician. The results of laboratory tests are also taken into account, which confirm the excess of a particular hormone or its deficiency. In the case when miscarriages occur due to endocrine disorders in the body, hormonal therapy is recommended.

Treatment with glucocorticoid drugs is prescribed, as a rule, at critical stages of pregnancy, namely at 12-13, 24 and 28 weeks. The fact is that it is during this period of time that a spontaneous increase in the production of androgens by the ovaries or adrenal glands may appear. In the event that the level of the hormone has increased precisely because of the functioning of the adrenal glands, Dexamethasone is prescribed. If hyperandrogenism is provoked by the ovaries, then the doctor will prescribe gestagens, for example, Utrozhestan.

If an increased level of androgens appeared due to the work of the ovaries and adrenal glands, then the violation is of a mixed nature, therefore Dexamethasone and progestogens are also prescribed.

To prevent the activation of the infectious process in women who take glucocorticoids, several courses of immunoglobulin are prescribed, which is administered intravenously.

If luteal phase deficiency is diagnosed, the doctor may recommend vaginal suppositories or Utrozhestan capsules for oral administration. This medication has a special active substance, the corpus luteum hormone - progesterone.

Before prescribing glucocorticoids to a pregnant woman, the doctor must evaluate the ratio of benefits and harms to the fetus. After all, synthetic drugs of this group (Metipred or / and Dexamethasone) easily penetrate the placenta and affect the fetus. Glucocorticoids can lead to fetal growth retardation (activation of the hypothalamic and pituitary systems of the unborn child is possible with a slowdown in the production of nucleic acids and proteins). A child is often born with clear signs of morphofunctional immaturity.

Also, these drugs can have a negative effect on the fetal brain. The size of the hippocampus (part of the limbic system) is reduced. So there is a memory deficit, behavioral disorders in adulthood are possible.

Long-term glucocorticoid therapy can provoke the development of type 2 diabetes mellitus and arterial hypertension (persistent increase in blood pressure) in adults.

In the event that a pregnant woman with a diagnosis of "recurrent miscarriage" (several miscarriages in history) suffers from urogenital infections, individually selected treatment is carried out, taking into account the manifestation of the disease. The age of the patient, the results of laboratory tests and the symptoms of the disease are taken into account. Therapy must be comprehensive. As a rule, eubiotics are prescribed, for example, Bifidumbacterin, as well as antibiotics and, of course, desensitizing treatment.

If a pregnant woman has several miscarriages caused by autoimmune disorders in the body, then therapy may consist of a whole range of medications, including immunomodulators, glucocorticoids, anticoagulants and antiplatelet agents. The course of treatment and the regimen depend on the individual characteristics of the patient. Only a doctor can prescribe or cancel medications. Any self-medication is fraught with negative consequences, both for the expectant mother and for the fetus.

If a pregnant woman is diagnosed with congenital defects in hemostasis or simply has violations of the complex of reactions that are aimed at stopping and preventing bleeding, treatment with atcoagulants and, possibly, antiplatelet agents is recommended. Depending on the disorders, the doctor may prescribe Clexane, Heparin for injection or / and Trental and even Aspirin.

Symptomatic therapy for threatened interruption

If a woman has a threat of miscarriage, then symptomatic treatment is also prescribed. Also, much attention is paid to placental insufficiency, or rather its prevention.

It is worth noting the importance of modern diagnostics and corrective manipulations aimed at isthmic-cervical insufficiency in the prevention of miscarriage.

Isthmic-cervical insufficiency is a violation that is reflected in the inability of the internal os to keep the fetal egg in the uterine cavity. Diagnose this problem with the help of ultrasound. The dimensions of the cervix, its length and width in the region of the internal os are taken into account.

On ultrasound, a picture of isthmic-cervical insufficiency is clearly visible. Normally, the pharynx should be closed, but if it is disturbed, it is expanded, the neck is reduced. Ultrasound diagnostics with habitual miscarriage (several miscarriages) is important to carry out more often. Additionally, a study is prescribed at 16-17 weeks of gestation for the diagnosis of isthmic-cervical insufficiency, so that sutures can be applied in time.

A doctor can prescribe an operation for suturing the cervix if the cervix is ​​shortened by more than 2 cm, and the pharynx is expanded by more than 1 cm.

Correction of the aforementioned insufficiency is carried out according to the McDonald method. Sutures are applied with special mersilene threads or silk. They are removed at the onset of labor or closer to the term of 35-36 weeks.

Any diagnosis in case of a threatened miscarriage, as well as the treatment of miscarriage, should be selected on an individual basis. There is no universal therapy for all cases. Any alarming symptoms during gestation should be a reason for urgent medical attention. Pain, bleeding are the main signs of disorders that can be a signal indicating an irreversible process has begun. The sooner a pregnant woman sees a doctor, the greater the chance of a successful outcome. You should not experiment on your health and the health of the unborn baby, even any one.

For certain reasons, a miscarriage can occur due to various hormonal disorders, previous abortions, STDs, viral and infectious diseases, in particular, if a woman is often stressed. In order to timely prevent the occurrence of an undesirable situation, one should consider the existing causes that provoke the occurrence of miscarriages. We'll try to figure this out.

Indeed, knowing about certain symptoms that precede the ongoing spontaneous abortion, taking appropriate actions in time, it is quite possible to safely endure and also give birth to a baby.

Some sources claim that almost fifteen to twenty percent of all pregnancies end in miscarriages. In addition, in many cases this is observed at a time when the pregnant woman does not even suspect that the pregnancy process has already begun, and the discharge that appears at this time believes that the next menstruation has come.

In such a situation, the psychological state of a woman is in a calmer state after she learns about what happened, she is less prone to the occurrence of strong psychological shocks, depression and stress. However, when a miscarriage occurs in the early period, it is definitely more difficult for a woman to endure it emotionally.

An early miscarriage is the process of carrying a baby that happens before the twelfth week. Often there are "late" involuntary abortions.

Diagnosis of a miscarriage

If the pregnant woman felt that any deviations were occurring in her body, then she should immediately seek medical help. There are various signs of a miscarriage, however, the doctor still takes into account the clinical symptoms.

The main method that is used in the study of miscarriage is ultrasound diagnostics. Since it determines the fact, it also helps to determine the method by which the treatment will be carried out, that is, whether it is necessary to continue to carry out therapy aimed at maintaining the pregnancy or not. Often a method is used to measure the level of hCG in the blood, because if the fetus has died, its level decreases.

The most dangerous, as well as serious, sign of a miscarriage is vaginal bleeding, in particular, if it is completely insignificant. It is from a weak discharge of blood, which intensifies over time, that a spontaneous abortion occurs, along with this process, spasms may also appear in the lower abdomen. Incoming discharge may have a scarlet hue, as well as brown. At the same time, they can be observed not very abundant and last more than a few days.

Cutting pains can be along with a miscarriage, but their absence can also be observed. It happens that symptoms appear, but they can disappear for a certain period of time, then reappear. In the event of one of these symptoms, a woman should immediately consult a doctor, since it is emergency medical care that can save the unborn baby.

If there is a sharp deterioration in the general condition of a woman, and for this there were no various precursors, in addition, pieces of tissue are observed in the resulting secretions, then this often indicates the following - a miscarriage has occurred. Often, the death of the fetus occurs before the start of the process of removing it from the female body.

Thus, it is quite often observed that the fetus comes out in parts. If it happens that the fetus is completely removed, then it looks like a round bubble with a grayish tint. Sometimes in bloody discharge there may be some particles that have a white color. For two or three days, along with pain, bleeding may occur.

When, after interrupting the process of bearing a baby, the cleaning of the uterus occurred in a completely independent way, the woman in this case does not need further appropriate therapy. However, if certain fragments of the fetus are found in the uterus, then their immediate removal is required. As a rule, after a miscarriage, a month or two later, the next menstruation begins.

When a woman’s body rejects an embryo, which occurs during the process of carrying crumbs up to the twenty-second week, such a process is called a miscarriage or spontaneous abortion.

If this process happened before the twelfth week of pregnancy, it is called early. In the case when the process of termination of pregnancy was in the interval from the twelfth to the twenty-second week, in this case the miscarriage is called late.

The concept of "premature birth" refers to the ongoing spontaneous interruption of the process of bearing a baby, observed in the period from 23 to 37 weeks. When, during 37-42 weeks, the fetus is rejected, then such delivery will be called urgent, when a completely viable baby is born.

Late birth - when a pregnant woman gives birth after the forty-second week, this does not have the best effect on the condition of the baby, as well as on the birth process itself. From a medical point of view, when a baby is born before the twenty-second week, it is a fetus. But if the birth of the crumbs occurred in the period from 22 to 37 weeks, then the baby is considered a premature newborn. Its weight is no more than half a kilogram, and its height, as a rule, is about twenty-five centimeters.

However, thanks to the achievements of modern medicine, babies born today, even with a very small weight, have a great chance to survive. Today, raising a baby who was born at seven months is not a problem.

What could be the causes of a miscarriage?

Not in all cases it is easy to determine the cause of the miscarriage. Even after completing a series of studies, a woman is not always able to find out why the abortion happened. This is explained by the fact that such a process can happen not because of existing health problems, but because of random factors that cannot be influenced.

The main causes of miscarriage include:

1. Hormonal problems observed in a pregnant woman. This reason is the most common, due to which in the first period there is a threat of miscarriage. But if a woman turns to the doctor in a timely manner, then there is a possibility that such a miscarriage can be eliminated. The doctor then prescribes the use of drugs that eliminate the resulting lack of hormones.

   As a rule, the specialist will recommend taking such drugs: duphaston, utrozhestan, since in case of a lack of a corpus luteum they have a beneficial effect on the process of maintaining pregnancy. When the problem is that the thyroid gland has pathologies, then the treatment is carried out in this direction.

   If the female body contains a significant amount of male hormones aimed at reducing the formation of progesterone and estrogen, this can also cause a miscarriage. This condition is commonly seen in polycystic ovary syndrome. Then the appropriate treatment should be carried out even before the pregnancy planning process.

2. performed in the anamnesis, because this manipulation is quite a lot of stress for the woman's body, which can provoke dysfunction of the adrenal glands and ovaries. In addition, abortion contributes to the appearance of inflammation in the genitals, which in the future may become one of the causes of childlessness, as well as recurrent miscarriages.
3. An anomaly in the fetus at the genetic level, which often comes into contact with a pathology that is hereditary in nature. In certain cases, this condition appears due to single mutations leading to the death of the fetus. At this moment, the female body at the hormonal level realizes that the development of the embryo has stopped and then a miscarriage occurs.

   In such cases, it is impossible to stop a spontaneous abortion, and there is no point in this, since the death of the fetus has already occurred. In the fetal genome, the occurrence of various mutations provokes the use of alcohol, smoking, in particular the intake of appropriate drugs, as well as the poor state of the environment. All possible harm should be excluded even in the process of planning conception.

4. Immunological ailments of various kinds can provoke a miscarriage. In many cases, for a reason, when women have a negative Rh factor. In order to avoid miscarriage in such cases, it is eliminated by a special drug administered to the pregnant woman as a neutralization of antibodies.
5. An unhealthy lifestyle is one of the important factors that negatively affect the fetus. Therefore, smoking and the use of alcohol-containing drugs should be excluded even before the conception process.
6. Infectious diseases and various infections that are transmitted sexually can cause an abnormal development of the fetus, which can affect the course of pregnancy.
7. Stress is a condition that manifests itself along with the release of hormones that enter the bloodstream. These hormones have an insufficiently favorable effect on the course of bearing a baby.
8. Sexual intercourse, as well as various falls, weight lifting, in some cases, can be an appropriate mechanism that provokes the process of abortion.

If a spontaneous abortion has occurred, then the doctor should explain the further actions that will need to be taken by the woman. After this process, the condition of women is quite severe, especially if the pregnancy was expected and planned.

It is more desirable to take a vacation for a while, you can apply for a sick leave, since a woman will need some time to restore her psycho-emotional, as well as physical condition.

Since no woman can be insured from terminating a pregnancy, therefore, when a miscarriage happened for the first time, the doctor will suggest undergoing an appropriate examination of the body in order to find out the reasons that provoke the appearance of this process.

In the case when the interruption did not occur for the first time, then a complete examination should be performed, which will help identify existing genetic ailments, possible infections, and also help determine the state in which the hormonal background is. The delivery of appropriate tests must be performed not only by a woman, but also by a man who can be the source of this problem.

What are the types of miscarriages?

Doctors of miscarriage are divided into several types:

1. Incomplete (inevitable) - when in the lower abdomen, in particular in the lumbar region, there are sharp pains that appear along with uterine bleeding. Moreover, if there is an increase in the lumen of the cervix, the fetal membrane bursts, then such a miscarriage is inevitable. In the case of an incomplete miscarriage, the incoming discharge and pain do not stop.
2. Failed spontaneous abortion - when the death of the embryo (fetus) occurs, but at the same time it continues to be directly in the uterus. Such a condition can only be determined at the doctor's consultation, during which the specialist listens to the baby's heartbeat.
3. Complete miscarriage - when there is a spontaneous abortion and the fetus has completely left the uterus. During this period, hemorrhages completely stop, and there are no unpleasant sensations.
4. Anembryony - when fertilization occurs, but the formation of the fetus is not carried out. Attachment of the egg to the wall of the uterus is observed, it is also possible the formation of a gestational sac, in which there is a yolk sac. At the same time, there is no fetus in the uterus, but there may be symptoms of pregnancy.
5. Repeated - observed in the case when a woman in the early stages had more than three spontaneous abortions. Somewhere around one percent of families have a similar disorder.
6. Chorionic adenoma - with such a violation of fertilization, it is observed along with a change in genetic information, after which only a small piece of tissue is formed instead of the embryo, which takes on a larger size. Such painful conditions for medical reasons end in spontaneous termination of pregnancy, that is, abortion.

In the case when an early miscarriage occurred, and appropriate treatment was carried out, then no complications will arise. The doctor will definitely prescribe antibiotics, and also recommend starting the appropriate hormonal contraceptives. It is antibiotics that can overcome the infection, but as a normalization of the hormonal background, contraceptives should be used.

However, when a woman has not resorted to curettage for a long time, it is possible to seek medical help in a timely manner, in which case a serious infection may occur, which can lead to endometritis, as well as inflammation of the uterine appendages. Subsequently, due to these complications, infertility may occur, since obstruction of the fallopian tubes occurs, thereby the appendages will function in the wrong volume.

Miscarriage - this condition is a severe stress that has an adverse effect on the immune as well as the hormonal system, therefore, oral contraceptives will need to be used for three months.

What precautions should be taken to prevent miscarriage?

It is good when a woman prepares in advance for the upcoming process of bearing a baby and plans to exclude those factors that can provoke a miscarriage. It is necessary to stop smoking and drinking alcohol-containing drinks.

Particular attention should be paid to nutrition, it should be complete and balanced. Sleep should preferably be eight hours. It is also advisable to perform a complete examination to help determine the presence of infections, and an appropriate study aimed at studying thyroid hormones should also be performed.

About the period at which there is a possibility of a miscarriage, you need to find out from the doctor. As a rule, special care should be taken at four to five weeks, including eight to nine weeks, as well as eleven to twelve weeks, that is, in the first half of the pregnancy process. In the development of the fetus, it is precisely such critical stages, as well as the influence exerted by various pathological factors, that can lead to the death of the fetus.

Throughout pregnancy, many health problems can arise, but the thoughts of a pregnant woman should only be positive, because this can serve as an excellent prevention of miscarriage. Since it is a stable emotional mood and mental state that can protect against spontaneous abortion.

In case of any danger, be sure to immediately consult a doctor. And remember that the problem is easier to prevent than to treat it.

Unfortunately, the onset of pregnancy is far from a guarantee that it will end safely and the baby will be born healthy. It often happens that the body simply rejects the life that has arisen in it and an involuntary termination of pregnancy occurs. This phenomenon is called a miscarriage and often it occurs precisely in the early stages of pregnancy, up to 12 weeks. Why does this happen, what does a miscarriage look like in early pregnancy, what reasons provoke it and what consequences does it have? We will consider all this further.

A miscarriage is considered an involuntary termination of pregnancy, which can occur up to the 22nd week of pregnancy.. However, the lion's share of miscarriages are still early and occur for up to 12 weeks. It often happens that a woman does not even suspect that she is pregnant: she just notices a delay, and then menstruation still occurs (just more abundantly and painfully), and with her a blood clot comes out of the vagina, similar to bursting bubble. This is how an early miscarriage happens.

Judging by the description, it may seem that this phenomenon occurs almost instantly, but this is not so. The process of abortion in the early stages lasts a certain period (up to several days) and consists of several stages:

1. Risk of miscarriage. A woman notes the appearance of dull, cramping pains in the lower abdomen and in the lower back, as well as spotting bloody discharge from the vagina. If a woman knows that she is pregnant, then this is an immediate signal for her to see a doctor. The sooner in this case seek medical help, the more chances there are to save and keep the fetus.
2. Gradual detachment of the placenta. After placental abruption occurs, the fetus dies due to hypoxia (oxygen starvation). It is already impossible to stop a miscarriage.
3. Final detachment of the placenta and the beginning of separation of the fetus.
4. The exit of the fetus and child's place from the uterine cavity.

It is extremely important after the incident to consult a doctor so that he makes a thorough examination and, if necessary, cleans the remaining tissues in the uterus.

Causes of early miscarriage

The most common causes of early miscarriage are:

• Genetic abnormalities in the fetus. Various developmental disorders can be either hereditary or completely spontaneous, caused by adverse external factors (for example, a viral infection in the mother). In this case, the female body regards the fetus as something pathogenic and incompetent and hurries to get rid of it.
• Hormonal disorders. A healthy and full pregnancy proceeds against the background of the production of the necessary hormones. So, in the early stages of pregnancy, to maintain it, the female body urgently needs such a hormone as progesterone. If, for some reason, it is not produced in sufficient quantities (for example, due to an excess of male hormones), the body cannot support pregnancy.

• Rh-conflict of the fetus and mother. If the fetus inherits from the father an opposite Rh factor than the mother (for example, the mother has a negative Rh factor, and the fetus has a positive Rh factor), the female body perceives it as something a priori alien and rejection may occur. With the timely identification of such a cause (it is advisable to take a blood test to determine the Rh factor for both parents at the stage of pregnancy planning), hormone therapy with the hormone progesterone is prescribed, which is a kind of protection for the baby.
• Various infectious diseases. There are many different sexually transmitted infections: syphilis, herpes, chlamydia, gonorrhea, toxoplasmosis, etc. If the mother has such a disease, the fetus and fetal membranes can also become infected, as a result of which the body will begin to reject the embryo as something pathogenic . Many of these diseases can be completely asymptomatic, which is why the expectant mother needs to undergo a thorough examination at the stage of pregnancy planning.

• Viral or chronic diseases. In the presence of any inflammatory processes in the body, it weakens significantly and becomes unable to support the pregnancy and hold the fetus, so the pregnancy is terminated.
• Abortions in the past. Abortion, one way or another, can negatively affect the functioning of the ovaries, adrenal glands, and cause the development of inflammatory processes in the female reproductive organs. Therefore, it is not surprising that such an intervention, even made long before a new pregnancy, can have a detrimental effect on it.

• The use of drugs and traditional medicine. Various medications taken in the early stages can lead to abnormalities in the development of the fetus, which in themselves are a possible cause of miscarriage. Few people know that many traditional medicines, and even such harmless herbs as nettle, tansy, St. John's wort, parsley, etc., when taken regularly, can cause uterine tone and provoke a miscarriage.
• Stress. Oddly enough, but stressful situations and nervous tension very often do not allow the body to keep the fetus and cause abortion.

• Strong physical activity. A miscarriage can also occur from severe physical overexertion. Therefore, pregnant women should abandon intense physical activity and weight lifting.
• Bad habits. Smoking, alcohol and drug abuse can lead to defects in the development of the fetus and, as a result, to miscarriage.
• Taking a hot bath. For the period of pregnancy, especially in its initial stages, a woman should refuse to take an excessively hot bath for a long time, since such procedures more than once caused the loss of a baby.

• Falls and injuries. Injuries themselves are not capable of harming the fetus, since it is reliably protected in the womb, but they can cause various disorders in her body, which will lead to negative consequences.
• Individual characteristics of the organism. These are various pathologies of the body of the expectant mother, as a result of which it is extremely difficult for her to bear a child: oncological diseases of the organs of the reproductive system, congenital anomalies (for example,), etc.

Early miscarriage symptoms

The most common symptoms of involuntary termination of pregnancy in its early stages can be:

• dull pain in the lower abdomen, radiating to the lower back (it has a periodic, cramping character);
• the appearance of brown or bloody discharge from the vagina (bloody discharge indicates that placental abruption has begun);
• profuse bleeding with clots and pieces of tissue (this indicates that the miscarriage has already taken place);
• (however, it is not always accompanied by discomfort and pain).

How is a threatened miscarriage diagnosed?

Ideally, a possible threat of abortion is diagnosed even before it occurs, at the planning stage. So, a woman planning a conception undergoes thorough examinations and tests to identify any pathologies that can interfere with the healthy bearing of a baby. If the pregnancy occurred spontaneously, then it does not matter, because with timely access to a gynecologist, you can also identify factors that indicate a possible termination of pregnancy. This happens with:

• comparison of the size of the uterus and the duration of pregnancy;
• determining the density of the closure of the cervix;
• identifying possible uterine tone;
• analysis of the presence and nature of vaginal discharge;
• taking tests (for example, a blood test for hormone levels, a blood test for intrauterine infections, a smear for ureaplasma, mycoplasmas, chlamydia, etc.).

A sufficiently informative method for diagnosing such a threat in the first trimester is transvaginal ultrasound, which makes it possible to examine the condition of the cervix, its length, etc.

Treatment of threatened miscarriage in the early stages

If there is a threat of spontaneous abortion, a woman is most often subject to hospitalization, she is prescribed bed rest (minimum physical activity) and emotional peace. Treatment is prescribed exclusively by the attending physician, based directly on the cause of the probable miscarriage. Usually pregnant women with such a threat are treated:

• hormonal drugs to increase the amount of progesterone (Dufaston, Utrozhestan), or to suppress male hormones in case of their excess;
• antispasmodics that reduce the tone of the uterus;
• vitamins to support the pregnancy itself;
• sedatives to maintain emotional health, which is also incredibly important for the preservation of the child.

Special treatment may also be prescribed, which is necessary in one case or another, for example, with ICI, sutures can be placed on the cervix to prevent its opening, with genital infections - local antibiotics, anti-inflammatory drugs, etc.

Prevention of miscarriage

The best prevention of miscarriage is a complete examination of both partners at the stage of pregnancy planning and the elimination of possible pathogenic factors. So, before the onset of pregnancy, it is advisable to take tests to determine the chromosome and gene set, to exclude autoimmune pathologies, to sexual infections, it is also necessary to carefully examine the thyroid gland, reproductive organs to identify various defects in their work, etc.

Already being pregnant, the expectant mother should also follow simple rules:

• eliminate bad habits;
• avoid excessive physical exertion;
• refrain from frequent use of strong tea and coffee;
• regularly visit a doctor and follow all his recommendations;
• maintain emotional calm;
• Watch closely for new symptoms and sensations.

Consequences after a miscarriage in the early stages

After a miscarriage, particles of fetal tissue or its membranes may remain in the uterus. That is why women after a miscarriage do an ultrasound scan to detect such residues and mechanical cleaning of the uterus if they are found.

If parts of the fetus are not removed from the uterus, an inflammatory process can begin, blood poisoning, and severe uterine bleeding can open, which can lead to death. That is why it is so important to seek medical help in a timely manner after the loss of a baby.

How many days does it usually bleed after a miscarriage? Normally, this can last from 5 to 10 days, if the blood goes on for a longer time, this is already a serious cause for concern. As for the restoration of menstruation and when they come next time after a miscarriage, this happens on average after 21-35 days.

It is absurd to think that after an early miscarriage, the next pregnancy may not occur or end in the same way. Only the root cause that provoked the loss of the baby earlier can affect a second pregnancy, if it is not detected and treated.

Video about the causes of miscarriage

This video explains in detail what a miscarriage is and what causes it most often accompanies.

I would like to hear the comments of those who had such a sad experience in life: how did you understand that a miscarriage occurred, at what time did it occur, what provoked it, and were there any negative consequences? Your comments will be very useful for those women who are just getting ready to become a mother.

It's good when the pregnancy is desired. However, two clear stripes on the test do not at all guarantee that the baby will be all right until birth. Sometimes the female body, for some reason, independently gets rid of the fetus some time after its appearance. We are talking about miscarriage in early pregnancy. Why is this happening and is there a way to prevent trouble?

Let's turn to impartial statistics: a quarter of all early-term pregnancies are doomed to spontaneous termination. In order to be able to influence the course of events, it is important to know the causes of a miscarriage and its signs.

How does an early miscarriage occur?

Unfortunately, in the presence of serious prerequisites for spontaneous abortion at an early stage, it is almost impossible to reverse the pathological process. The fetus at this time is so small that the woman does not even understand what is happening to her. At first glance, it looks like the resumption of the menstrual cycle after a long delay (1 - 2 weeks). Menstruation, more abundant than usual, is accompanied by pulling pain in the lower abdomen. In addition, not all women go to the hospital after the incident. Only a few get to see a doctor - mostly those who are frightened by the appearance of a blood clot that has come out, resembling a torn bladder. Ideally, all women need a medical examination - if there really was a miscarriage, then additional cleaning may be necessary after it.

When a woman is aware of her "interesting" situation, it is much easier for her to predict the onset of a spontaneous miscarriage at an early date. First of all, you should carefully monitor the sensations in the lower abdomen and back. Painful dull and pulling spasms, smearing discharge with bloody or tissue lumps signal danger. If you seek medical help immediately, there is a chance to keep the pregnancy.

An early miscarriage is said to be when the pregnancy ends spontaneously before the 12th week of the fetus's existence. A late miscarriage occurs for up to 22 weeks, and subject to the timely and coordinated actions of doctors, a premature baby has every chance of surviving.

Early miscarriage: prejudice

There are many myths in society about the causes of spontaneous abortion. How to avoid an early miscarriage, you will be told on any women's forum, but not all advice can be trusted. It is reliably known that before the 12th week of pregnancy, the following factors do not pose a threat to the intrauterine development of the fetus:

• air travel by plane;
• minor blunt trauma in the abdomen;
• moderate exercise;
• a single case of spontaneous abortion up to 12 weeks in history;
• active sex life;
• stress.

The real causes of miscarriage in the early stages

Doctors cite many socio-biological and medical factors as the reasons for spontaneous abortion. It is often very difficult to determine what exactly caused the misfortune: sometimes a miscarriage is based on one factor, and sometimes a whole complex. A certain percentage of women are familiar with this pathology firsthand: the unfortunate survived several miscarriages in a row. In medical circles, this phenomenon was designated as habitual miscarriage. We list the most serious and common factors that cause the threat of miscarriage in the early stages:

• most often, the body itself gets rid of non-viable offspring if the appearance and development of the fetus is associated with a certain anomaly or genetic pathology. This may be a hereditary “breakdown” at the gene level or a spontaneous mutation caused by radiation, a dangerous virus, or a difficult environmental situation. Medicine, alas, cannot change or prevent this process. That is why thorough preparation for the upcoming pregnancy is impossible without the advice of future parents from a geneticist;
• a significant danger to the normal development of pregnancy is a violation of the immune and hormonal systems. A woman needs to pass the necessary check at the stage of planning a child, then doctors will be able to eliminate all the "pitfalls" in advance. Quite often, progesterone deficiency, an excess of androgens, pathologies in the activity of the thyroid gland and adrenal glands become an obstacle to fulfilling the dream of motherhood;
• Another urgent problem for the successful development of the fetus in the womb of a woman is the Rhesus conflict. The mother's body reacts to the fetus as a foreign object and gets rid of it, since the Rh factor of its blood is with the “-” sign, and it was taken from the father with the “+” sign. If concerns about this are real, the situation is corrected with the help of immunomodulatory therapy even at the stage of pregnancy planning;

• The undoubted enemy of a healthy pregnancy is infection (regardless of origin). In particular, these are all diseases that are transmitted “through the bed”: herpes, cytomegalovirus, toxoplasmosis, syphilis, chlamydia, trichomoniasis, etc. Pathogens, affecting the fetal membranes, infect the fetus, which leads to miscarriage at an early stage of pregnancy;
• a disappointing ending of early pregnancy awaits a woman with chronic inflammatory and infectious diseases of internal organs. The most insidious of them: viral hepatitis, rubella, pneumonia, influenza, severe tonsillitis;
• it is extremely difficult for the female body to cope with pregnancy because of the stress caused by abortion. Artificial termination of pregnancies in the past threatens with secondary infertility and habitual miscarriage in the future. A woman must certainly inform the doctor about such facts of her biography during pregnancy planning;

• one should not ignore such individual characteristics of the female body, such as, for example, congenital anomalies of development and oncological diseases of the internal genital organs, ICI. These and other pathologies exclude pregnancy as such.

The first symptoms of a miscarriage in the early stages

The nature of the development of a miscarriage excludes simultaneity - spontaneous abortion can be divided into several stages. So, let's find out how to determine an early miscarriage.

The first "bells" are painful sensations covering the back in the lumbar region and lower abdomen. Often at the same time, brownish or reddish clots stand out from the genital tract. Blood during an early miscarriage is a very dangerous sign that indicates that tissue detachment has begun. Even a few drops of blood on underwear are a serious reason for immediate medical attention. Reliable prevention of spontaneous abortion is a regular visit to the antenatal clinic for a routine examination and delivery of all necessary tests. Only in this way will the expectant mother be sure that everything is in order with her baby.

What does an early miscarriage look like: the main stages

The first stage of the pathology, the signs of which we learned above, is very common in expectant mothers. To save the baby, expectant mothers are forced to lie on the conservation of almost the entire prenatal contractions. The initial stage of the pathology is marked by hypertonicity of the uterus, bleeding and discomfort, reminiscent of contractions.

The second stage of violation leads to more serious consequences. At this moment, all the signs already indicate a full-fledged miscarriage at an early stage: a fragmentary detachment of the fetal egg from the inner wall of the uterus begins. However, at this time, the trouble can still be prevented, doctors say. This is possible thanks to the immediate and coordinated intervention of professionals, provided that the pregnant woman got to the hospital in a timely manner.

The next stage of spontaneous abortion at an early stage is a miscarriage on the go. Now there is nothing to help the fetus. The pregnant woman is suddenly seized by sharp spasms, bleeding begins almost immediately - the most convincing sign of an early miscarriage. This indicates the final death of the fetal egg, which comes out in whole or in part (incomplete miscarriage). In the photo, a fetal egg with an early miscarriage:

Pathology ends with a complete spontaneous abortion. After an early miscarriage, the uterus contracts and quickly returns to "pre-pregnant" size. A complication in this case is an incomplete abortion or missed pregnancy (diagnosed on ultrasound), when there is a high risk of pus formation or the onset of sepsis.

How to recognize a miscarriage early

At first glance, it is quite simple to determine a miscarriage, so some women believe that if they feel well after the incident, they can neglect a visit to the hospital. However, this is a dangerous delusion: all signs of spontaneous abortion at an early stage are also characteristic of other, more serious diseases that, without proper diagnosis, can be mistaken for a miscarriage:

• ectopic pregnancy;
• malignant formation in the cervical region;
• bloodless torsion of an ovarian cyst;
• cervical injury.

These conditions can be excluded only within the walls of a medical institution.

What to do with an early miscarriage

Unfortunately, doctors are not able to radically change the course of events at the very beginning of pregnancy - you cannot go against nature.

It is common practice to prescribe Tranexam to stop bleeding. If a woman has had several failed pregnancies in the past, Utrozhestan will be prescribed. When, thanks to the efforts of doctors, the pregnancy can be brought to the second trimester, with a threatened miscarriage, it is worth applying stitches or a pessary if there is a short cervix with isthmic-cervical insufficiency. In principle, this is where the methods of dealing with pathology end.

Now we list what will not help in the process of developing a miscarriage:

• bed rest - a conscious decrease in the mother's motor activity cannot stop a miscarriage if there are real prerequisites for its accomplishment;
• taking drugs: No-shpa, Papaverine, Magne B6, Analgin.

A few weeks after a complete miscarriage, a woman needs to see a doctor and donate blood to analyze the level of hCG. If all indicators are normal, there is nothing to worry about. However, if the level of the hormone has not decreased at all, or has decreased, but has not dropped to the required minimum, there is a possibility of a mole. This is a dangerous complication that requires immediate medical attention.

An abortion in progress can be completed in several ways. If, during the examination, blood is still excreted from the vagina, and the fetal egg or embryo is still in the uterus, the doctor may determine the following tactics of action:

• expectant approach lasting up to 7 days (perhaps the body will reject the unnecessary without outside interference);
• a drug approach (a woman is prescribed Misoprostol, under the influence of which the uterine muscles are strongly compressed and bring the remnants of the fetal egg out);
• surgical cleaning (if vaginal bleeding becomes massive).

How to prevent early miscarriage

To exclude all possible factors that provoke an early miscarriage, you need to acquire offspring under the professional guidance of a doctor. To do this, a woman undergoes a full examination not during pregnancy, but even at the stage of planning a child. This is the only way to make sure that there are no various “breakdowns” at the cellular level and internal pathologies. Moreover, future parents are reviewing and adjusting their usual lifestyle in accordance with the upcoming changes: at this stage, it is important to put an end to addictions, adjust the daily routine and diet.

Early miscarriage: how to understand where to go next

After such a crushing failure, the woman is recommended to undergo a rehabilitation course of treatment. If the cause of the incident could not be established earlier, doctors will conduct the necessary diagnostics to determine it now. This is important, otherwise a woman runs the risk of facing the same problem the next time she prepares for motherhood.

The ultrasound procedure is a mandatory step after an early miscarriage. If there are fragments of an egg or embryo in the uterus, a woman will need a cleaning to avoid the development of inflammation or infection. After all the necessary procedures, the doctor will prescribe the patient a course of antibiotic therapy, which will exclude various infectious diseases, as well as a course of hormones that will put the woman's endocrine system in order.

Among other things, a failed mother is in dire need of professional psychological support. The loss of a baby, even if it is so tiny, leaves an indelible imprint in the mind of a woman. It is important to experience this moment with the support of a psychologist or relatives.

It is wrong to fence oneself off from the outside world and remain alone with one's misfortune, so negative emotions will simply “eat up” all hope for the best. Psychologists recommend that women who have experienced a miscarriage not be ashamed of their feelings and not hold back aggression and tears - the sooner you can get rid of them, the faster the recovery will come. And in no case should you be afraid of the future: modern medicine and competent doctors will do everything possible so that a new pregnancy ends with the triumphant cry of a long-awaited baby!