Spontaneous abortion (miscarriage)

Spontaneous miscarriage - spontaneous abortion before the fetus reaches a viable gestational age.

According to the WHO definition, abortion is spontaneous expulsion or extraction of an embryo or fetus weighing up to 500 g, which corresponds to a gestational age of 22 weeks of gestation.

ICD-10

• 003 Spontaneous abortion
• 002.1 Missed abortion
• 020.0 Threatening abortion.

[1], [2], [3], [4], [5]

Epidemiology

Epidemiology of spontaneous abortion (miscarriage)

Spontaneous miscarriage is the most common complication of pregnancy. Its frequency is from 10 to 20% of all clinically diagnosed pregnancies. About 80% of miscarriages occur before 12 weeks of gestation. When taking into account pregnancies to determine the level of human chorionic gonadotropin, the number of miscarriages increases to 31%, and in 70% of them the pregnancy is terminated until it can be recognized clinically. In the structure of sporadic early miscarriages, 1/3 of the pregnancies are interrupted up to 8 weeks according to the type of anembryony.

[6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24]

Is there a risk of another miscarriage?

Miscarriage - a random occurrence that does not always indicate the presence of problems. With one miscarriage, the chances for the next healthy pregnancy are quite good. A bad sign is a series of miscarriages. In this case, you need to be diagnosed and tested to determine the health problems of a woman.

[25], [26], [27], [28], [29], [30], [31], [32], [33]

Causes of the spontaneous abortion (miscarriage)

Causes of spontaneous abortion (miscarriage)

Most miscarriages occur because the fertilized egg cannot develop normally. Miscarriage is not the result of stress, exercise or intimacy. In most cases, doctors cannot understand what caused it.

The risk of miscarriage decreases after the first 12 weeks of pregnancy.

Spontaneous abortion (miscarriage) - Causes

[34], [35], [36], [37]

Symptoms of the spontaneous abortion (miscarriage)

Abortion symptoms

• Vaginal bleeding (mild or severe, persistent or at intervals). It is sometimes difficult to know if bleeding is a symptom of a miscarriage, but with simultaneous pain the risk increases.
• The appearance of pain in the lower abdomen, lower back or pelvic organs.
• Vaginal secretion of aborted tissue.

Spontaneous abortion (miscarriage) - Symptoms

[38], [39]

Treatment of the spontaneous abortion (miscarriage)

Medication for miscarriage

Miscarriage can not be stopped by anything. In the absence of a large loss of blood, temperature, weakness or other signs of an inflammatory process, miscarriage will happen by itself. This may take several days. With negative Rhesus, Rh antibodies should be vaccinated to prevent recurrence of miscarriages in the future.

Most miscarriages do not require medical intervention except in rare cases. When miscarriage is necessary to cooperate with a doctor to prevent the development of problems. If the uterus cannot be quickly cleared, a large blood loss occurs and an inflammatory process develops. In such cases, is scraping the uterus. Miscarriage does not occur quickly. It takes time, and symptoms vary from case to case. In case of miscarriage, use the following recommendations.

• Use pads (but not tampons) during bleeding that will last for a week or more. Allocations will be more abundant than usual. Tampons can be used during the next cycle, which will begin in 3-6 weeks.
• Take acetaminophen (Tylenol) in case of pain, which may last several days after miscarriage. Carefully read the instructions on the package.
• Eat well, eat foods rich in iron and vitamin C, as anemia may occur as a result of bleeding. Products rich in iron: meat, crustaceans, eggs, legumes, vegetables, green. Vitamin C is found in citrus fruits, tomatoes and broccoli. Check with your doctor about a possible intake of iron-containing tablets and multivitamins.
• Talk with your doctor about future pregnancy plans. Experts agree that you can try to get pregnant after one normal cycle. If you do not want to have a baby yet, consult a doctor about contraceptives.

Spontaneous abortion (miscarriage) - Treatment

[40]

Medications and surgical treatment of miscarriage

It is impossible to prevent and stop miscarriage with medication. In this case, the goal of treatment is to prevent the inflammatory process and excessive blood loss. Such complications usually develop when the uterus is not completely cleansed. For decades, in the event of an incomplete miscarriage, a curettage procedure was usually performed. Now women have a wider choice: with miscarriage in the first trimester and the absence of symptoms of complications (high fever and heavy bleeding), non-surgical treatment is preferred.

• In many women, the body itself completes the process of cleaning the uterus, while the doctor only carefully monitors the patient's state of health.
• Surgical intervention is aimed at quick cleaning of the uterus, it is usually carried out in case of severe bleeding and symptoms of the inflammatory process.
• Medications are aimed at accelerating the process of uterine contraction and its cleansing. Drugs are taken longer and can cause pain and side effects, but in this case there is no need for anesthesia, which in itself is fraught with consequences.
• Non-surgical treatment does not always effectively clean the uterus, therefore, in the absence of a positive result, the doctor usually recommends curettage.

[41], [42], [43]

Prevention

Spontaneous abortion prevention

Methods for the specific prevention of sporadic miscarriage are absent.

For the prevention of neural tube defects, which can cause early miscarriages, folic acid is recommended for 2-3 menstrual cycles before conception and in the first 12 weeks of gestation at a daily dose of 0.4 mg. If a history of a woman has had a fetal neural tube defect in previous pregnancies, the prophylactic dose should be increased to 4 mg / day.

[44], [45], [46], [47], [48], [49]

Forecast

Prognosis for spontaneous abortion

As a rule, spontaneous abortion has a favorable prognosis. After 1 spontaneous miscarriage, the risk of a subsequent miscarriage increases slightly and reaches 18–20% compared with 15% with no miscarriages in history. If there are 2 consecutive spontaneous interruptions of pregnancy, it is recommended to conduct a survey before the onset of the desired pregnancy in order to identify the causes of miscarriage in this married couple.

[50]