Miscarriage (spontaneous abortion). Symptoms of miscarriage in the second trimester Miscarriage in the second trimester

Any woman planning a pregnancy, unfortunately, can experience an early miscarriage. According to statistics, from 10 to 20% of pregnancies can end in miscarriage, while about 20% of women lose the fetus without even realizing that they were pregnant. Usually nothing bothers them, they just note that they first experience heavy periods, and after a few days they begin to have heavy periods, most often with pain.

Miscarriage - from a gynecological point of view, this is a spontaneous termination of pregnancy, which lasts up to 22 weeks. This countdown is ongoing because a fetus weighing even less than 500 grams after 22 weeks can be saved by today’s medicine. A child of smaller age and weight has no chance of this.

In this article we will look in detail at how to identify the signs of a miscarriage, what to do if it happens, and why you should definitely see a doctor.

I. Symptoms of miscarriage

1. You notice bloody discharge

Vaginal discharge after a delay and not according to the calendar is the first sign of a miscarriage. They may contain blood clots and an admixture of rejected tissue from the unformed fetus. If they are detected, you should immediately contact your doctor. If the discharge is heavy, the specialist will tell you to call an ambulance; if it is not strong, you can come to the gynecology office yourself.

Important: If the discharge contains any clot and you think it may be fetal tissue, collect this “mixture” in a clean container or special test container, close the lid tightly and take it to the doctor. Yes, this may seem strange, but thanks to this, after the examination, the doctor will be able to tell whether it was a spontaneous miscarriage or not.

2. You feel pain in your stomach and back

In addition to bleeding, you may have severe muscle cramps - this is also a reason to consult a doctor immediately. If at the same time you experience nagging pain in the lower back, discomfort in the abdomen and cramps, this may mean that there is a threat of miscarriage. Be sure to consult your doctor before taking pain medications for symptoms that indicate miscarriage.

3. An infection has appeared in the uterus

A so-called septic miscarriage can occur if a woman’s uterus is infected - this phenomenon is very dangerous, and therefore you should immediately call an ambulance.

The symptoms of a septic miscarriage are specific: vaginal discharge with an unpleasant odor; bleeding; fever and chills of the body; severe cramps and pain in the abdomen.

4. Miscarriage in the second trimester

If a miscarriage does not occur early, but after three months of pregnancy, there are other signs. If they are detected, you should immediately contact a doctor. Firstly, this is fluid dripping from the vagina - this indicates that the amniotic fluid sac is damaged. Secondly, there is spotting and bleeding from the vagina. Thirdly, the appearance of blood in the urine, painful sensations when urinating. Fourthly, there may be internal bleeding, which is accompanied by severe pain in the shoulders or in the stomach area.

II. Risk of miscarriage. Diagnosis by a doctor

1. Visit to the doctor

If there are any signs of miscarriage, get checked by your doctor immediately. First of all, he will do an ultrasound to see if there is a fetus in the uterus. If so, the specialist will immediately check how the child is developing inside, and in the long term will analyze his heartbeat. If there is no fetus, this, of course, means that you are not pregnant and a miscarriage occurred, the symptoms of which you noticed.

The doctor will also immediately perform a vaginal examination to see the opening of the cervix. A good specialist will immediately prescribe tests that will allow you to assess your hormonal levels.

If you bring with you tissues collected from secretions that may be parts of an unformed fetus, your doctor should conduct an examination to confirm or refute your suspicions.

2. Be prepared for bad diagnoses

The doctor may tell you that there is a risk of miscarriage, but this does not mean that a miscarriage has occurred: if you feel cramps or have bleeding, but the cervix is ​​closed, then there is a chance that a miscarriage may not happen, although there is a threat of it. In this case, doctors must do everything to avoid this.

If the uterus contracts and its cervix dilates, it is, unfortunately, impossible to prevent a miscarriage. When the fertilized egg freely leaves the uterus, a complete miscarriage will occur; if the tissue comes out, but particles of the fetus or placenta still remain in the vagina, doctors will have to intervene. There is also such a terrible incident as a frozen pregnancy - it occurs if the fetus dies inside the uterus for some reason. A woman’s body will no longer get rid of it on its own—that’s up to the doctors.

3. Listen to the doctor

If the threat of miscarriage is confirmed, follow your doctor's advice to prevent the miscarriage itself and save the baby. Most likely, your doctor will prescribe rest for you until your symptoms subside. You will also be prohibited from any physical activity and intimate intimacy. It will be necessary to refuse trips to places where timely medical care may not be available.

If a miscarriage does occur, but not all the tissues of the fertilized egg come out, the doctor will advise you to either wait until the body independently rejects the remaining tissues (this can last about a month), or you may be prescribed either suppositories or: they will provoke rejection of the remaining tissues within day. If you suddenly develop an infection, your doctor will remove any remaining fetal tissue.

4. Give yourself time

After a miscarriage, every woman needs time to recover physically and, even more so, mentally. This may take you several days, or even more.

Your period will only resume next month, and then you will be able to get pregnant again. If you don't want this, use contraception. You should not have sex or use tampons for two weeks after a miscarriage because this will prevent the tissue in the vaginal walls from healing.

Usually after or, even more so, later, a woman experiences severe sadness and experiences mental pain. Do not under any circumstances reproach yourself and try not to be alone: ​​let there be close people nearby who will help you cope with grief. Don't be shy or afraid to accept support from your family, find a special support group that will help you. Remember that most women who experienced a miscarriage were able to give birth to a healthy baby in the future, and even more than one.

III. Causes of miscarriage and planning the next pregnancy

1. Cause of early miscarriage

There are many reasons that lead to spontaneous termination of pregnancy. Firstly, these are hormonal disorders in a woman’s body. An incorrect balance of hormones (lack of progesterone or excess of male hormone) can lead to the loss of a child. Usually this problem is diagnosed in advance, and therefore the woman is prescribed hormonal therapy, which eliminates the possibility of miscarriage.

Secondly, a woman can lose her baby due to the Rh factor of the blood: if she is negative, and the father of the child is positive, then a Rh conflict may develop. In this case, the fetus will inherit the father’s positive Rh, and the mother’s body will identify it as foreign and reject it. If such a pathology is immediately diagnosed, then the hormone progesterone can be used, which will protect the embryo and prevent miscarriage.

Thirdly, genetic abnormalities of the fetus, which arise either from the hereditary factors of the parents, or were formed in a specific egg or sperm, can lead to a miscarriage.

Fourthly, the cause of the loss of a child can be an infection: any increase in body temperature to 38 degrees due to a disease of the internal organs will lead to a miscarriage, because during infection the whole body becomes intoxicated, and it becomes unable to hold the embryo. Therefore, when planning a pregnancy, the expectant mother needs to undergo a full examination in order to detect and immediately treat chronic diseases.

Fifthly, if a woman has ever had an abortion, this may affect her future fate: she may either have miscarriages or develop infertility altogether. However, of course, many women still give birth to healthy children after abortions.

Sixth, medications or herbs (for example, nettle, parsley, St. John's wort, tansy and cornflower) can lead to miscarriage. Seventh, the cause may be severe stress, grief and prolonged mental stress. If you experience bad, negative feelings during pregnancy, your doctor may prescribe sedatives or send you to a psychologist.

Eighth, the possibility of a miscarriage will be affected by your lifestyle: get rid of bad habits (be sure to give up alcohol, cigarettes, and drugs), switch to a balanced, healthy diet. Don't lift heavy things, try not to fall or hit your stomach.

Ninth, miscarriage can occur if the mother is diabetic, overweight or underweight; if she has diseases of the thyroid gland, uterus or cervix and other organs involved in the reproductive process. If a woman is over 35 years old, this is also the case, experts say.

2. Plan your pregnancy

To avoid miscarriage, approach the issue of pregnancy responsibly: watch your body, do not abuse alcohol, cigarettes and fatty foods; checks health; Avoid anything that could cause the loss of a child.

If you are already pregnant, be sure to see a doctor and take care of yourself. Do moderate exercise, practice safe sex to protect against infections, and do not work or generally be in places where you could be exposed to radiation from infectious agents, environmental toxins, or chemicals.

The second trimester of pregnancy continues from 14 to 26 weeks of gestation.

List of dangerous conditions

Anemia in pregnant women (usually iron deficiency anemia) ranks first and its frequency is 21-80%, depending on the geographic location of the woman’s residence.

In second place is the threat of miscarriage or late miscarriage, although in the 2nd trimester of pregnancy the risk of this complication is slightly lower than in the first and reaches 5-10%.

The third place is given to placenta previa and its frequency in the second trimester reaches 10% (in the third it decreases significantly).

Causes of dangerous conditions

Factors that cause the threat of late miscarriage include:

• development of isthmic-cervical insufficiency (both anatomical and functional);
• uterine defects (uterine malformations, tumors);
• Rhesus conflict pregnancy;
• infectious processes, including sexually transmitted infections;
• premature rupture of membranes, leakage of water.

Anemia in pregnant women is caused by:

• unsatisfactory living conditions;
• poor nutrition;
• chronic intoxication (harmful working conditions, disturbed ecology);
• chronic somatic pathology (kidney diseases, gastritis, diabetes mellitus, chronic infections, cardiovascular diseases);
• existing anemia before pregnancy;
• bleeding during pregnancy;
• multiple pregnancy;
• a large number of births;
• frequent childbirth;
• heredity.

The fairly high incidence of placenta previa in the 2nd trimester of pregnancy is explained by the rapid growth of the uterus, especially from 18 to 22 weeks. Predisposing factors include:

• burdened obstetric and gynecological history (abortion, curettage, complicated childbirth);
• surgical interventions on the uterus;
• genital infantilism;
• gynecological pathology (fibroids, endometriosis, chronic endometritis).

Symptoms

Signs of a threatened miscarriage in the 2nd trimester are:

• the appearance of nagging/aching pain in the lower abdomen;
• hypertonicity of the uterus, both constant and periodic (the uterus is like a “stone”);
• the appearance of dark bloody discharge;
• When examined, the cervix passes through the tip of the finger or the entire cervical canal is passable for the finger).

Anemia in pregnant women is characterized

• the occurrence of weakness, fatigue,
• change in taste
• low blood pressure, dizziness and tendency to faint,
• skin and hair are prone to dryness,
• hair and nails become brittle,
• The pregnant woman looks very pale, blueness appears under the eyes.

Placenta previa occurs against the background of frequently recurring bleeding from the genital tract, which leads to anemia in the pregnant woman. The intensity of bleeding depends on the duration of pregnancy and the nature of presentation (lateral or complete). Bleeding is painless, can occur at rest and is characterized by the appearance of scarlet blood from the vagina.

Complications

All of the listed threatened conditions of the 2nd trimester of pregnancy contribute to the development of the following complications:

• fetoplacental insufficiency;
• delay in the development of amnion and chorion;
• worsening anemia with placenta previa and the threat of miscarriage;
• intrauterine growth retardation;
• anemia contributes to the threat of miscarriage and low placentation;
• chronic fetal hypoxia;
• spontaneous termination of pregnancy;
• anomalies of generic forces;
• complicated course of the postpartum period;
• anemia increases the risk of gestosis by 1.5 times;
• incorrect position and presentation of the fetus with placenta previa.

Treatment and prevention

Treatment of anemia in pregnant women involves prescribing a diet rich in protein and iron, as well as iron supplements. In case of anemia of degrees 2 and 3, a woman is subject to hospitalization, where she is prescribed iron supplements orally (in tablet form, iron is better absorbed by the body). These drugs include: tardiferon, sorbifer-durules, fenyuls and others. The number of tablets taken depends on the iron content of the drug. In addition, preventive treatment of threatened abortion and fetoplacental insufficiency is indicated. In case of intolerance to oral iron-containing preparations or in case of impaired absorption of iron in the intestine, parenteral iron preparations (ferrum-lek, venofer, ectofer) are prescribed. In severe anemia (hemoglobin below 60 g/l), red blood cell transfusions are indicated.

If bleeding occurs during placenta previa, the pregnant woman must be hospitalized. In the hospital, she is prescribed strict bed rest and psycho-emotional rest. Therapy is carried out aimed at reducing the tone of the uterus and preventing the threat of miscarriage. Antispasmodics (no-spa, papaverine, magnesium sulfate) and tocolytics (ginipral, partusisten) are prescribed. Preventive treatment of iron deficiency anemia with iron supplements is also indicated. Blood transfusions of red blood cells and fresh frozen plasma are carried out according to indications (in case of severe and/or repeated bleeding, a sharp decrease in hemoglobin). In parallel, treatment is carried out to improve uteroplacental blood flow (Trental, Chimes, Actovegin, Magne-B6, vitamins E, C and group B). Termination of pregnancy is carried out according to vital indications on the part of the mother.

The threat of late miscarriage is also treated inpatiently, where bed rest, antispasmodics, tocolytics, vitamins and metabolic drugs (improving uteroplacental blood flow) are prescribed. In case of isthmic-cervical insufficiency, surgical treatment is indicated - suturing the cervix (from 13 to 27 weeks).

In the prevention of anemia, special attention is paid to proper and balanced nutrition, preventive intake of multivitamins and minerals, and normalization of the rest day regimen.

To prevent bleeding during placenta previa or the threat of miscarriage, a woman is advised to refrain from heavy physical activity and heavy lifting, avoid stressful situations and undergo preventive courses of treatment.

Forecast

Iron deficiency anemia can be cured in almost 99% of cases, and the prognosis for this condition is favorable for the woman; delivery is carried out through the natural birth canal.

The prognosis for placenta previa is always serious, and the percentage of successful completion of pregnancy depends on the type of presentation (the prognosis is worse with complete presentation), the frequency of repeated bleeding, the development of accompanying complications of pregnancy (anemia, fetal growth retardation) and other factors. In 90% of cases with incomplete presentation, labor ends surgically; in case of complete presentation, there is an absolute indication for cesarean section.

The percentage of successful completion of pregnancy with the threat of miscarriage in the second trimester depends on the cause that caused it, timely and adequate treatment. However, in most cases, the threat of interruption in the second trimester is successfully stopped and reaches 75-80%.

Some studies during pregnancy

Late spontaneous abortion in the second trimester - treatment.

Late spontaneous abortion (13-21 weeks) is a common pathology. There are many reasons leading to spontaneous abortion in the second trimester. A number of them (chromosomal abnormalities) cannot be corrected, and if they are detected, it is advisable to perform an induced abortion. A number of other causes (isthmic-cervical insufficiency, placental insufficiency) require corrective treatment.

Termination of pregnancy at 22 weeks or later is considered premature birth. After 22 weeks, the newborn is potentially viable.

A threatened abortion is accompanied by an increase in tone, periodic contractions of the uterus, shortening of the cervix and a slight opening of the cervical canal (internal os of the cervix).

Late spontaneous abortion in the second trimester - causes

1) chromosomal abnormalities of the fetus;

2) exposure to adverse external factors (smoking, alcohol abuse, substance abuse);

3) isthmic-cervical insufficiency;

4) hormonal disorders (hyperandrogenism);

5) genital tract infections and fetal IUI, etc.

Further normal development of pregnancy can be hampered by malformations of the uterus (bicornuate, saddle-shaped), the presence of large myomatous nodes with centripetal growth and submucosal localization, as well as a low location of the intermuscular myomatous node (in the area of ​​the uterine isthmus). Overstretching of the uterus is important in case of multiple pregnancy or acute polyhydramnios. The role of autoantibodies (antiphospholipid, anti-cardiolipin) in the pathogenesis of late abortion is discussed.

Fetal chromosomal abnormalities:

Pathology of autosomal chromosomes:

Trisomy on chromosome 21 (Down syndrome);

Trisomy on chromosome 18 (Edwards syndrome, which consists of a single umbilical artery, flexion deformation of the fingers, crossing of the index and little fingers, shortening of the first toe). Less than 10% of these newborns survive to 1 year of age;

Trisomy on chromosome 13 (Patau syndrome: cleft lip and palate, eye abnormalities, polydactyly. Less than 3% of newborns survive to 3 years of age);

Short arm deletion syndrome of chromosome 5 (cry-the-cat syndrome, mental retardation, moon face).

Pathology of sex chromosomes:

Klinefelter syndrome (chromosome set 47XXY). The phenotype is male, but the distribution of subcutaneous fat and the development of mammary glands is female. Lack of facial hair. Infertility;

Turner syndrome (chromosome set 45X0). Small stature, wing-shaped skin folds on the neck, amenorrhea, kidney anomalies, malformations of the cardiovascular system (coarctation of the aorta). Infertility;

Chromosome set 47XYY. High growth. Male genotype and phenotype, intellectual impairment. Poorly trained. Infertile.

Children with Down syndrome are more often born to women of late age (40 years and older). A triple screening test can detect up to 80% of cases of this syndrome in utero, before birth. False-positive results are noted in no more than 5% of cases. They examine the concentration of AFP (detection rate 20-25%), the concentration of hCG in the blood serum and use ultrasound (sensitivity 65-75%). The final diagnosis is made by examining the karyotype.

Detection of fetal pathologies using ultrasound

We present ultrasound data on identifying signs of Down, Patau, Edwards syndromes, as well as hormone studies (AFP, hCG, E3).

Ultrasound signs of trisomy 21 (Down syndrome):

Thickening of the skin fold;

Short femurs;

Enlargement of the renal pelvis;

Duodenal atresia;

Echogenic focus in the heart.

The examination should be carried out at 18-22 weeks of pregnancy.

Ultrasound signs of trisomy 13 (Patau syndrome):

Ultrasound signs of trisomy 18 (Edwards syndrome):

Deformation of fingers;

Cysts of the choroid plexus of the ventricles of the brain;

Late spontaneous abortion in the second trimester - signs

Clinical signs of spontaneous abortion. Spontaneous abortion in the second trimester can be manifested by pain in the lower abdomen, lower back, and unusual discharge from the genital tract (mucous, watery, bloody). You should pay attention to symptoms such as a constant increase in uterine tone and abdominal pain, changes or absence of the fetal heartbeat, weakness, pale skin, tachycardia, decreased blood pressure (partial placental abruption is possible, in which there may be no external bleeding).

It is necessary to clarify the gestational age according to the anamnesis, examination, ultrasound, and find out the condition of the fetus (alive, asphyxia, intrauterine death). Pay attention to signs of fetal IUI, infections of the urinary system, and pathology of the gastrointestinal tract. Careful palpation of all parts of the abdomen will determine the hypertonicity of the uterus or the presence of regular contractions. Until 24 weeks of pregnancy, parts of the fetus are not palpable through the anterior abdominal wall, so you should not try to identify them. It is necessary to listen to the fetal heartbeat, including using a Doppler sensor.

During a vaginal examination, it is necessary to conduct an examination using speculum. Take a swab from the lower vagina. Take a smear to determine the leakage of amniotic fluid.

Express tests include blood and urine tests, and establishing the sensitivity of microbial flora to antibiotics. It is also necessary to conduct an ultrasound to determine the condition and size of the fetus and the location of the placenta.

The situation may vary. If there is a threat of late miscarriage, they adhere to expectant tactics aimed at maintaining the pregnancy.

When amniotic fluid leaks, the situation becomes more complicated. Typically, labor develops with chorioamnionitis, when the pregnancy should be terminated. When diagnosing gross malformations of the fetus or an unpromising pregnancy, the woman should be advised to terminate it. But in all cases, it is necessary to take into account and support the woman’s desire until she is threatened with life-threatening complications.

Late spontaneous abortion in the second trimester - treatment

To maintain pregnancy when there is leakage of amniotic fluid, there are no signs of infection, and the fetus is in normal condition, acute tocolysis is used by intravenous administration of tocolytics. Change sterile diapers every 2-3 hours. Pregnancy is maintained until 34 weeks, then the obstetric situation is left to its natural course. The amniotic membranes may stick together and the leakage of water may stop. There is little harm from conservative tactics if they are based on careful monitoring of symptoms of infection and prevention or treatment.

Empirical antibacterial therapy (erythromycin, metronidazole) is indicated.

Management of spontaneous abortion (basic provisions). If it is impossible to save the pregnancy (cervical opening more than 3 cm) or impractical (fetal malformations), premature termination of pregnancy is carried out through the natural birth canal, even with a transverse position of the fetus, since its size is quite small. The exception is observations with complete placenta previa.

The main provisions are as follows.

They provide the woman with maximum psychological support and attention.

Provide adequate pain relief.

After a spontaneous abortion, curettage of the uterus with a large, blunt (Winter) curette is required, since there are almost always remnants of placental tissue in the uterine cavity.

When the pregnancy is 22 weeks or more, the presence of a pediatrician is necessary to assess the viability of the fetus.

Miscarriage - symptoms

A miscarriage, or so-called spontaneous abortion, is a pathological termination of pregnancy up to 20 weeks. Unfortunately, this is not a rare phenomenon, and according to statistics, 15-20% of diagnosed pregnancies end in spontaneous termination. The causes of miscarriage are: inflammatory diseases of the reproductive system in the mother, a history of abortion, age over 35 years, hormonal disorders, fetal development abnormalities and infections.

What are the typical symptoms of a miscarriage?

Since at 6 weeks of pregnancy (4 weeks from the moment of conception) the fetus is implanted into the uterus and attached to its wall, spontaneous abortion may not be recognized until this time. Signs of miscarriage in the 6th week correspond to the symptoms of spontaneous abortion in the first trimester of pregnancy. The first signs of miscarriage in the first trimester of pregnancy (up to the 12th week inclusive): cramping pain in the lower abdomen with bloody discharge.

Moreover, if an embryo with membranes is found in the clots, then the miscarriage is considered complete. It is characterized by tight closure of the cervix after bleeding has stopped. The main symptoms of incomplete miscarriage: the release of part of the contents of the uterine cavity and continued bleeding. In both cases, maintaining the pregnancy is impossible.

For a period of up to 4 weeks, a miscarriage has no symptoms and passes like normal periods, only more abundant, because the woman herself may not know that she was pregnant. If the dead fetus remains in the uterus, then such an abortion is called failed. It can be suspected by the deterioration of the pregnant woman’s well-being: weakness, lethargy, loss of appetite, weight loss. During an obstetric examination, the size of the uterus does not correspond to the gestational age. Ultrasound examination with a vaginal probe confirms the diagnosis.

Signs of an incipient miscarriage

The first signs of a threatened miscarriage (threatened abortion) may appear in the form of nagging pain in the lower abdomen and lower back, while the external os of the cervix is ​​closed. Sometimes there may be slight bleeding from the genital tract. With timely access to a specialized medical institution and assistance, pregnancy can be saved. If you ignore the symptoms of a threatened abortion, the likelihood of miscarriage increases significantly.

Signs of miscarriage in the second trimester

Symptoms of second trimester miscarriage are similar to labor. First, contractions begin, which intensify, the cervix smooths and opens, the membranes rupture and amniotic fluid is released, then the fetus is born, after which the placenta comes out. If the baby's weight is less than 400 grams, it is considered a miscarriage; if it is more than 400 grams, then it is considered a newborn. Symptoms of late miscarriage may be associated with abnormalities in the development of the placenta, formations in the uterine cavity (fibroids), and the harmful effects of toxic substances on the fetus (medicines, alcohol, drugs).

Tactics for a pregnant woman at the first sign of a threatened miscarriage

At the first sign of a threat of miscarriage, you should immediately consult a doctor. In order to make sure that it is advisable to continue the pregnancy, it is necessary to check the size of the uterus and make sure that they correspond to the term, and see whether the external os of the cervix is ​​closed. If doubts remain, then the woman is sent for an ultrasound with a vaginal sensor. If the embryo is viable and its size corresponds to the gestational age, then the pregnant woman is offered to go to the hospital for treatment. For endocrine pathologies associated with insufficient levels of progesterone, hormonal drugs are prescribed.

In case of incomplete or failed abortion, curettage of the uterine cavity is performed under general anesthesia in order to remove remains of the fetus with membranes from the uterine cavity. After which a course of antibacterial therapy is prescribed to prevent endometritis.

If you have a miscarriage during pregnancy, you should not give up on the possibility of having a child. It’s just that you need to approach your next pregnancy more thoughtfully. It will be necessary to contact a competent specialist who will tell you what tests to take, what examinations to undergo, prescribe a course of necessary treatment and, perhaps, after 6 months (you shouldn’t try earlier) the long-awaited pregnancy will occur.

Threatened miscarriage - main causes, symptoms and treatment

The reasons for the threat of miscarriage can be very diverse. According to statistics, up to 20% of pregnancies end in miscarriage.

There are early miscarriages - up to 12 weeks and late - from 12 to 22 weeks of pregnancy. In the case of spontaneous termination of pregnancy from 23 to 37 weeks, this process is called premature birth.

Reasons for threatened miscarriage

There are the following reasons that threaten miscarriage in the early stages of pregnancy:

1. Genetic defects in the embryo that are incompatible with life. According to statistics, about 70% of women are at risk of miscarriage. Genetic disorders are not hereditary, but arise as a result of certain mutations in the germ cells of men and women due to the action of exogenous factors (viruses, alcohol, drugs). It is not possible to prevent miscarriage associated with genetic mutations; it is only possible in advance, before pregnancy, to reduce the risk of genetic defects in the fetus by eliminating mutagenic factors.
2. Hormonal disorders in women associated with insufficient production of the hormone progesterone, necessary for the onset, maintenance and progression of pregnancy. It is possible to prevent miscarriage associated with a lack of progesterone if the causative factor is identified in a timely manner and eliminated.
   • Also, a high level of androgens in a pregnant woman’s body can contribute to the threat of miscarriage, because these hormones suppress the secretion of female hormones - progesterone and estrogen, necessary for pregnancy.
   • An imbalance of adrenal and thyroid hormones in a pregnant woman’s body also contributes to the risk of miscarriage.
3. Rh conflict, which occurs as a result of the body of a Rh-negative woman rejecting the body of a Rh-positive fetus. For this problem, progesterone is often prescribed to prevent miscarriage.
4. Infectious diseases in women caused by nonspecific and specific infections.
   • Nonspecific diseases include influenza, hepatitis, pneumonia, pyelonephritis, appendicitis, etc.
   • Specific infections include gonorrhea, chlamydia, trichomoniasis, toxoplasmosis, herpes and cytomegalovirus infections.
5. Considering the high risk of miscarriage due to infectious causes, it is recommended to be examined before pregnancy and, if necessary, undergo the necessary course of therapy so that subsequent pregnancy proceeds without complications.
6. Previous abortions can cause miscarriage, since abortion is a manipulation that is stressful for a woman’s body and disrupts the functioning of her genitals.
7. Taking medications and herbs can cause the risk of miscarriage. For example, taking hormonal drugs, narcotic analgesics, antibiotics, etc. Among the herbs that can provoke the threat of miscarriage in the early stages are St. John's wort, nettle, tansy, parsley, etc.
8. Frequent emotional stress provokes the threat of miscarriage.
9. Maintaining an unhealthy lifestyle, which consists of taking drugs, alcoholic beverages, including smoking and drinking caffeine-containing drinks.
10. The threat of miscarriage is also promoted by sexual intercourse, physically heavy exertion, falls, and blows to the stomach.

Causal factors for the threat of miscarriage in late pregnancy, in addition to those described above, may be:

• bleeding disorders,
• pathology of the placenta - abruption or presentation,
• the presence of late gestosis in a pregnant woman - increased blood pressure, impaired renal function, which is accompanied by the presence of protein in the urine and the appearance of swelling,
• polyhydramnios,
• the presence of isthmic-cervical insufficiency, which occurs after previous traumatic births or abortions, which is accompanied by trauma to the cervix or isthmus of the uterus,
• various types of injuries - in the form of bruises to the abdomen and/or head.

Considering the huge number of reasons that contribute to the threat of miscarriage, both in early and late stages of pregnancy, it is necessary to carefully prepare for pregnancy.

The first signs of a threatened miscarriage

The first signs of a threatened miscarriage are, first of all, any change in the pregnant woman’s well-being. The first signs of a threatened miscarriage may be:

• Feeling of heaviness and pain in the lower abdomen and lumbar region.
• The appearance or change in color of discharge - from scarlet to dark brown. The volume of discharge does not matter - spotting or heavy bloody discharge is a reason to urgently consult a doctor.
• The change in the tone of the uterus that a woman feels - tension of the uterus and cramping pain, especially in the later stages, require immediate help from a doctor.

Sometimes, in the absence of complaints, during a routine examination by a doctor, an ultrasound scan can determine the threat of miscarriage: increased uterine tone, fetal heartbeat disturbances, discrepancy between the size of the uterus and the gestational age, etc.

Pain with threatened miscarriage

Pain when there is a threat of miscarriage can be very diverse and be the first and only sign. Pain when there is a threat of miscarriage is most often localized in the lower abdomen, above the womb, in the lumbar region and sacrum. The pain can be constant or periodic, not stopping for several days and increasing in intensity and duration. The pain can be nagging, cramping or sharp. The presence of pain that increases and is accompanied by bloody discharge are signs of a threatened miscarriage and require urgent help from an obstetrician-gynecologist.

Temperature at risk of miscarriage

The temperature when there is a threat of miscarriage can be normal or elevated (up to 37.4 ° C), especially in the early stages of pregnancy, which is explained by the hyperthermic effect of the hormone progesterone and is a variant of the norm.

• If a high temperature appears and there are signs of any infection in the body, then this can provoke the threat of miscarriage, or if it already exists, then aggravate this process.
• Also, in the case of an unreasonable increase in temperature to 38°C or higher, in the absence of other symptoms, this is an alarming sign and a reason to consult a doctor.

Discharge when there is a threat of miscarriage

When there is a threat of miscarriage, discharge changes its character and may be one of its first signs. The discharge becomes bloody in nature, its color varies from bright red to dark brown. Bloody discharge can be scanty, spotting or copious. In addition, in the later stages of pregnancy, the threat of miscarriage can be suspected even in the absence of bloody discharge, but in the presence of light-colored liquid discharge. Such watery discharge indicates leakage of amniotic fluid, as a result of a violation of the integrity of the amniotic membranes. Discharge in the event of a threatened miscarriage is almost always accompanied by pain in the lower abdomen and/or lower back.

Symptoms of threatened miscarriage

Symptoms of threatened miscarriage are characterized by:

1. Pain in the lower abdomen and/or lumbar region. The pain is nagging, constant or cramping, gradually increasing.
2. The appearance of bloody discharge.
   • In the early stages of pregnancy, the color of the discharge varies from scarlet (which may indicate detachment of the ovum) to dark, dark brown (which may indicate that detachment of the ovum has occurred and a hematoma has formed, which is leaking).
   • In late stages of pregnancy (in the second and third trimesters), bloody discharge occurs due to detachment of the placenta from the endometrium of the uterus; their color can also range from light to dark. As a result of placental abruption, the fetus does not receive additional oxygen and nutrients, and if total detachment occurs, the child may die.
3. Bloody discharge can be slight, spotting or copious.
4. A manifestation of the threat of miscarriage in late pregnancy can be watery discharge due to leakage of amniotic fluid. As a result of a violation of the integrity of the amniotic membranes, a colorless liquid leaks out and surrounds the fetus. This process is accompanied by an increase in uterine muscle tension - hypertonicity, which also poses a threat of miscarriage.
5. The presence of uterine hypertonicity, which must be separated. Those. There is uterine hypertonicity, which is determined by ultrasound, and uterine hypertonicity, which is felt by the pregnant woman herself. Increased tone of the uterus can be local, which affects a certain area of ​​it, and total, when the entire uterus is tense. Local uterine tone is usually determined using ultrasound; it is not very dangerous, but requires significant attention. The total tone of the uterus is felt by the pregnant woman as a pronounced thickening and is accompanied by pain in the abdomen.

Threatened miscarriage in the first trimester (from 1st to 12th week)

The threat of miscarriage in the first trimester (from the 1st to the 12th week) most often occurs during the first critical period, which occurs in the 2nd and 3rd weeks of pregnancy. During this period, a woman may not know that she is pregnant, but it is very important, since the fertilized egg penetrates the uterine cavity and is implanted into the endometrium. This process can be disrupted by various exogenous and endogenous factors. Endogenous factors include genetic disorders in the embryo that are incompatible with life.

Exogenous – a woman’s lifestyle, in particular taking alcohol, drugs, medications, smoking and stress can cause a threat of miscarriage. Also, pathology of the genital organs in a woman can cause a violation of the penetration of the fertilized egg into the uterus and its further implantation. This pathology includes:

• disturbances in the structure of the uterus (saddle-shaped or bicornuate uterus, the presence of septa in it, genital infantilism),
• traumatic damage to the endometrium after abortion,
• presence of uterine fibroids,
• presence of scars after cesarean section.

The next critical period when there may be a threat of miscarriage in the first trimester is the 8th - 12th weeks of pregnancy. The main cause of the threat in this period is hormonal disorders in a woman, for example, insufficient production of the hormone progesterone.

Threatened miscarriage in the second trimester (from the 13th to the 26th week)

The threat of miscarriage in the second trimester (from the 13th to the 26th week) can occur during the critical period, which is observed from the 18th to 22nd week of pregnancy, when intensive growth of the uterus is observed. During this period, various types of placenta previa are especially dangerous - low, incomplete or complete. If a woman has a pathology of internal organs and/or some kind of infection, the placenta turns out to be sensitive and its abnormal location may be accompanied by detachment and bleeding, which is a threat of miscarriage.

You need to know that all trimesters of pregnancy are considered critical in those days on which menstruation should have occurred if pregnancy had occurred, as well as in those periods when there was a spontaneous or artificial termination of previous pregnancies - there is an opinion that the woman’s body retains the memory of the necessary hormonal changes.

Threatened miscarriage in early pregnancy: symptoms and treatment

About 20% of women experience an unplanned termination of pregnancy. Even more are diagnosed with “threatened miscarriage in the early stages.” It is very important to know what this diagnosis means and how to avoid it. Take care of your health even before pregnancy.

If a miscarriage occurs after 23 weeks of pregnancy, it is possible to save the baby. Now medicine has the ability to care for babies who weigh just over half a kilogram. That is why, in case of any discomfort, you must immediately contact a specialist.

Types of miscarriages

In order to avoid miscarriage and its complications, visit a specialist if you experience any discomfort. Pregnancy should not be accompanied by pain and health problems. During a normal pregnancy, a woman may only feel general weakness.

Video - the main causes of miscarriage

Causes of early miscarriage

Not all women know that they have had a miscarriage. The fetus spontaneously leaves the uterus, and minor discomfort and bleeding are mistaken for menstruation. However, there are cases when a mother has already become attached to her albeit very small child. What to do in this case? Only a subsequent pregnancy can correct the situation. But before that, it’s worth understanding what could lead to a miscarriage and reduce the risks of subsequent miscarriage.

We will look at the main causes of early miscarriages (before 22 weeks). The largest number of miscarriages occur before 12 weeks. So, the main causes of miscarriages:

In addition to the above reasons for miscarriages, it is worth noting that you should not use medications in the early stages of pregnancy. Many of them can cause miscarriage or contribute to the development of defects in the fetus. Some medicinal herbs can also cause miscarriage (cornflower, nettle and celandine).

An unhealthy lifestyle, poor nutrition, smoking and drinking alcohol can cause miscarriage. Leading a healthy lifestyle is necessary even before planning a pregnancy. This is the only way to give birth to a healthy and strong baby. In some cases, even sexual intercourse during early pregnancy can cause miscarriage.

Main symptoms of threatened miscarriage

Not all women have any symptoms of a threatened miscarriage. Life may be going on as usual when suddenly a pregnant woman is faced with a huge blow. This usually happens in cases where a woman neglects an additional examination by a gynecologist. Already from the first weeks of pregnancy, you need to visit a specialist to find out the nature of the pregnancy and eliminate the possibility of negative consequences.

The most common symptom of a threatened miscarriage is nagging pain in the lower abdomen. The pain may radiate to the lower back. In some cases, there is heaviness in the lower abdomen and slight cramps. The pain can be localized either on the side or in the middle of the abdomen.

When bleeding appears, placental abruption begins. Some women don't even know they're pregnant and mistake spotting for their period. There cannot be menstruation throughout the entire period of pregnancy. Any bleeding indicates problems with the female organs. If they appear in the early stages, detachment of the fertilized egg occurs.

You should be especially careful about discharge with pieces of tissue or clots. They occur after a miscarriage. In this case, it is no longer possible to save the child, but you need to contact a specialist as soon as possible in order to avoid problems with your own health.

The main symptoms of a miscarriage are severe pain and bleeding. Brown discharge may occur. However, this does not mean that a miscarriage will definitely occur. With proper treatment and diagnosis, the child can be saved. The main thing is not to hesitate and contact a competent specialist in a timely manner.

Necessary examinations and tests:

• gynecological examination;
• Ultrasound of the pelvic organs;
• test for sex hormones;
• thyroid hormone studies;
• blood test for hidden intrauterine infections;
• analysis for the presence of antibodies to human chorionic gonadotropin;
• Analysis of urine;
• smear for hidden sexually transmitted infections.

Based on research, the specialist identifies the cause of the threatened miscarriage and prescribes appropriate treatment. The sooner a woman contacts a specialist, the higher the opportunity to save the fetus. Under no circumstances should you self-medicate - this can only cause harm and provoke further complications.

Treatment for threatened miscarriage

Threatened miscarriage is not a miscarriage, but a reversible condition. With timely treatment, the fetus can be saved. But if an abortion was diagnosed in progress, then it is no longer possible to save the fetus. In this case, the woman needs to worry about her health and carry out the curettage procedure as quickly as possible.

Treatment of threatened miscarriage in the early stages depends on the cause of the disease. If there are hidden infections and sexual diseases, they are treated. If the Rh factors of the parents come into conflict, it is necessary to administer anti-Rh serum.

When treating a threatened miscarriage, the doctor may prescribe antispasmodics and sedatives (of natural origin). It is necessary to take vitamins to strengthen the body. For hormonal disorders, Duphaston or Utrozhestan are most often prescribed.

If the cause of abortion is an increase in the level of “male” hormones, glucocorticoids (Dexamethasone and Metipred) will be needed for treatment. Taking hormonal drugs is possible only after testing.

Treatment is carried out only in a hospital. However, after the pregnant woman’s condition returns to normal, the medications prescribed by the specialist will need to be used for some more time. At the same time, they recommend bed rest, abstinence from sexual contacts, and regular visits to a specialist.

• consult a doctor after pregnancy;
• give up coffee;
• do not drink alcohol;
• Do not take too hot a bath;
• quit smoking;
• control blood sugar levels;
• get tested for STDs;
• monitor the health of your spouse;
• proper nutrition, avoidance of stress and a healthy lifestyle.

Consequences after early miscarriage

After a miscarriage, you should definitely visit a specialist. The fetus may remain in the uterus, which will lead to intoxication of the body. Sepsis may develop, and this is a direct threat to life.

The doctor will prescribe special means to contract the uterus and perform surgery. The remains of the fertilized egg must be removed from the uterus as quickly as possible.

Many women, faced with a miscarriage, try to conceive a new child as quickly as possible. You shouldn’t do this - doctors advise planning to conceive a child no earlier than five months after a miscarriage. After a miscarriage, you need to pay attention to contraception. A woman has every chance of becoming pregnant, but at this time she has the highest risk of a subsequent miscarriage.

After a miscarriage, it is necessary to conduct a thorough examination of the condition of the woman’s body. We need to find out what caused the miscarriage. It is also worth making sure that the miscarriage did not cause serious health problems.

Video - when can you get pregnant again after a miscarriage?

Recovery after miscarriage

The doctor competently selects treatment that is aimed at eliminating the cause of the miscarriage. In most cases, within six months the woman’s body is completely restored and ready for subsequent conception of a child. After a miscarriage, it is imperative to protect yourself during sexual intercourse. If a woman becomes pregnant, there is an 80% chance that it will end in a miscarriage. Try to be especially attentive to your health and lead a healthy lifestyle.

Many women become depressed and despair after a miscarriage. This may have a negative impact on your health. Maintain the same lifestyle, avoid stress and any conflicts. Subsequent miscarriages can only be prevented through a healthy lifestyle and proper treatment.

According to experts, every fourth pregnancy fails in the early stages, even before the onset of missed menstruation. In this case, the woman does not notice changes in her condition and perceives the bleeding as another menstruation. The only sign of such a failed pregnancy may be the detection of increased levels of the hormone hCG (human chorionic gonadotropin) in the blood and urine (in this case, a pregnancy test may give a positive result). Human chorionic gonadotropin is a hormone that in a healthy woman can only be produced by the tissues of the fertilized egg.

Starting from 5–6 weeks from conception until 22 weeks of pregnancy, termination of pregnancy is called spontaneous abortion or miscarriage. The fetus is not viable. If the loss of a child occurs after 22 weeks of pregnancy and the child weighs more than 500 g, then they speak of premature birth. The likelihood of a child’s survival at these stages is much greater, although the risk of developing various health problems in such newborn babies is very high.

Stopping an ongoing miscarriage or premature birth is very difficult, sometimes impossible, so we must try to prevent the development of such conditions. It is important to understand that when signs of a threatened miscarriage are detected, it is not enough to simply get rid of them; it is necessary to discover the cause of the miscarriage and, if possible, eliminate it.

Reasons for threatened miscarriage

Let's figure out what can lead to the development of a threat of miscarriage.

Genetic disorders

No matter how blasphemous it may sound, in most cases, early miscarriage is biologically expedient, since its cause is most often gross genetic abnormalities of the embryo. The shorter the pregnancy, the greater the likelihood that it will be terminated for this reason. Thus, the woman’s body gets rid of the non-viable embryo, so there is no need to stop such a miscarriage. Genetic causes, as a rule, do not recur. A woman who has lost her first pregnancy has every reason to hope for a successful outcome in subsequent pregnancies, even without examination and treatment. In this case, competent preparation for conception is sufficient.

Hormonal imbalance

Disruptions in the hormonal system can also cause miscarriages and premature births. For example, this can happen with a lack of progesterone, the ovarian hormone that maintains pregnancy. As a rule, women have menstrual cycle irregularities (the cycle is very short or, conversely, extended). The production of progesterone in the ovaries is stimulated by the hormone hCG. If the risk of miscarriage is high, then from the very beginning of pregnancy the doctor may order monitoring of blood tests for hCG over time (usually once a week). A decrease in its amount or maintaining the same level indicates a risk of miscarriage. Normally, hCG levels in the early stages double every 2-3 days. Progesterone levels do not rise as quickly, but a drop during pregnancy can also be a sign of trouble.

Infectious diseases

Cytomegalovirus, herpes, rubella and many other diseases can cause spontaneous abortion. Only competent and timely treatment of diseases can prevent fetal death.

Chronic diseases

If the expectant mother suffers from severe chronic life-threatening diseases, then the placenta (the organ of nutrition and respiration of the fetus) becomes defective, which can lead to both miscarriages and premature birth. In this way, nature tries to preserve the life and health of a woman. In addition, constant use of certain medications and even medicinal herbs can also negatively affect pregnancy. Many substances have a teratogenic (capable of causing birth defects) or abortifacient (leading to miscarriage) effect. Of course, such women need to consult a doctor in advance and choose the optimal treatment before pregnancy.

Problems with the uterus

This group of reasons includes anomalies in the structure of the genital organs, previous abortions and curettage of the uterine cavity, leading to the impossibility of full functioning of the reproductive system. With such problems, the likelihood of pregnancy loss is especially high in periods up to 12 weeks, when the placenta is formed.

Rhesus conflict

Women with a negative Rh factor who are carrying a child with a positive Rh factor may encounter a Rh conflict: the mother’s immune system may react inadequately to the fetus, since it is half foreign to her. However, this happens only to 30% of women and most often to those who are carrying more than their first baby.

How does the threat of miscarriage manifest itself?

The threat of miscarriage in the first weeks of pregnancy rarely makes itself felt. If symptoms of this dangerous condition do appear, they differ little from the usual signs of pregnancy.

Discomfort in the lower abdomen is a fairly common phenomenon during pregnancy, as is a feeling of tension. The most characteristic sign of a threatened miscarriage is aching pain in the lower abdomen and lower back, reminiscent of pain during menstruation. Such pain does not go away without medication, when changing body position, and sometimes even begins at rest. Often accompanied by discharge from the genitals ranging from light brown to deep red. If such symptoms occur, consult a doctor. Less dangerous are pains in the groin and lateral abdomen, which appear between the 10th and 20th weeks of pregnancy during physical activity. If such pain appears when walking or a sudden change in body position and quickly passes with rest, then, as a rule, they are associated with the load on the ligamentous apparatus of the growing uterus and do not require any special treatment other than limiting physical activity.

After 20 weeks of pregnancy, pain in the lower abdomen and lower back manifests itself as increased tone of the uterus (hypertonicity), which is periodically felt as tension in the abdomen (the stomach seems to be “cramping”, it feels harder to the touch than usual, and a pulling sensation may occur in the lower abdomen or lower back ). If such sensations are not painful, come no more than 4-5 times a day, last 1-2 minutes, pass with rest, then most likely these are so-called Braxton-Higgs contractions, which do not threaten the development of pregnancy. These training contractions in late pregnancy prepare the body for childbirth. If the pain during such contractions is quite strong and often repeated, does not go away completely after a couple of minutes, and other unfavorable signs are also observed (an increase in the number of mucous membranes or the appearance of bloody discharge) - this may indicate a threat of miscarriage, which requires medical attention. For a fetus developing in the uterus, hypertonicity is dangerous due to impaired blood supply to the placenta and, consequently, oxygen starvation and delayed growth and development.

Premature abruption of a normally located placenta is also accompanied by pain. In this case, the placenta separates from the uterus prematurely (with normal pregnancy and childbirth, placental abruption occurs only after the birth of the child). In this case, severe constant pain occurs, severe bleeding from the genital organs may begin, which threatens the life of the mother and fetus. This is usually the result of a fall or blow to the stomach, but can also occur against the background of certain diseases (for example, hypertension). Ultrasound is used to diagnose placental abruption. If the diagnosis is confirmed, immediate delivery by cesarean section is indicated. During the fixation of the fertilized egg in the wall of the uterus, small fragments of its mucous membrane may be rejected, which causes the appearance of small bloody discharge from the vagina. This discharge may be brown, brown or intensely red in color, but it is not profuse, does not last longer than a few days and does not pose a danger to the normal course of pregnancy.

After the fact of pregnancy is established using a hCG test or ultrasound, any bleeding is regarded as a critical situation, forcing the woman to immediately see an obstetrician-gynecologist. In the early stages of pregnancy, uterine bleeding is most often caused by the threat of miscarriage. However, they can be minor and painless. In such cases, with timely treatment, pregnancy can be maintained. When termination of pregnancy is already inevitable, the bleeding will be prolonged, increasing and not stopping in any way, accompanied by cramping pain in the lower abdomen.

See a doctor urgently!

Any symptoms characteristic of this is a reason to consult a doctor as soon as possible. If you are concerned about severe pain in the lower abdomen, bloody or watery discharge, it is better to contact the ambulance service and ensure complete rest until the doctors arrive. Do not panic. Fear increases uterine contractions, increasing the risk of miscarriage. In order to assess the amount of discharge, thoroughly wet the perineal area, replace a disposable pad or put a handkerchief in your panties, and lie on your side or back with your legs elevated. If the bleeding intensifies, the pad will quickly become wet; if it stops, it will remain practically uncontaminated. If you have abdominal pain, you should not eat or drink until the cause of the pain is determined. Also, you should absolutely not take painkillers, apply a heating pad to your stomach, or try to cleanse the intestines with an enema. Such actions sometimes have irreparable consequences. To alleviate the condition, you can only take antispasmodics.

If installed, you will need rest for the next 2-3 weeks. Sometimes the correct regimen can only be ensured in a hospital setting, in specialized pregnancy pathology departments. Treatment consists of creating a protective, often bed rest, using drugs that relax the uterine muscle, sedatives, and hemostatic drugs. In early pregnancy, analogues of natural pregnancy hormones are often prescribed. If necessary, they may offer surgical intervention to support the cervix - applying a special suture to hold the fetus. After discharge from the hospital, it is recommended to limit physical and emotional stress for several more weeks, as well as abstain from sexual contact.

A miscarriage is a spontaneous termination of pregnancy in the first or second trimester, before the 22nd week. At this stage, the fetus reaches a weight of 500 g, which means that even if the pregnancy ends before the 40th week, it can be saved. Therefore, from the 22nd week they talk about premature birth.

Miscarriages occur frequently.

According to various estimates, 15–20% of all pregnancies end in the early stages.

But these are only those cases when women already knew about pregnancy. It happens much more often that they don’t even know about pregnancy when it is interrupted How many people are affected by or at risk for pregnancy loss or miscarriage?.

Miscarriages are divided into two types:

1. Spontaneous, or sporadic, when a woman has suffered 1-2 miscarriages.
2. Familiar. This means that three or more pregnancies ended in miscarriages, usually at the same period. One woman in a hundred experiences repeated miscarriages.

Why do miscarriages happen?

In most cases, miscarriages are a law of nature. No one knows exactly how the mother’s body determines that this fetus is not worth bearing, but arguing with this process is usually pointless. It is also not always possible to predict a miscarriage: we can only guess what happened.

Fetal chromosomal abnormalities

Three out of four miscarriages occur in the first trimester of pregnancy, that is, in the first three months. At this time, the most common cause of miscarriage is fetal anomalies.

Chromosomes are structures that are made up of DNA, that is, genes. Genes are the instructions by which all processes in our body take place. Genes determine how and when the embryo will develop, how it will become a child and how it will then live, what its blood type will be, and even what sweets it will like more than others.

When mom and dad's cells meet, fertilization occurs; after a few hours, the fertilized egg divides for the first time. This is a very complex process, and things may not go according to plan. For example, it turns out that the embryo has an extra chromosome or, conversely, one is missing. But whatever the breakdown, the result is the same: the fetus is not viable. So the body rejects it, this is a natural mechanism You Asked: What Causes a Miscarriage?.

In most cases, the woman does not even notice that a miscarriage has occurred.

Chemical changes in the body are minor, and not everyone feels them. The delay is also small, so it can be attributed to natural changes in the cycle, but outwardly such a miscarriage is no different from.

About two-thirds of all early miscarriages are just such anomalies. They cannot be predicted, prevented or cured. Of course, the quality of the germ cells of mom and dad affects the viability of the embryo. But anomalies occur even in completely healthy parents with normal eggs and sperm.

If pregnancy has been established by tests, analyzes and even ultrasound, it can still end in miscarriage due to fetal abnormalities.

Empty fertilized egg

Some pregnancies are terminated because anembryonia develops. This is a phenomenon when there is a fertilized egg, but there is no embryo formed in it. This is also a consequence of breakdowns after conception. Miscarriage.

Problems with the placenta

In order for the embryo to develop, it must attach to the wall of the uterus and begin to be nourished by the placenta. The placenta is a special organ that connects the organisms of the mother and fetus. This organ is formed before the 14th–16th week of pregnancy. And if during this period something went wrong and the placenta “did not work out,” the pregnancy will be terminated, because without a placenta the fetus cannot be carried to term.

Chronic diseases

In the second trimester, the risk of miscarriage can be affected by the mother's health status, and in particular by certain chronic diseases:

1. Diabetes mellitus (if not controlled).
2. Autoimmune diseases.
3. Kidney diseases.
4. Disorders of the thyroid gland.

Infections

Some infections can harm the fetus and cause miscarriage. These are HIV (if not treated and controlled), chlamydia, gonorrhea, syphilis, rubella, toxoplasmosis and cytomegalovirus if the last three are contracted during pregnancy. Please note that this list does not include ureaplasmosis or any changes in vaginal flora.

Medicines

Many medicines, including natural ones (herbs, the same coltsfoot), can affect the course of pregnancy. Therefore, you can take any medications only if they are safe and approved by your doctor.

Features of the structure of the uterus

The shape, structure and position of the uterus can affect how your pregnancy progresses. But abnormalities that can actually lead to miscarriage are extremely rare.

Sometimes the muscle ring of the cervix is ​​weaker than necessary for bearing a fetus. This condition is called isthmic-cervical insufficiency. Because of it, the cervix opens before childbirth, causing a miscarriage Causes of miscarriage. This anomaly should be noticed by a gynecologist who will offer treatment options.

Polycystic ovary syndrome

A syndrome that causes enlarged ovaries, difficulty conceiving, and increases the risk of miscarriage What causes pregnancy loss/miscarriage?, although no one knows exactly how polycystic disease affects pregnancy. Many women with this problem carry the fetus until the 40th week.

What increases the risk of miscarriage

1. Mother's age. The risk of miscarriage in women aged 20–24 years is 8.9%, after 45 years - 74.7% Maternal age and fetal loss: population based register linkage study.
2. Bad habits. Smoking and drugs (in any quantities), alcohol (more than 50 ml of strong drinks per week).
3. Caffeine. Small amounts of caffeine do not affect the fetus, so up to 200 mg of caffeine per day can be taken. Usually this norm is twice as high. , how much caffeine is in tea and coffee, so as not to get confused.
4. Obesity.

What does not affect miscarriage?

Contrary to many myths, pregnancy cannot be prevented by:

1. Stress and anxiety of a pregnant woman, fear.
2. Any daily activity Early Pregnancy Loss, including work (if it is not initially related to hazardous activities).
3. Sports and, if there are no contraindications for them, which the gynecologist will tell you about.
4. Spicy food.
5. Flying.

What to do if you have a miscarriage

In any case, you need to visit a doctor to check whether there is any unnecessary tissue left in the uterus. As a rule, the body gets rid of everything unnecessary on its own. Sometimes the uterus needs help: either take a medicine that opens its cervix, or turn to surgical methods.

To find out the cause of a miscarriage, you need to take a general blood test, check for infections and examine the uterus. Together with your partner, you can get tested by a geneticist and identify chromosomal abnormalities. However, it is not a fact that these tests and examinations will tell us anything: there are still too many mysteries in this issue.

One of the most difficult tasks after a miscarriage is to cope with the feeling and not blame yourself for what happened. Everyone experiences problems differently, but just in case, remember:

1. If the pregnancy was terminated, then most likely the fetus had no chance, no matter how cynical it may sound.
2. It is not our fault that the human body is so complex and so difficult to reproduce.
3. Miscarriages occur frequently, and after them, most women become pregnant and give birth without any particular difficulties.
4. It's normal to worry and be sad.
5. If you find it difficult, you can always seek psychological help.

What can we do to prevent miscarriage?

Sadly, almost nothing.

If the miscarriage is due to genetic reasons, then we are powerless. If infections are to blame, then we can (for example, from rubella and influenza) or try to avoid infection. If chronic diseases are to blame for the miscarriage, then we can treat them or at least control them.

But in most cases, miscarriage is not the fault of the parents, but a complex, albeit terrible, from our point of view, selection mechanism.

Spontaneous miscarriage at various stages of pregnancy ends in the death of the fetus and is a complex obstetric and gynecological problem, usually accompanied by serious psychological consequences for the couple.

The concept of “spontaneous miscarriage,” depending on the clinical manifestations and in accordance with the classification of the World Health Organization (WHO), includes such pathological conditions of pregnancy as threatened spontaneous miscarriage, abortion in progress, incomplete miscarriage, complete miscarriage and failed miscarriage.

Its frequency reaches 20% of the total number of clinical pregnancies, some of which are not diagnosed in the early stages. Among women whose pregnancy was diagnosed based on a study of the level of human chorionic hormone before the next menstruation, the rate of miscarriages increases to 30-60%. When is there a risk of miscarriage, and what are its causes?

Determination of the pathological condition and its cause

“Threatened miscarriage” is a clinical term used to describe the condition that precedes the possible spontaneous termination of pregnancy at various stages during the first 21 weeks. The 2nd – 3rd and 6th – 8th weeks are considered critical with regard to the development of manifestations of the pathological condition.

A spontaneous miscarriage is, according to WHO definition, the expulsion from a woman’s body of an embryo or an immature and non-viable fetus weighing 500 grams or less, which corresponds (approximately) to a pregnancy of up to 22 weeks.

Depending on the timing, this pathological condition is distinguished as:

1. Early if it occurs before 12 weeks (first trimester). At these times, 40-80% occurs. Moreover, up to 78% of spontaneous abortions, especially among women with an unknown cause of previous miscarriage, occur at 6-8 weeks of pregnancy, when the embryo dies. The likelihood of this condition decreases significantly (to 2%) in the presence of fetal heartbeats, that is, at 8 weeks. At 10 weeks and with a normal fetal heartbeat, the rate of spontaneous abortion is only 0.6%.
2. Later - after 12 weeks, that is, in the second trimester, but before 22 weeks of gestation. The incidence of miscarriage is lower compared to the first trimester, and its likelihood decreases significantly with increasing gestational age.

Almost half of women with this pathology form a separate group in which it is not possible to establish the main or any cause at all. For the rest, as a rule, not one, but several causes are identified, exerting their influence sequentially or acting simultaneously. In most cases, the causes of threatened miscarriage are multifactorial.

The most significant reasons are considered to be the following factors:

1. Genetic.
2. Infection and inflammatory processes of the internal genital organs.
3. Endocrine disorders.
4. Immune deficiency.
5. Congenital and acquired pathology of the internal genital organs of an organic nature.

Genetic factors

They account for an average of 5% of all causes of spontaneous miscarriage. About 40-60% of early miscarriages (in the first trimester) are caused by chromosomal abnormalities in the form of autosomal trisomy (most often), double trisomy, triplody and tetraplody, various forms of mosaicism, translocation, etc.

Infection and inflammatory processes of the internal genital organs

Miscarriage and, accordingly, its threat for periods up to 22 weeks, associated with inflammatory causes, are due to the specificity of penetration from the mother’s blood through the placenta:

• bacteria - mycobacteria, gram-positive and gram-negative cocci, treponemas, listeria;
• protozoa - plasmodium, toxoplasma;
• viruses;
• associations of microorganisms - bacterial-bacterial, viral-viral, bacterial-viral.

The most common type of disorder in pregnant women is a violation of the ratio of different types of vaginal microflora, or dysbiosis (in 10-20%), with subsequent development. Diagnosis of dysbiosis through vaginal smears allows you to navigate the need for further research to identify the presence of pathology. Microorganisms can cause an inflammatory process in the placenta (placentitis), accompanied by histopathological changes. In this case, the presence of microorganisms in the maternal body can occur with a clinical picture of inflammatory processes or asymptomatically.

For a long time, dysbiosis was not considered a risk factor for the threat, but recently an imbalance in the microflora of the vaginal environment is considered one of the main causes of intrauterine infection of the fetus and complications of pregnancy. Relatively often pathogenic pathogens such as group A streptococci and opportunistic anaerobic infection are sown.

Disturbed microbiocenosis is always accompanied by a disorder of the local immune state of tissues, which is expressed in an increase in immunoglobulins “A” and a decrease in the content of immunoglobulins “G”. It is the disorder of the mechanisms of local immunity that significantly reduces the compensatory and protective ability of the body, which is ultimately the determining factor in the course and outcome of the disease during infection and disruption of microbiocenosis.

In the first trimester, contact and hematogenous (through the woman’s blood) routes of infection predominate, and in the second trimester, ascending ones, when microorganisms spread from the lower genital organs. This leads to infection of the amniotic membranes (regardless of their integrity) and amniotic fluid, resulting in an increase in the synthesis of prostaglandins by the amniotic membrane, which promote uterine contractions.

Infection of the fetus occurs directly from the amniotic fluid or as a result of the spread of infectious pathogens to the fetus through the umbilical cord. In addition, many acute viral or bacterial diseases of a pregnant woman are accompanied by severe symptoms of intoxication and high body temperature, which, in turn, can stimulate an increase in uterine tone and even uterine contractions, leading to the threat and further termination of pregnancy.

Infection in the first trimester, when the placental barrier is not yet fully formed, poses a particular danger. The main source of inflammatory processes in the first trimester of pregnancy are structural and/or functional inferiority of the cervix, as well as acute and chronic inflammation of the cervical canal (), which are usually accompanied by similar inflammation of the endometrium.

Immune deficiency

It is the most common cause of pregnancy loss (40 to 50%). Regulation of the woman’s body’s recognition of a foreign protein and the development of an immune response is carried out by the human tissue compatibility system, or human leukocyte antigens of class I and II. The immunological factor of miscarriage can be caused by immunity disorders both at the humoral level in the form of antiphospholipid syndrome, and at the cellular level in the form of the formation of antibodies in the woman’s body as a response to the father’s antigens in the embryo.

Among the various mechanisms that normalize the immune response in the early stages of gestation, progesterone plays a significant role. The latter activates the synthesis by lymphocytes, which normally contain progesterone receptors, the number of which increases depending on the duration of pregnancy, of a specific protein - the so-called blocking progesterone-induced factor. It affects both the cellular and humoral mechanisms of immune reactions, by changing the balance of cytokines, and in the early stages of the first trimester it prevents spontaneous abortion.

Endocrine disorders

Among all other reasons for such a condition, the threat of miscarriage ranges from 17 to 23%. They are caused by the following functionally interrelated pathological conditions:

1. Inferior function of the corpus luteum, which is, in turn, the result of dysfunction at various levels of the hypothalamic-pituitary-ovarian and hypothalamic-pituitary-adrenal systems. One of the consequences of the inferior function of the corpus luteum is insufficient secretion of the hormone progesterone. Therefore, additional progesterone or the progestogen dydrogesterone (Duphaston) introduced into a woman’s body when there is a threat of miscarriage has a stimulating effect on the synthesis of the progesterone-inducing factor and, accordingly, leads to the continuation of pregnancy.
2. Excessive secretion of androgens (), which is the cause of termination of pregnancy in 20-40%. Hyperandrogenism can be ovarian, adrenal and mixed, but regardless of the form, it can lead to early miscarriages.
3. Thyroid dysfunction (hyper- and hypothyroidism, thyroiditis).
4. Diabetes mellitus.

The most common complications of endocrine pathology, especially against the background of increased levels of androgens, is not only the immediate threat of spontaneous. The development of isthmic-cervical insufficiency of a functional nature, arterial hypertension and gestosis in the second trimester, low attachment of the placenta, which also cause the threat of miscarriage, are also possible.

Congenital and acquired pathology of the internal genital organs of an organic nature

The first includes congenital malformations, mainly of derivatives of the Müllerian ducts, isthmic-cervical insufficiency, abnormal divergence and branching of the uterine arteries. The frequency of threatened spontaneous abortions with these defects is 30% higher compared to other pregnancies.

Acquired pathology - intrauterine synechiae, or (the risk is up to 60-80%, depending on their severity and location), fibroids and other tumor-like formations, endometriosis and adenomyosis, isthmic-cervical insufficiency (from 7 to 13%), acquired in as a result of rough and frequent intrauterine manipulations. With adhesions, the threat arises mainly in the second trimester, and with implantation in the area of ​​the intrauterine septum - in the first trimester.

Other (less significant) reasons among all causes of threatened and miscarriage average up to 10%. These include:

• late age of a woman;
• diseases of infectious viral etiology occurring with a body temperature above 37.7 °;
• heavy physical activity;
• sexual intercourse during pregnancy;
• somatic pathology, especially of the endocrine glands;
• some pathological conditions of the partner, including various disorders of spermatogenesis;
• Rh negative blood group;
• unfavorable environmental factors;
• deficiency of vitamin “B 9” (folic acid), which causes an abnormal karyotype of the fetus and especially increases the risk of pathology during the period from the 6th to the 12th week of pregnancy;
• occupational hazards, toxins and intoxications, including nicotine and narcotic;
• some medications (intraconazole, non-steroidal anti-inflammatory and cytostatic drugs, antidepressants with a pronounced anti-anxiety effect), the use of radiation therapy.

Getting acquainted with brief information about the main manifestations of this pathology helps to correctly assess some changes in the state of your body during pregnancy, especially in its early stages, and understand how to behave in the event of a threat of miscarriage.

Symptoms of the pathological condition

About 30-40% of pregnancies are terminated after implantation of a fertilized egg, and only about 10-15% of them are accompanied by relatively meager and mild (in terms of severity) clinical symptoms, characterized as “threatening spontaneous miscarriage.” This condition is caused by increased tone of the uterus and increased contractile activity. Since at this stage the connection between the fertilized egg and the uterus is still fully preserved, timely treatment often allows the pregnancy to be maintained.

The most significant signs of a threatened miscarriage are the patient’s complaints in a satisfactory general condition of:

1. The absence of another menstruation, when the woman does not yet know or doubts the presence of pregnancy.
2. A feeling of discomfort and/or a mild sensation of heaviness, aching, pulling or, extremely rarely, cramping pain (as it progresses) in the lower abdomen (above the pubis), sometimes radiating to the lumbar and sacral regions. The intensity of pain does not depend on body position, urination or defecation. It does not decrease as a result of rest, but can gradually increase on its own, especially even with minor physical activity.
3. Discharge from the genital tract. They are scanty (spotting), bloody or serous-bloody. Discharge when there is a threat of miscarriage (their presence or absence) is of great importance in prognostic terms - termination of pregnancy already in the earliest stages occurs in 12.5 -13.5% of women with bleeding and in 4.2-6% (that is, in 2 times less often) - without them.

During a gynecological examination, the following signs are determined:

• presence of bloody discharge in the genital tract;
• the cervix is ​​not changed, its external os is closed;
• the size of the uterus corresponds to the timing of the delay of menstruation, that is, the timing of gestation;
• the uterus responds to examination by increasing its tone (it becomes denser).

There are no laboratory tests specific for this threatening condition. The concentration of human chorionic gonadotropin (hCG) in plasma normally ranges from 45,000 to 200,000 IU/L in the first trimester, and from 70,000 to 100,000 IU/L in the second trimester. With the development of the pathological condition in question, hCG levels remain normal or are slightly reduced.

More reliable is the karyopyknotic index (KPI), which is determined using a colpocytological examination of a smear taken in the area of ​​the lateral walls of the vagina. It is a characteristic of the degree of saturation of a woman’s body with estrogen. In the first trimester, the CPI should be no more than 10%, at 13-16 weeks the CPI is 3-9%, and at later stages - no more than 5%. In the event of a threat of miscarriage, the CPI exceeds the specified standards.

Ultrasound data are also indirect and often not reliable enough. The threatening condition is sonographically characterized by such indirect signs as locally, along the anterior or posterior wall, increased tone of the uterus (this may also be a common reaction to manipulation), low location of the fertilized egg, the appearance of constrictions and unclear deformed contours. According to the data, it is sometimes possible to reliably determine the threat of miscarriage in the second trimester by the presence of individual areas of placental abruption with the formation of retrochorial (behind the chorionic membrane) hematomas, by a change (not always) in the diameter of the isthmus, which normally should not be more than 5 mm.

Treatment for threatened miscarriage

Treatment tactics depend on the duration of pregnancy, the severity and nature of the pain syndrome, the presence or absence of discharge and its nature, KPI data, manual and echographic examinations.

There is no consensus on whether the woman needs to be hospitalized. Some clinicians consider hospitalization necessary in any case of suspected threatened miscarriage. Emergency care in the event of a threatened miscarriage is necessary in case of heavy and/or repeated bleeding, especially accompanied by symptoms of anemia.

In case of single spotting, vague or minor pain, absence of progesterone deficiency, negative CPI results and inconclusive echographic data, currently abroad and many specialists in Russia recommend treatment on an outpatient basis (even without special medications).

Is it possible to walk if there is a threat of miscarriage and what regime should be followed?

Bed rest is not required. The woman is given recommendations in terms of completeness and balance of dietary nutrition, normalization of intestinal function and limitation of activity associated with the application of physical and psycho-emotional effort - do not lift heavy objects, significantly limit the duration of walking, abstain from sexual intercourse, and avoid conflict situations. If the pain in the lower abdomen and bleeding have stopped, you can gradually expand your physical activity, but completely eliminate lifting even minor weights.

In other cases, treatment is carried out in the inpatient department of pathology of pregnant women. Prescribed bed rest, Magne B6, which has mild sedative and muscle relaxing effects, as well as reducing anxiety and improving the function of the digestive tract, sedatives of plant origin (in the first trimester) in the form of valerian root extract, motherwort and hawthorn tinctures and tranquilizers (in the second trimester).

In order to reduce the tone of smooth muscles and reduce uterine contractile activity, antispasmodics are used orally, intramuscularly or intravenously in solutions - No-shpa, Drotaverine, Baralgin, Papaverine. Sometimes a 25% solution of magnesium sulfate, 10 ml every 12 hours, is simultaneously used intramuscularly.

Some beta-adrenomimetic drugs (tocolytics), for example, Partusisten (active ingredient fenoterol), Ritodrine, Alupent, which are used at the 20th week of pregnancy and at later stages, have an inhibitory effect on the contractile activity of the uterus.

With ongoing bleeding, many doctors still prescribe hemostatic drugs - Dicinone (sodium etamsylate), aminocaproic acid, tranexamic acid, etc. However, in the pathological condition under consideration, their use is not always justified, since the discharge of blood in this case is not associated with a violation of blood clotting .

In addition, in order to reduce the load of medications on the developing fetus and the woman’s body, physiotherapeutic methods are also used - electrical relaxation of the uterus through the use of sinusoidal alternating current, endonasal galvanization, inductothermy of the renal zones, magnesium iontophoresis using sinusoidal modulated current. In this case, the issue of installing an obstetric-gynecological pessary is sometimes decided, since there is no definitively reliable data on its effectiveness.

If there is an excess androgen content in the blood (with diagnosed hyperandrogenism), short courses of glucocorticosteroids (Prednisolone or Dexamethasone) are used, and in case of gestagenic insufficiency of the corpus luteum, Utrozhestan in capsules, the active component of which is natural micronized progesterone, is prescribed intravaginally. In the case of the presence of antibodies to progesterone, it is possible to use dydrogesterone (Duphaston), which is a synthetic analogue of the first. At the same time, the use of progesterone and dydrogesterone is permissible only in case of insufficient function of the luteal body. Routine use of these drugs is not advisable.

An individual differentiated approach in choosing tactics for treating threatened miscarriage in many cases helps prevent the unfavorable outcome of this pathological condition.