How often miscarriage

Miscarriage | March of Dimes

Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy. Some women have a miscarriage before they know they’re pregnant.

We don’t know all the causes of miscarriage, but problems with chromosomes in genes cause most.

It can take a few weeks to a month or more for your body to recover from a miscarriage. It may take longer to recover emotionally.

Talk to your health care provider about having medical tests before you try to get pregnant again.

Most women who miscarry go on to have a healthy pregnancy later.

What is miscarriage?

Miscarriage (also called early pregnancy loss) is when a baby dies in the womb (uterus) before 20 weeks of pregnancy. For women who know they’re pregnant, about 10 to 15 in 100 pregnancies (10 to 15 percent) end in miscarriage. Most miscarriages happen in the first trimester before the 12^th week of pregnancy. Miscarriage in the second trimester (between 13 and 19 weeks) happens in 1 to 5 in 100 (1 to 5 percent) pregnancies.

As many as half of all pregnancies may end in miscarriage. We don’t know the exact number because a miscarriage may happen before a woman knows she’s pregnant. Most women who miscarry go on to have a healthy pregnancy later.

What are repeat miscarriages?

If you have repeat miscarriages (also called recurrent pregnancy loss), you have two or more miscarriages in a row. About 1 in 100 women (1 percent) have repeat miscarriages. Most women who have repeat miscarriages (50 to 75 in 100 or 75 percent) have an unknown cause. And most women with repeat miscarriages with an unknown cause (65 in 100 women or 65 percent) go on to have a successful pregnancy.

What causes miscarriage and repeat miscarriages?

We don’t know what causes every miscarriage. But some miscarriages and repeat miscarriages can be caused by:

Problems with chromosomes

About half of all miscarriages are caused when an embryo (fertilized egg) gets the wrong number of chromosomes. This usually happens by chance and not from a problem passed from parent to child through genes. Chromosomes are the structures in cells that holds genes. Each person has 23 pairs of chromosomes, or 46 in all. For each pair, you get one chromosome from your mother and one from your father. Examples of chromosome problems that can cause miscarriage include:

Blighted ovum. This is when an embryo implants in the uterus but doesn’t develop into a baby. If you have a blighted ovum, you may have dark-brown bleeding from the vagina early in pregnancy. If you’ve had signs or symptoms of pregnancy, like sore breasts or nausea (feeling sick to your stomach), you may stop having them.
Intrauterine fetal demise. This is when an embryo stops developing and dies.
Molar pregnancy. This is when tissue in the uterus forms into a tumor at the beginning of pregnancy.
Translocation. This is when part of a chromosome moves to another chromosome. Translocation causes a small number of repeat miscarriages.

Problems with the uterus or cervix.

The cervix is the opening to the uterus that sits at the top of the vagina. Problems with the uterus and cervix that can cause miscarriage include:

Septate uterus. This is when a band of muscle or tissue (called a septum) divides the uterus in two sections. If you have a septate uterus, your provider may recommend surgery before you try to get pregnant to repair the uterus to help reduce your risk of miscarriage. Septate uterus is the most common kind of congenital uterine abnormality. This means it’s a condition that you’re born with that affects the size, shape or structure of the uterus. Septate uterus is a common cause of repeat miscarriages.
Asherman syndrome. If you have this condition, you have scars or scar tissue in the uterus that can damage the endometrium (the lining of the uterus). Before you get pregnant, your provider may use a procedure called hysteroscopy to find and remove scar tissue. Asherman syndrome may often cause repeat miscarriages that happen before you know you’re pregnant.
Fibroids (growths) in the uterus or scars from surgery on the uterus. Fibroids and scars can limit space for your baby or interfere with your baby’s blood supply. Before you try to get pregnant, you may need a surgery called myomectomy to remove them.
Cervical insufficiency (also called incompetent cervix). This is when your cervix opens (dilates) too early during pregnancy, usually without pain or contractions. Contractions are when the muscles of your uterus get tight and then relax to help push your baby out during labor and birth. Cervical insufficiency may lead to miscarriage, usually in the second trimester. To help prevent this, your provider may recommend cerclage. This is a stitch your provider puts in your cervix to help keep it closed.

Infections

Infections, like sexually transmitted infections (also called STIs) and listeriosis, can cause miscarriage. An STI, like genital herpes and syphilis, is an infection you can get from having sex with someone who is infected. If you think you may have an STI, tell your health care provider right away. Early testing and treatment can help protect you and your baby. Listeriosis is a kind of food poisoning. If you think you have listeriosis, call your provider right away. Your provider may treat you with antibiotics to help keep you and your baby safe. Having certain infections may cause miscarriage, but they’re not likely to cause repeat miscarriages.

Are you at risk for a miscarriage?

Some things may make you more likely than other woman to have a miscarriage. These are called risk factors. Risk factors for miscarriage include:

Having two or more previous miscarriages
Being 35 or older. As you get older, your risk of having a miscarriage increases.
Smoking, drinking alcohol or using harmful drugs. If you’re pregnant or thinking about getting pregnant and need help to quit, tell your provider.
Being exposed to harmful chemicals. You or your partner having contact with harmful chemicals, like solvents, may increase your risk of miscarriage. A solvent is a chemical that dissolves other substances, like paint thinner. Talk to your provider about what you can do to protect yourself and your baby.

Some health conditions may increase your risk for miscarriage. Treatment of these conditions before and during pregnancy can sometimes help prevent miscarriage and repeat miscarriages. If you have any of these health conditions, tell your health care provider before you get pregnant or as soon as you know you’re pregnant:

Autoimmune disorders. These are health conditions that happen when antibodies (cells in the body that fight off infections) attack healthy tissue by mistake. Autoimmune disorders that may increase your risk of miscarriage include antiphospholipid syndrome (also called APS) and lupus (also called systemic lupus erythematosus or SLE). If you have APS, your body makes antibodies that attack certain fats that line the blood vessels; this can sometimes cause blood clots. If you have APS and have had repeat miscarriages, your provider may give you low-dose aspirin and a medicine called heparin during pregnancy and for a few weeks after you give birth to help prevent another miscarriage. Lupus can cause swelling, pain and sometimes organ damage. It can affect your joints, skin, kidneys, lungs and blood vessels. If you have lupus, your provider may treat you with low-dose aspirin and heparin during pregnancy.
Obesity. This means you have too much body fat and your body mass index (also called BMI) is 30 or higher. BMI is a measure of body fat based on your height and weight. If you’re obese, your chances of having a miscarriage may increase. To find out your BMI, go to cdc.gov/bmi.
Hormone problems, like polycystic ovary syndrome (also called PCOS) and luteal phase defect. Hormones are chemicals made by the body. PCOS happens when you have hormone problems and cysts on the ovaries. A cyst is a closed pocket of that contains air, fluid or semi-solid substances. If you’re trying to get pregnant, your provider may give you medicine to help you ovulate (release an egg from your ovary into the fallopian tubes). Luteal phase defect can cause repeat miscarriages. It’s when you have low levels of progesterone over several menstrual cycles. Progesterone is a hormone that helps regulate your periods and gets your body ready for pregnancy. If you have luteal phase defect, your provider may recommend treatment with progesterone before and during pregnancy to help prevent repeat miscarriages.
Preexisting diabetes (also called type 1 or type 2 diabetes). Diabetes is when you have too much sugar (also called glucose) in your blood. Preexisting diabetes means you have diabetes before you get pregnant.
Thyroid problems, including hypothyroidism and hyperthyroidism. The thyroid is a butterfly-shaped gland in your neck. Hypothyroidism is when the thyroid gland doesn’t make enough thyroid hormones. Hyperthyroidism is when the thyroid gland makes too many thyroid hormones.

Having certain prenatal tests, like amniocentesis and chorionic villus sampling. These tests have a slight risk of miscarriage. Your provider may recommend them if your baby is at risk for certain genetic conditions, like Down syndrome.

Having an injury to your belly, like from falling down or getting hit, isn’t a high risk for miscarriage. Your body does a good job of protecting your baby in the early weeks of pregnancy.

You may have heard that getting too much caffeine during pregnancy can increase your risk for miscarriage. Caffeine is a drug found in foods, drinks, chocolate and some medicine. It’s a stimulant, which means it can help keep you awake. Some studies say caffeine may cause miscarriage, and some say it doesn’t. Until we know more about how caffeine can affect pregnancy, it’s best to limit the amount you get to 200 milligrams each day. This is what’s in about one 12-ounce cup of coffee.

What are the signs and symptoms of miscarriage?

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy.

Signs and symptoms of miscarriage include:

Bleeding from the vagina or spotting
Cramps like you feel with your period
Severe belly pain

If you have any of these signs or symptoms, call your provider. Your provider may want to do some tests to make sure everything’s OK. These tests can include blood tests, a pelvic exam and an ultrasound. An ultrasound is a test that uses sound waves and a computer screen to show a picture of your baby inside the womb.

Many women have these signs and symptoms in early pregnancy and don’t miscarry.

What treatment do you get after a miscarriage or repeat miscarriages?

If you’ve had a miscarriage, your provider may recommend:

Dilation and curettage (also called D&C). This is a procedure to remove any remaining tissue from the uterus. Your provider dilates (widens) your cervix and removes the tissue with suction or with an instrument called a curette.
Medicine. Your provider may recommend medicine that can help your body pass tissue that’s still in the uterus.

Do you need any medical tests after a miscarriage or repeat miscarriages?

If you miscarry in your first trimester, you probably don’t need any medical tests. Because we don’t often know what causes a miscarriage in the first trimester, tests may not be helpful in trying to find out a cause.

If you have repeat miscarriages in the first trimester, or if you have a miscarriage in the second trimester, your provider usually recommends tests to help find out the cause. Tests can include:

Chromosome tests. You and your partner can have blood tests, like karyotyping, to check for chromosome problems. Karyotyping can count how many chromosomes there are and check to see if any chromosomes have changed. If tissue from the miscarriage is available, your provider can test it for chromosomal conditions.
Hormone tests. You may have your blood tested to check for problems with hormones. Or you may have a procedure called endometrial biopsy that removes a small piece of the lining of the uterus to check for hormones.
Blood tests to check your immune system. Your provider may test you for autoimmune disorders like, APS and lupus.
Looking at the uterus. You may have an ultrasound, a hysteroscopy (when your provider inserts a special scope through the cervix to see your uterus) or a hysterosalpingography (an X-ray of the uterus).

How long does it take to recover from a miscarriage?

It can take a few weeks to a month or more for your body to recover from a miscarriage. Depending on how long you were pregnant, you may have pregnancy hormones in your blood for 1 to 2 months after you miscarry. Most women get their period again 4 to 6 weeks after a miscarriage.

It may take longer to recover emotionally from a miscarriage. You may have strong feelings of grief about the death of your baby. Grief is all the feelings you have when someone close to you dies. Grief can make you feel sad, angry, confused or alone. It’s OK to take time to grieve after a miscarriage. Ask your friends and family for support, and find special ways to remember your baby. For example, if you already have baby things, like clothes and blankets, you may want to keep them in a special place. Or you may have religious or cultural traditions that you’d like to do for your baby. Do what’s right for you.

Certain things, like hearing names you were thinking of for your baby or seeing other babies, can be painful reminders of your loss. You may need help learning how to deal with these situations and the feelings they create. Tell your provider if you need help to deal with your grief. And visit Share Your Story, the March of Dimes online community where you can talk with other parents who have had a miscarriage. We also offer the free booklet From hurt to healing that has information and resources for grieving parents.

If you miscarry, when can you try to get pregnant again?

This is a decision for you to make with your partner and your provider. It’s probably OK to get pregnant again after you’ve had at least one normal period. If you’re having medical tests to try to find out more about why you miscarried, you may need to wait until after you’ve had these tests to try to get pregnant again.

You may not be emotionally ready to try again so soon. Miscarriage can be hard to handle, and you may need time to grieve. It’s OK if you want to wait a while before trying to get pregnant again.

More information

From hurt to healing (free booklet from the March of Dimes for grieving parents)

Share Your Story (March of Dimes online community for families to share experiences with prematurity, birth defects or loss)

Centering Corporation (grief information and resources)

Compassionate Friends (resources for families after the death of a child)

Journey Program of Seattle Children’s Hospital (resources for families after the death of a child)

Lupus Research Alliance: Pregnancy and family planning

Share Pregnancy & Infant Loss Support (resources for families with pregnancy or infant loss)

Last reviewed: November, 2017

Miscarriage - NHS

A miscarriage is the loss of a pregnancy during the first 23 weeks.

Symptoms of a miscarriage

The main sign of a miscarriage is vaginal bleeding, which may be followed by cramping and pain in your lower abdomen.

If you have vaginal bleeding, contact a GP or your midwife.

Most GPs can refer you to an early pregnancy unit at your local hospital straight away if necessary.

You may be referred to a maternity ward if your pregnancy is at a later stage.

But bear in mind that light vaginal bleeding is relatively common during the first trimester (first 3 months) of pregnancy and does not necessarily mean you're having a miscarriage.

Causes of a miscarriage

There are potentially many reasons why a miscarriage may happen, although the cause is not usually identified.

The majority are not caused by anything you have done.

It's thought most miscarriages are caused by abnormal chromosomes in the baby.

Chromosomes are genetic "building blocks" that guide the development of a baby.

If a baby has too many or not enough chromosomes, it will not develop properly.

In most cases, a miscarriage is a one-off event and most people go on to have a successful pregnancy in the future.

Preventing a miscarriage

The majority of miscarriages cannot be prevented.

But there are some things you can do to reduce the risk of a miscarriage.

Avoid smoking, drinking alcohol and using drugs while pregnant.

Being a healthy weight before getting pregnant, eating a healthy diet and reducing your risk of infection can also help.

What happens if you think you're having a miscarriage

If you have the symptoms of a miscarriage, you'll usually be referred to a hospital for tests.

In most cases, an ultrasound scan can determine if you're having a miscarriage.

When a miscarriage is confirmed, you'll need to talk to your doctor or midwife about the options for the management of the end of the pregnancy.

Often the pregnancy tissue will pass out naturally in 1 or 2 weeks.

Sometimes medicine to assist the passage of the tissue may be recommended, or you can choose to have minor surgery to remove it if you do not want to wait.

After a miscarriage

A miscarriage can be an emotionally and physically draining experience.

You may have feelings of guilt, shock and anger.

Advice and support are available at this time from hospital counselling services and charity groups.

You may also find it beneficial to have a memorial for the baby you lost.

You can try for another baby as soon as your symptoms have settled and you're emotionally and physically ready.

It's important to remember that most miscarriages are a one-off and are followed by a healthy pregnancy.

How common are miscarriages?

Miscarriages are much more common than most people realise.

Among people who know they're pregnant, it's estimated about 1 in 8 pregnancies will end in miscarriage.

Many more miscarriages happen before a person is even aware they're pregnant.

Losing 3 or more pregnancies in a row (recurrent miscarriages) is uncommon and only affects around 1 in 100 women.

Page last reviewed: 09 March 2022
Next review due: 09 March 2025

Miscarriage, how to avoid - Planning and management of pregnancy in the gynecology of the Literary Fund polyclinic after a miscarriage

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A miscarriage is always associated with severe consequences for the whole body of a woman and for her reproductive organs in particular, it also affects the family situation, disrupts the woman's work schedule. An unfavorable outcome of pregnancy requires great mental and physical costs on the part of parents. Therefore, contacting doctors to find out the causes of the problem is the very first and correct step towards the birth of a child. nine0033

Any competent gynecologist will tell you that the problem of miscarriage can be solved. With proper preparation for pregnancy and its management, the next time you will have a successful pregnancy. Most girls after a miscarriage go to extremes: they try to get pregnant again as soon as possible. And if this succeeds, then the miscarriage is very often repeated. And you need to give the body a rest for 2-3 months, then identify and eliminate the cause. And only then try.

Causes of miscarriage

Many are convinced that miscarriages are due to a fall, bruise, or some other physical shock. Any woman who has had a miscarriage can remember that not long before she either fell or lifted something heavy. And I am sure that she lost her unborn child precisely because of this. However, those women whose pregnancy was normal also fall and lift heavy things. Most sudden miscarriages do not occur for this reason. The reason is in violations of the pregnancy itself. Approximately half of miscarriages are due to abnormal genetic development of the fetus, which can be hereditary or accidental. Merciful nature, following the principles of natural selection in everything, destroys the defective and unviable fetus. But you should not be afraid of this. The fact that there is a defect in one embryo does not mean at all that all the others will be the same. nine0033

The woman's body is almost always to blame for the other half of miscarriages. They are caused by various known and unknown factors, such as: acute infectious diseases suffered in the first trimester of pregnancy, poor environment or difficult working conditions, excessive psychological or physical stress, abnormal development of the uterus, radiation, alcohol, smoking and certain types of drugs.

The causes of early and late miscarriage may differ, although they may overlap. The most important thing is to find out and eliminate or compensate for your own cause of miscarriage. Having discovered the cause, the gynecologist will tell you how to avoid another loss. nine0033

Miscarriage

Miscarriage statistics also include “missed pregnancy”. Sometimes it happens that the embryo dies and lingers in the uterine cavity. Most often, this fact is detected by ultrasound. The dead fetus may begin to decompose, and this, thereby, will lead to poisoning of the mother's body.

Doctors resort to surgical curettage, which is associated with a risk of inflammation and complications. With such a miscarriage, the next pregnancy is planned after the body is fully restored - not earlier than a year. During this year, you will have to find out the cause of the missed pregnancy and treat it. nine0033

Miscarriage up to 6 weeks

The main causes of miscarriage on this line are malformations of the embryo itself. Statistics say that from 70-90% of embryos had chromosomal abnormalities: they are random and will not occur in other pregnancies. You may have been ill, taken medication, or were under the influence of other harmful factors. Fate saved you from a child with malformations.

The human body is perfect and finds a way to correct the situation by miscarriage. Today is a tragedy for you. The real tragedy would be the preservation and birth of a sick, non-viable child. So don’t cry and understand: everything is for the best, you won’t help grief with tears ... And after three months, try again - it will almost certainly turn out to be successful. nine0033

It should also be noted that the fact of a miscarriage does not mean that you have lost something. So for a period of 7-8 weeks, the absence of an embryo in the fetal egg is found - "anembryony". It is believed that in 80-90% of cases, miscarriages are undiagnosed non-developing pregnancies.

Miscarriage between 6 and 12 weeks

Miscarriage in this period is also considered early. Its most common causes are:

Endocrine disorders

Endocrine disorders, when the ovaries do not synthesize enough hormones to keep the fetus in the womb, or the amount of male sex hormones is increased, is one of the most common causes of miscarriage and miscarriage. nine0033

Imbalance of hormones in a woman's body is very likely to lead to an early termination of pregnancy. With a lack of the main hormone progesterone produced by the ovaries, this happens most often. Another hormonal problem is an increase in the tone of the uterus, which provokes the expulsion of the fetus.

Progesterone prepares the uterine mucosa for implantation and is the hormone for maintaining pregnancy in the first months. If conception occurs, the fetus cannot properly establish itself in the uterus. As a result, the fertilized egg is rejected. But pregnancy can be saved with the help of progesterone preparations if this problem is detected in time. nine0033

An excess of male sex hormones that suppress the production of estrogen and progesterone can also be the cause of an early miscarriage. Often, the cause of recurrent miscarriages are androgens that affect the formation and development of pregnancy; as well as thyroid and adrenal hormones. Therefore, a change in the function of these glands can lead to miscarriage.

Undertreated sexual infections

This problem must be solved before conception. Often the cause of miscarriage is sexually transmitted infections: syphilis, trichomoniasis, toxoplasmosis, chlamydia, cytomegalovirus and herpetic infections. Their effect on the fetus and the course of pregnancy is different for each woman and depends on the timing of infection, the activity of the microorganism, the degree of immune protection and the presence of other adverse factors. Depending on the situation, they can lead to the formation of fetal malformations, intrauterine infection, feto-placental insufficiency, early miscarriage or premature birth. Infection of the fetus and damage to the membrane of the fetus leads to miscarriage. To avoid this, infections should be treated before pregnancy. The use of therapy is possible during pregnancy as prescribed by a doctor. nine0033

Viral infections and other diseases

Any disease accompanied by intoxication and fever above 38 ^about C can lead to a miscarriage. Rubella, influenza and viral hepatitis occupy a leading position in this list. At a period of 4-10 weeks for pregnancy, ordinary tonsillitis can also become tragic, pneumonia carries a more serious risk. Pyelonephritis and appendicitis can cause early labor. When planning a pregnancy, it is imperative to undergo a medical examination in order to identify and treat foci of infections. nine0033

Extremely dangerous during pregnancy rubella - it leads to severe fetal malformations, so infection during pregnancy is an indication for medical abortion.

Any disease during pregnancy can lead to non-viability of the fetus. And the body, through a miscarriage, insures you against unwanted offspring. With such a miscarriage, the next pregnancy has every chance of going well.

Immune causes of miscarriage

Sometimes antibodies that are hostile to the fetus are formed in the blood of a pregnant woman. This cause can be predicted and eliminated in advance. Most often, the conflict occurs when the embryo inherits the positive Rh factor of the father, and the negative Rh factor, the mother's body rejects the embryonic tissues that are alien to it. Constant monitoring of antibody titer and the introduction of anti-Rhesus immunoglobulins allows you to maintain and maintain pregnancy. In case of an immune conflict, progesterone preparations are also used to prevent miscarriage, which in this case has an immunomodulatory effect. nine0033

Reduced immunity

Reduced immunity during pregnancy also refers to immune causes. The body is simply not able to grow a new life in itself. You need to take care of yourself and recover before the next conception.

Anatomical causes of miscarriage

Anatomical causes of miscarriage are the most intractable. Malformations of the uterus are a serious reason for miscarriage. Sometimes you just have to deal with it.

Miscarriage between 12 and 22 weeks

Such a miscarriage is considered late. Its causes coincide with the causes of miscarriages in the early stages (anatomical, immune, infectious, endocrine).

At this time, miscarriage also occurs due to isthmic-cervical insufficiency - a weak cervix cannot hold the fetus and opens. For this reason, a miscarriage can occur in the 2nd or 3rd trimester. Isthmic-cervical insufficiency is observed in 15.0-42.7% of women suffering from miscarriage. Careful monitoring of the pregnant woman allows you to identify the problem in time and make surgical correction of the cervix before the onset of childbirth. nine0033

In isthmic-cervical insufficiency, there is only one method of treatment - mechanical narrowing of the cervical canal. To do this, the neck is either sewn up or a special ring is put on it. However, the latter method is less efficient, because the ring can easily slide off the neck, then it will no longer hold back the process of opening it.

After suturing, if necessary, it is possible to use antibiotics and drugs that normalize the microflora of the vagina. The treatment of the vagina and the control of the state of the seams are carried out daily for 5 days. Stitches are removed at 37-38 weeks and with premature onset of labor. nine0033

Isthmic-cervical insufficiency may be primary (for no apparent reason), may be the result of abortion or hormonal disorders (increased levels of androgens - male sex hormones or their precursors).

Miscarriage after 22 weeks

Such a loss is hard to forget. Obstetricians talk about premature birth after the 28th week of pregnancy. Traditionally, a child born after this period is considered viable. But medicine knows many cases when it was possible to save the life of earlier children. nine0033

We recommend that you be carefully examined for miscarriage, check the above factors. In addition to them, the cause of a miscarriage can be antiphospholipid syndrome, while the woman's body perceives the child as something alien and rejects it. This disease, like the others listed, can be corrected; you have a very real chance of bearing a child.

Miscarriages due to hemostasis disorders

All of the above causes account for only 30-40%. Up to 70% of miscarriages are caused by disorders in the blood coagulation system (hemostasis). nine0033

Blood coagulation disorders leading to pregnancy loss can be divided into thrombophilic (increased clotting) and hemorrhagic (bleeding tendencies). Both of these extremes are dangerous to the fetus. Various disorders leading to the formation of small blood clots lead to the fact that the fetus loses sufficient blood supply, development is disturbed and the fetus is rejected.

The main hemorrhagic changes can appear even in childhood in the form of increased bleeding during cuts, tooth extractions, the onset of menstruation. But sometimes they declare themselves only during pregnancy and are the cause of a miscarriage. Bleeding in the early stages and detachment of the chorion is difficult to stop. nine0033

You may not guess, but incomprehensible headaches, weakness, fatigue, temporary loss of smell or hearing may be symptoms of disorders in the blood coagulation system.

When planning a pregnancy, a genetic examination should be carried out and, if necessary, treatment should be initiated.

It is advisable to be examined for hidden hemostasis defects even for those who consider themselves healthy. This will allow you to predict the occurrence of complications and prevent loss. Early therapy can prevent miscarriage at 98% of cases. If defects in hemostasis are already detected during pregnancy, it can be difficult to maintain it.

What to do after a miscarriage?

Find the cause! The ideal option is to be examined by future parents: it is much more reasonable to postpone conception and spend two or three months to identify the causes than to risk getting pregnant again, spend two months waiting, and then lose everything again and still go to the doctors.

Until you understand the reason, it will not evaporate. In most cases, the answers lie on the surface. Take care of your health and your future baby. nine0033

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What is a miscarriage and why it can happen

###1### What is a miscarriage

First of all, you should define the terms. Miscarriage in gynecological practice is called spontaneous termination of pregnancy in the first 20–22 weeks. Why 20-22 weeks? There is such a consensus: doctors save a fetus born with a weight of 500 grams or more. The chances of saving someone who was born weighing less than 500 grams are zero. At 20–22 weeks, the fetus just usually reaches such a mass. nine0033

The frequency of miscarriages is quite high: they end in 15-20% of pregnancies.

That is, for a practicing doctor, this is a fairly common situation, although in the life of each person, of course, this can happen only once or not at all.

Medical statistics, which make it possible to translate medicine into the language of numbers and make it a more accurate science, indicate that of these 15-20% of pregnancies that end in miscarriages, 80% or more occur in the first 12 weeks. That is, the longer the gestational age, the less likely it is that a spontaneous miscarriage will occur. Thus, if I, as a doctor, meet a woman who is diagnosed with a threatened miscarriage, give her an ultrasound and see a fetus with a heartbeat, I can immediately tell her that the probability of a miscarriage is no longer 15%, but 5%. If I see a situation where the gestation period is already more than 12 weeks, then the probability is already 2-3%. nine0033

How does a miscarriage happen? Regardless of the reason, the scenario is the same.

First the fetus dies; then detachment from the walls of the uterus begins (then the woman has spotting, which is classified as a “threatening miscarriage”), and then the exfoliated is thrown out of the uterine cavity. The problem is that the same symptoms can be observed in both an ectopic pregnancy and a normal, healthy intrauterine pregnancy. If the ultrasound shows a live intrauterine pregnancy, in most cases the cause of bleeding during pregnancy remains unknown. It is the appearance of bloody discharge against the background of a live intrauterine pregnancy that is designated by doctors as a “threatening miscarriage”. In the vast majority of cases, despite the formidable diagnosis, such a pregnancy is completely safely completed. Of course, any woman passionately wants to know what this bloody discharge is because of, because she thinks: now I will find out what it is because of, I will remove this factor from my life, and everything will be fine, they will stop with me. We have to disappoint a woman: in most cases, we do not know the reason. nine0033

Accidental and habitual miscarriage

All miscarriages are divided into two large types - sporadic (accidental) and habitual. In essence, they are determined by the same range of causes, only the proportion of each of the causes in two cases will be very different. In turn, all causes can be divided into two large groups: internal causes caused by fetal problems, and external causes caused by problems in the mother's body. Accordingly, sporadic miscarriages are most often determined by causes associated with the fetus, and habitual miscarriages are determined by the mother's body. nine0033

Medical statistics show that more than half of sporadic miscarriages in the first 12 weeks are due to genetic disorders in the fetus.

Moreover, the shorter the gestational age, the higher the likelihood that the cause was a genetic disorder in the fetus. These are generalized data from numerous studies, mostly Western ones. Let's look at this most common reason first. The fact is that no matter how kings of nature we think we are, the same laws of nature apply to us as to an ant, an insect, a blade of grass. nine0033

Nobody canceled these biological laws: the best and the strongest survive in the good sense of the word, in the biological sense.

A biological individual cannot always produce 100% quality cells (in this case we are talking about germ cells). So, 1 ml of a man's sperm contains on average 20 million spermatozoa, and normally about 10% of them, that is, 2 million, are pathological forms. And such a spermogram will be considered normal. In a woman, too, poor-quality eggs can mature, and the older we get, the more likely it is that a poor-quality egg will mature. It's not because we're deliberately doing something wrong - lifting something heavy, drinking an extra cup of coffee, overworking at home/work. Unlike spermatozoa, which are constantly renewed, all the eggs of a future woman are laid at the moment when her mother is at the 20th week of pregnancy. nine0033

And new eggs are never laid again, they are only used up, only lost throughout the life of a girl/woman.

That is, if you are 35 years old, then the egg that came out of your ovary this month has been lying in the ovary waiting for its turn to ovulate for more than 35 years. Therefore, of course, in a 20-year-old woman and in a 40-year-old woman, not only the quantity, but also the quality of the eggs will be different. Because everything unfavorable that is around us in terms of nutrition, environment, air and water affects the first only 20 years, and the second - already 40.

The dependence of the frequency of spontaneous miscarriage due to genetic disorders in the fetus on the age of the eggs (and, consequently, on the age of the woman) was shown thanks to the introduction of in vitro fertilization technology - IVF. A very good study was conducted on a group of patients over 40 who underwent IVF. Half of them were implanted with their own fertilized eggs, and the other half - donor eggs taken from women under 25 years old. In the group that carried embryos from donor eggs, the miscarriage rate corresponded to that of women under 25 years of age and was three to four times lower than in the group that was implanted with embryos obtained from their 40-year-old eggs. Thus, the probability of miscarriages and genetic disorders of the fetus is determined by the biological age of the woman. It's the kind of thing we can't reverse in any way, and it should be taken into account when a pregnancy is postponed to a later date. nine0033

Thus, if a defective egg meets a normal sperm or vice versa, then the resulting pregnancy with a poor-quality embryo is rejected at a certain stage and a miscarriage occurs.

And here comes the most interesting, because we still do not know which mechanism in the body recognizes that the pregnancy is of poor quality. But this mechanism exists, and it works very well, otherwise all abnormal pregnancies would lead to the birth of not quite healthy or completely unhealthy people, and humanity would have already degenerated. We do not know this mechanism, but we can say: if a woman has a spontaneous miscarriage, then these mechanisms work for her and from a biological point of view she is healthy. It is much worse if we see a different situation (although it is quite rare): far beyond the 20-week period, we do an ultrasound and find severe defects in the fetus. Because of these defects, after birth, he may either be disabled or not be able to survive at all, but now he lives inside the uterus, which suggests that the mechanisms that recognize healthy and unhealthy pregnancy did not work in this woman. nine0033

Therefore, with all the emotional and psychological disadvantages that a spontaneous miscarriage brings for a woman, there is a big plus in this event, which is not obvious to the patient.

This is a universal biological mechanism that allows you to keep us and our offspring healthy and prevents the birth of a handicapped child.

If the majority of spontaneous miscarriages are caused by genetic disorders, the question arises which pregnancies should then be saved. Unfortunately, any gynecologist has encountered cases in his practice when attempts to “pull out” a pregnancy with incredible efforts lead to a deplorable result. That is, the pregnancy threatened to terminate, the woman was given numerous medications, and she persisted, but after the 20th week it turned out that the fetus had serious developmental disorders. It should be said separately about medicines. Serious Western studies (there is such a term as "double-blind placebo-controlled study", it guarantees the quality and statistical significance of the results as much as possible) show that there is not a single medication, except for progesterone, a female hormone that can affect pregnancy. nine0033

If a pregnancy is doomed to death, it will die; if it must survive, it will survive, unless, of course, we are talking about a healthy woman who has biological mechanisms currently unknown to us for culling poor-quality pregnancies.

We, in Russia, have a different practice, caused not by scientific objective data, but rather by cultural differences - the fact that our medicine has been isolated from the world community for a long time.

The second most common cause of miscarriage is infection. This is the same failure. Severe flu is an obvious reason for sporadic miscarriage. Pregnancy does not destroy the disease, but its consequence - the general poor condition of the woman's body, the environment that ensures the life of the fetus. Unlike genetic reasons, when the embryo was laid "bad", in the case of infection, the embryo was laid healthy and of high quality. But suddenly the woman fell ill with a severe flu - a temperature of 40, vomiting, dehydration. It is difficult for a tiny creature to survive in such adverse conditions, and it dies. The death of the embryo is due to environmental disturbances - high temperature, dehydration, intoxication. nine0033

If a second miscarriage occurs, it is difficult to attribute it to the flu: it is hard to believe that a woman gets the same severe flu from year to year at the same time. Here it is - the difference between sporadic and habitual miscarriage.

The first one happens really by chance - it's a classic "failure". The second is a pattern: when we see a woman with a habitual miscarriage, she, as a rule, has an interruption at about the same time. Then we assume that there is a reason that does not exist very clearly in the body: it does not prevent a woman from living outside the state of pregnancy, but it makes itself felt when a normal pregnancy occurs. This reason, which does not exist very noticeably in a woman's body, prevents her from carrying a pregnancy to term. It leads to the fact that normal conditions for the survival of a healthy fetus are not created, and it dies, and this happens from time to time. This is the fundamental difference between a habitual miscarriage and a sporadic one. In this case, we will conduct a series of studies (quite expensive) to find out what the reason is. nine0033

Today, there is a consensus in the world scientific community that recurrent miscarriage is considered a case when a woman has two miscarriages in a row. If a woman had one miscarriage and she comes to me and asks what is the probability that this will happen again, these are the same 15-20%. If this situation occurred twice in a row, then the probability that this will happen again is already about 30–35%, and if three times in a row, it is almost 40%.

In about 2% of married couples, wives suffer from recurrent miscarriage. nine0033

If in the case of sporadic miscarriages, the fetus and its disorders are most often “to blame”, then in case of habitual miscarriages, its environment, the woman’s body, is usually “to blame”. As with sporadic miscarriages, genetics can be the cause. But if in sporadic miscarriage genetics is the cause of 70–80% (up to 6 weeks in general 90%) of all interruptions, then in the case of habitual miscarriage, genetic disorders are found only in 2–3% of patients. The same is true for infections: in a recurrent miscarriage, the likelihood that repeated abortions are due to infection is no more than 1%. nine0033

Hormonal disorders in a woman's body, on the other hand, are more likely to cause habitual rather than accidental miscarriage.

Disturbances in the structure of the uterus - a septum inside the uterus, a bicornuate uterus, the presence of synechia (the so-called adhesions inside the uterus) - these are all things that can also lead to repeated miscarriages.

Approximately 40% of women diagnosed with "recurrent miscarriage" are found to have various immune disorders that cause the fetus to be rejected by the mother's body. Immune disorders are divided into autoimmune and alloimmune. Autoimmune disorders are situations where a woman's immune system works against its own genes, proteins. One of the most common diseases of this kind among women with recurrent miscarriage is antiphospholipid syndrome. Phospholipids are the "glue" that holds cells together. A woman with antiphospholipid syndrome produces factors (antibodies) against her own phospholipids, which are abundant in the placenta. As a result of the syndrome, blood clots form in the small vessels of the placenta, which disrupt blood circulation, and therefore disrupt the function of the placenta to deliver nutrients to the fetus. Pregnancy under such conditions cannot “stretch” for a long time - sooner or later, the death of a healthy embryo / fetus occurs. Women suffering from antiphospholipid syndrome carry a pregnancy in no more than 10% of cases. Its treatment allows you to reverse the statistics - gestation occurs as early as 90% of cases. A woman is given drugs that thin the blood and prevent the formation of blood clots - the placenta performs its function, and the pregnancy is carried.

Alloimmune causes are aggressive factors directed against foreign proteins, that is, the paternal part of the fetal genome. In general, our immune system is required to produce antibodies and get rid of any foreign and pathologically altered cells. Why a pregnancy consisting of 50% of "foreign" genes is not rejected (not to mention 100% of genetic foreignness when a surrogate mother carries a "foreign" embryo in the IVF program) is not yet entirely clear. By the way, scientists believe that when it is found out what is the mechanism that prevents the rejection of pregnancy cells with "foreign genes", this can help in the development of a cure for cancer. After all, cancer consists of pathologically altered cells, which, for some reason, are also not rejected, not destroyed by the immune system. One way or another, during pregnancy, a woman in relation to foreign genes / proteins of the placenta and fetus develops a condition called immunological tolerance - “we do not notice and do not attack strangers”. In the case of a habitual miscarriage, this tolerance does not exist: the mother's immune system recognizes foreign genes and proteins of pregnancy, attacks them, and thereby leads to repeated miscarriages. nine0033

Quite often, in about 40% of all cases, after conducting the necessary examination of both spouses, we, unfortunately, do not find any reasons explaining why this couple has repeated miscarriages.

There is such a term as "unexplained recurrent miscarriage", as well as "unexplained infertility". Maybe in five years, medicine will find something new in this area, new explanations, but so far this has not happened. This is a psychologically difficult moment for both the doctor and the patients.

Two worlds, two approaches

When a woman is at risk of miscarriage, the actions of a doctor in Russia and abroad will be fundamentally different, and this is due not so much to different scientific data as to cultural differences that have arisen during the isolation of our medical school. Abroad, such women are simply sent home: they are "prescribed" bed rest, a general clinical examination, and sexual rest. Time will tell how this situation will end: either the pregnancy will continue, or a miscarriage will occur if it was of poor quality, and it’s good that it was “rejected” by the body. nine0033

In Russia, the psychological attitude of the population towards medicine is slightly different and medicine is slightly different.

In our country, threatened miscarriage is an indispensable indication for hospitalization: there the patient is prescribed "no-shpu", drugs that relax the uterus, hemostatic drugs. This is not a matter of biological or medical differences - it is a matter of psychology for most of our population: if a doctor did not give a pill, then he did not seek to help. And it is quite difficult to convey to people that the laws of nature apply here - you cannot influence them. According to our Russian protocol, I have no right not to offer hospitalization in case of a threatened miscarriage. However, scientific medical facts clearly show that hospitalization does not fundamentally change anything in the prognosis: the likelihood of spontaneous miscarriage does not decrease from this. Western studies show that there are no medications that can cure sporadic miscarriage. If the pregnancy persists, then it is nature that preserves the pregnancy, not the cure. There are such medicines for a habitual miscarriage: if it was possible to identify the cause of repeated abortions, it can be influenced. This treatment is prescribed either before the onset of pregnancy, or in the early stages of pregnancy, before any symptoms of threatened miscarriage appear.