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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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).

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.

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 started.

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.

Sign up for a consultation with an obstetrician-gynecologist by phone +7 (495) 150-60-01

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why terminate a pregnancy in the later stages and how it is done in Krasnoyarsk

“Like a bolt from the blue”

“We counted the fingers and toes, saw how the heart was beating. Then there was a short pause, and the doctor asked us to go for a walk so that the baby would roll over and he could finish the study. When we returned, there were already two doctors in the doctor's office. Now they were staring at the monitor together and trying to see something. I understood that there were some problems.

And suddenly, like a bolt from the blue, the phrase sounded: “I can’t see the baby’s bladder. There is some kind of education, but what it is is too hard to understand ", - there are hundreds of stories with a similar beginning.

For many women, becoming a mother is a cherished dream. In most cases, pregnancy ends safely - the birth of a healthy baby. But sometimes families get a disappointing prognosis even at the stage of the first ultrasound and tests. Finding out that a child has serious illnesses is always difficult, especially if the health of the father and mother is all right and there are no prerequisites for terrible diagnoses.

Where to go, what to do, what decisions to make? These are only the first questions that arise in pregnant women who have received a poor prognosis.

It is not customary in society to discuss this topic. In our time, when the question of whether abortion is considered murder is still unresolved, the topic of late pregnancy termination, when the unborn child is not just an embryo, but already looks like a full-fledged baby, is painful even for the medical community.

"No error"

Memories of mothers who have experienced the loss of a child (from the forum of the charity fund "Light in Hands"): "After 12 weeks, no one will terminate a pregnancy without a special consultation of doctors and a clearly established diagnosis. Needless to say, none of the doctors spoke to us normally, no one explained a clear sequence of actions, terms, risks, what does “abortion of pregnancy”, etc. mean in general?

Genetic abnormalities are detected at the stage of screenings of a pregnant woman, there are three in total. Screening is a set of studies that allows you to get the most complete information about the health of the fetus. If the ultrasound doctor has doubts during the examination, the patient is sent to the Medical Genetic Center.

“Of course, most of all we are tuned in to early diagnosis, namely, to identify some deviations up to 12 weeks, less often up to 21-22 weeks. But sometimes there are cases when deviations can be detected only in the second half of the term: usually this happens either when a woman registers late and has never been examined before, or when the pathology manifests itself late. Then a decision is already made on a more detailed examination and on the possible termination of such a pregnancy, ”said Tatyana Elizaryeva, head physician of the medical genetic center.

The Medical Genetic Center of Krasnoyarsk sees patients from all over the Krasnoyarsk Territory. In the event that the doctor has doubts about the health of the child during the screening, the pregnant woman is sent for a more detailed examination

If the woman has passed all the examinations and the diagnosis is confirmed, she is invited to the medical commission of the genetic center. You can come to it either alone or with your husband or family members, usually the patient is asked how it is convenient for her. The commission includes several specialists: an ultrasound diagnostician, a neonatologist, an obstetrician-gynecologist, a doctor specializing in a particular pathology (cardiac surgeon, neurosurgeon, pediatric surgeon, etc.). There, the woman is told in detail about what is happening, what kind of pathology the child has, whether it can be treated and what kind of treatment it is.

“It is important to let a woman understand what she is facing and offer all possible options. If these are chromosomal disorders and an intellectual deficiency in the fetus, for example, Down's syndrome, we explain that a child can be born and, in the absence of any physical disabilities, even be able to develop - sit, perhaps write and draw, communicate a little. But we also make it clear that such a child will never be able to live independently, especially after the departure of parents or other guardians, such a child requires rather large financial costs, which not every family is ready for, such a child will always require more attention and strength, and for his parents will have to fight every step in his development. All this is necessary so that families understand what they are getting into in both cases. In any situation, we, as doctors, are obliged to respect their choice,” emphasizes Tatiana Elizarieva.

After a medical consultation, any couple has time to think and make an informed decision. Doctors note that today the equipment and technology of the medical genetic center excludes even the very possibility of making an incorrect diagnosis. In addition, in each case, the results of the tests are processed by several doctors, each giving an opinion and recommendations on pregnancy.

“This is a forced measure”

You can terminate a pregnancy up to 22 weeks, including using medication. The procedure is carried out in the Krasnoyarsk maternity hospital No. 4.

“Medical indications for termination of pregnancy from 12 to 22 weeks are fetal developmental anomalies that are incompatible with life and cannot be surgically corrected,” said Lyudmila Popova, chief physician of maternity hospital No. 4.

This is a chromosome analysis. In a healthy person, all chromosomes are paired, in the picture at number 21 there are three chromosomes instead of two. This is what Down syndrome looks like

According to doctors, a woman can choose to terminate her pregnancy or report it. But often mothers do not fully realize what they doom themselves and their families to when they give birth to children with serious pathologies or non-viable ones.

Memories of mothers who experienced the loss of a child from the forum of the Light in Hands Charitable Foundation): “The diagnosis was terrible, the doctors said that children with such pathologies are born dead or die in infancy. Realizing that losing a baby, a long-awaited daughter, after her birth would be simply fatal for me, I agreed to an abortion for medical reasons. To be honest, I still don’t understand if I did the right thing, and I blame myself that I went along with my relatives and doctors by agreeing to this abortion. ”

“It's very hard to survive. Walk for 9 months and know that a child can die on the first or second day. What is more difficult: walking and knowing that it will be so, or terminating a pregnancy in the middle? Usually women agree with the opinion of doctors, but sometimes they still decide to leave the child, ”says Lyudmila Popova.

In general, most often, before the 22nd week, women agree and go for an abortion.

“This is not just an abortion at the request of a woman, this is a forced measure. Because then supporting the lives of these children is a colossal burden. It happens that mothers then refuse them, because they cannot cope, they give them to the Homes for the Disabled, and then the state takes care of these children, ”concluded Lyudmila Popova.

“After 22 weeks, this is already a full-fledged birth”

Until 2019, in the Krasnoyarsk Territory, pregnancy was not terminated at later stages (after 22 weeks of pregnancy) due to indications from the fetus (congenital malformations incompatible with life, which for some reason have not been previously identified). Women had only one way out - to give birth to a child with a pathology. And only at the end of 2018, the clinical protocol of the Ministry of Health of the Russian Federation "Artificial termination of pregnancy at a later date for medical reasons in the presence of fetal developmental anomalies" was approved, on the basis of which this medical technology was introduced in the Krasnoyarsk Regional Clinical Center for Maternal and Child Health.

The procedure for terminating a pregnancy in the later stages is the same throughout Russia: an anesthetic is administered to the fetus in utero, after which the elimination (cardiac arrest) of the fetus is carried out, and labor is induced. The procedure is performed by an ultrasound doctor, an anesthesiologist, an anesthetist nurse and a laboratory assistant.

“Like any manipulation, the interruption procedure has certain risks associated with both the use of medications and the operation. Bleeding may develop, there may be negative consequences from drugs - side effects, allergies. Any intervention in a woman's body, even at the present stage of the development of medicine, is always a health risk that can lead to complete deprivation of reproductive function. Many couples decide to prolong the pregnancy, hoping for a miracle, for a diagnostic error, ”says Pavel Baurov, head of the advisory clinic at the Regional Clinical Center for Maternal and Childhood Welfare.

Head of the advisory polyclinic of the Regional Clinical Center for Maternal and Childhood Pavel Baurov

Women who refuse to terminate a pregnancy in case of medical indications, most often name their personal beliefs as the reasons, as well as their families. In the case when a decision is made to leave a non-viable child, the patient continues to be observed in the consultation.

How to survive the impossible

Late pregnancy termination is a severe psychological trauma. After the procedure itself, each woman is waiting for the rehabilitation process, a psychologist always works with her. Now there are such specialists at every antenatal clinic. A psychologist from the Center for Maternal and Childhood Welfare talks with a patient before and after the procedure.

“A woman in such a situation has a lot of difficult experiences. And one of the most difficult that appears at such moments is the feeling of guilt. Thoughts often arise in the mother’s head: “How could I allow this to be done?”, even if the situation is completely hopeless. The moment of choice also leaves an imprint - the woman still decides whether to terminate her pregnancy or keep it. Guilt, as a rule, is irrational, not corresponding to the real situation, ”the psychologist notes.

Memories of mothers who have experienced the loss of a child (from the forum of the charitable foundation "Light in Hands"): “Two years have passed. And yes, we still gave birth to a child, a beautiful daughter. But there was not a day that I did not remember my first daughter. I wake up in the middle of the night and remember those days. I keep these memories as the only thing left of my child.”

Medical termination is exactly the same antenatal loss ( situation where the baby dies at during pregnancy — ed. ). A woman loses a baby for a long time, despite the fact that from the end of the first trimester she already perceives him as a person, interacts with him, communicates internally.

A psychologist has no influence on a woman's choice - such is the professional position. It helps to realize some things, provides psychological support. Sometimes the situation itself can be completely hopeless when a diagnosis of a pathology that is incompatible with life is made, but even this does not always affect the final choice of a couple. A psychologist helps to dispel any doubts, relieve tension and at least slightly alleviate the moment of suffering.

After the interruption, the woman goes through the process of mourning, as after any other loss. If adaptation is disrupted for too long and a person cannot live a full life, then psychologists talk about pathological mourning, which requires more serious treatment. It is very important that the environment of the woman also helps to survive the crisis.

“Unfortunately, no one taught us sympathy, our society, and usually people feel discomfort next to those who have suffered a loss. As a rule, a woman's relatives think that the most important thing is that she stopped worrying about . This is where all these tips start: “stop crying”, “live on”, “get together”, and so on. But a woman doesn’t need this, she needs to live her grief, cry out her tears, she needs to speak out, ”says psychologist Svetlana Chursina.

Rehabilitation usually takes months, but even when a woman returned to normal life, this difficult moment will remain in her memory forever, it is impossible to erase it. From time to time, with tears, she will still remember her unborn baby.

Clinical psychologist of the Center for Maternal and Child Health Svetlana Chursina

Patients often ask the question: “What should I do with the child? What will happen to him after I give birth to him?

“The doctor cannot insist, but still it is better if you look at the baby and say goodbye to him. It is better to keep some of his things related to pregnancy, ultrasound scans and so on. Firstly, the brain is arranged in such a way that until it sees it, it will not believe that this is final, therefore subconsciously it will not give you rest, there will always be doubts: “What if he were alive, but if he were healthy? “. Secondly, after some time, women who could not look at the child and say goodbye may regret it. Still, over time, this is perceived as the loss and death of a loved one, so you should not completely depersonalize the baby. But in any case, the choice is up to the woman herself. You can offer, but in no case insist,” advises Svetlana Chursina.

At the Center for Maternal and Child Health, a woman receives 1-2 consultations, after which the doctors recommend that she (if necessary) contact a psychologist at the antenatal clinic, or visit free support groups. In Russia, the charitable foundation "Light in Hands" works with mothers who have suffered perinatal loss. You can get advice and find out all the working conditions on the fund’s hotline.

Psychologists advise relatives, friends and colleagues to start from the desires of a woman - do not impose help, insist on talking if she does not want it. “Time heals” is one of the main principles of recovery, so the main thing is to give a woman this time.

According to doctors, there are no right or wrong decisions when it comes to terminating a pregnancy, there are only those with which the family can live on. The task of doctors is to support the life and health of both the mother and her child at any cost. Life and quality of life depend only on the family where they faced the problem. It is impossible to predict possible risks by 100%, and you need to remember that no family is immune from this. Today in the Krasnoyarsk Territory there is all the necessary medical support for pregnant women with pathologies of the unborn baby and for those who decide to terminate the pregnancy. We hope that as few families as possible will need such assistance.

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