Miscarriage go to hospital

Treating miscarriage | The Royal Women's Hospital

If a miscarriage has begun, there is nothing that can be done to stop it. Any treatment you have will be aimed at avoiding heavy bleeding and infection.

A discussion with the doctor or nurse will help you to work out which treatment options are best and safest for you.

On this page:

No treatment (expectant management)
Treatment with medicine
Surgical treatment (curette)
Waiting for treatment
After a miscarriage

No treatment (expectant management)

You can choose to wait and see what will happen. This is called 'expectant management'. If nothing is done, sooner or later the pregnancy tissue will pass naturally. If it is an incomplete miscarriage (where some but not all pregnancy tissue has passed) it will often happen within days, but for a missed miscarriage (where the fetus or embryo has stopped growing but no tissue has passed) it might take as long as three to four weeks.

While you are waiting you may have some spotting or bleeding, much like a period. When the pregnancy tissue passes, you are likely to have heavier bleeding with crampy, period-like pains. You can use sanitary pads and take pain relieving tablets, such as paracetamol.

If your miscarriage is incomplete, with just a small amount of pregnancy tissue remaining, it’s probably best to take a wait and see approach. But if there is heavy bleeding or signs of infection you will need treatment.

If the tissue does not pass naturally or you have signs of infection, the doctor will recommend a dilatation and curettage (D&C). You and the doctor can discuss and decide the preferred option for you.

Things to know

There are many reasons why some women prefer to wait and see. It may feel more natural, it may help with the grieving process or it may give you more of a sense of control.
Some women become worried or frightened when the bleeding gets heavier, especially if blood clots, tissue or even a recognisable embryo is passed.
Usually, the wait and see approach takes longer than any other approaches such as surgery or medication. Sometimes bleeding can last for up to four weeks.
Although excessive bleeding and blood transfusion are very rare, they are slightly more common with expectant management than with surgery.
A few women still need to have surgery – sometimes urgently – if they develop infection, bleed heavily or if the tissue does not pass naturally.
The waiting time can be emotionally draining for some women.

Treatment with medicine

Medicine is available that can speed up the process of passing the pregnancy tissue. For an incomplete miscarriage, the medicine will usually encourage the pregnancy tissue to pass within a few hours. At most it will happen within a day or two. For a missed miscarriage, it may happen quickly, but it can take up to two weeks and, occasionally, longer.

Medication is not suitable if there is very heavy bleeding or signs of infection. It is usually not recommended for pregnancies that are older than about nine weeks.
If the tissue does not pass naturally, eventually your doctor will recommend a dilatation and curettage (D&C).

Things to know

The pregnancy tissue will pass between four to six hours after taking the medicine, during which time you may be in hospital. After a few hours, if the pregnancy hasn’t passed, you may be sent home to wait. This will depend on where you are and which hospital you are in.
The medicine has side effects which usually pass in a few hours but can be unpleasant, such as nausea, vomiting, diarrhoea, fever and chills. The tablets can be swallowed or dissolved under the tongue, or inserted in the vagina.
After receiving the medication there may be some spotting or bleeding like a period. When the pregnancy tissue passes, you are likely to notice heavier bleeding and clots with strong cramping, period-like pains. You can use sanitary pads and take pain relieving tablets such as paracetamol.
Some women may need stronger pain killers or a pain relieving injection.
A few women still need to have surgery, sometimes urgently, if they develop infection, bleed heavily or if the tissue does not pass.

Surgical treatment (curette)

A D&C (or ‘curette’) is a minor operation. The full name is dilatation and curettage. It is done in an operating theatre, usually under general anaesthetic. There is no cutting involved because the surgery happens through the vagina. The cervix (neck of the uterus) is gently opened and the remaining pregnancy tissue is removed so that the uterus is empty. Usually the doctor is not able to see a recognisable embryo.

The actual procedure usually only takes five to ten minutes, but you will usually need to be in the hospital for around four to five hours. Most of this time will be spent waiting and recovering.

You may have to wait a day or two to have a curette and sometimes, while you are waiting, the pregnancy tissue will pass on its own. If this happens and all of the tissue is passed you may not need to have a curette.

A curette is done in the following circumstances:

You have heavy or persistent bleeding and/or pain.
The medical staff advise that this is a better option for you; this may be because of the amount of tissue present, especially with a missed miscarriage.
This is an option you prefer.

Things to know

The risks of a D&C are very low, but include:

some pregnancy tissue remains in uterus. This can cause prolonged or heavy bleeding and the operation may need to be repeated
infection needing antibiotics
damage to the cervix or uterus. This is very rare (around 1 in 1000) and, when it does happen, it is usually a small hole or tear which will heal itself
excessive bleeding (very rare)
anaesthetic risks. These are very low for healthy women, but no anaesthetic or operation is without risk.

Waiting for treatment

If you have heavy bleeding with clots and crampy pain, it is likely that you are passing the pregnancy tissue. The bleeding, clots and pain will usually settle when most of the pregnancy tissue has been passed. Sometimes the bleeding will continue to be heavy and you may need further treatment.

You should go to your nearest emergency department if you have:

increased bleeding, for instance soaking two pads per hour and/or passing golf ball sized clots
severe abdominal pain or shoulder pain
fever or chills
dizziness or fainting
vaginal discharge that smells unpleasant
diarrhoea or pain when you open your bowels.

What to do while you are waiting

You can try to rest and relax at home.
Usual activity that is not too strenuous will not be harmful. You can go to work if you feel up to it.
If you have pain you can take paracetamol.
If there is bleeding, use sanitary pads rather than tampons.

After a miscarriage

It is usual to have pain and bleeding after a miscarriage. It will feel similar to a period and will usually stop within two weeks. You can take ordinary painkillers for the pain. Your next period will usually come in four to six weeks after a miscarriage.
See a doctor or attend a hospital emergency department if you have strong pain and bleeding (stronger than period pain), abnormal discharge, (especially if it is smelly), or fever. These symptoms may mean that you have an infection or that tissue has been left behind.
Try and avoid vaginal sex until the bleeding stops and you feel comfortable.
Use sanitary pads until the bleeding stops (do not use tampons).
All contraceptive methods are safe after a miscarriage
See a GP (local doctor) in four to six weeks for a check-up.

Anti-D injection after a miscarriage

It is important to have your blood group checked. If you’re RhD negative and the fetus is RhD positive this can cause problems for future pregnancies. This is because the fetus’s blood cells have RhD antigen attached to them, whereas yours do not. If small amounts of the fetus’s blood mixes with your blood, your immune system may perceive this difference in blood cells as a threat and produce antibodies to fight against the fetus’s blood. Once your body has made these antibodies they can’t be removed. This is unlikely to have caused your miscarriage and is more likely to affect future pregnancies. Women with a negative blood type usually need an Anti-D injection, which will stop the antibodies forming.

Future pregnancies after a miscarriage

One of the most common concerns following a miscarriage is that it might happen again. However, if you have had one miscarriage the next pregnancy will usually be normal.

If you do try for another pregnancy, try and avoid smoking, alcohol and excess caffeine as they increase the risk of miscarriage. It is recommended that all women take folic acid while trying to conceive, and continue until three months of pregnancy. In your next pregnancy you are encouraged to see your GP and have an ultrasound at about seven weeks. If ultrasound is done too early in pregnancy the findings are often uncertain and cause unnecessary worry.

Feelings and reactions

There is no ‘right’ way to feel following a miscarriage. Some degree of grief is very common, even if the pregnancy wasn’t planned. Partners may react quite differently, just as people can respond differently to a continuing pregnancy. Feelings of loss may persist for some time and you may have mixed feelings about becoming pregnant again. Some friends and family may not understand the depth of emotion that can be attached to a pregnancy and may unreasonably expect for you to move on before you are ready.

Some couples decide that they want to try for a pregnancy straight away, while others need time to adjust to their loss. If you feel anxious about a possible loss in future pregnancies, you may find it helpful to talk to someone about this. If it’s difficult to speak with your friends and family about these issues, your doctor, community support group and counsellors can provide information and assistance.

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

What to do after a miscarriage

If a woman has a miscarriage, it is important to take competent measures to restore health. This will help to cope mentally and prepare the ground for a new pregnancy. According to medical statistics, 15-20% of pregnancies end in spontaneous termination for various reasons. The symptoms of what happened rarely go unnoticed, which makes it possible to diagnose the pathology in time, consult a gynecologist, undergo adequate treatment and plan the birth of a child for the future.

Specialists classify spontaneous abortion into two categories:

1. Termination of biochemical pregnancy - the embryo leaves the uterine cavity in the first or third weeks after conception. A woman during this period most often does not suspect that she is carrying a child. Pregnancy becomes known only when testing for the content of hCG in the urine and blood. The blood that has left the body is usually perceived as menstruation, which, for unknown reasons, began outside the scheduled time. Units who carefully monitor their health go to the doctor.

2. Spontaneous abortion or miscarriage in early pregnancy - up to 22 weeks, when the weight of the embryo does not reach 0.4 kg.

What is a miscarriage like? If parts of the fetus remain in the uterus, they speak of an incomplete miscarriage, which occurs more often in the early stages of pregnancy. To neutralize the negative consequences, to prevent the development of an infectious process in the tissues, the product of conception is evacuated from the uterine cavity by the methods of medical interruption, gynecological curettage, and vacuum aspiration. Therapy may include the use of drugs aimed at contracting the uterus and pushing the contents out.

Ultrasound examination is considered to be the control method of diagnostics.

Why the body rejects the embryo

The causes of miscarriage often lie in the presence of chromosomal abnormalities in the fetus. Among the factors provoking rejection of embryos are also:

Heredity and genetic failure at the stage of fertilization of the egg by the sperm.
A non-viable fetus may appear as a result of various risk factors - environmental conditions, occupational hazards, viral illness of parents. It is impossible to neutralize these factors. The only way out of the situation is to reduce the likelihood of their manifestation by protecting the expectant mother from dangers during gestation.
Hormonal imbalance caused by disruption of the endocrine system. The situation can be affected by an insufficient amount of progesterone in the mother's body or an excess of testosterone. With early detection of a failure of the hormonal system, a woman undergoes specially organized therapy before pregnancy.
The presence of tumors , neoplasms in the pelvic organs.
Isthmic-cervical insufficiency when the isthmus and cervix dilate prematurely, unable to cope with the increasing pressure caused by the growing fetus in the body.
There is a risk of miscarriage in the presence of anomalies in the work of the cardiovascular and renal systems.
Drug addiction , alcohol addiction, substance abuse of mother and father.
Depressive conditions , stress, nervous stress of a pregnant woman.
Mechanical stress , blows, bruises, excessive physical labor of the future woman in labor.
X-ray examination - radiation can cause miscarriage.
Drug use . In the first trimester, you can not use potent medicinal formulas. Drugs can cause the development of defects in the embryo. Some decoctions of herbs are also contraindicated - parsley, tansy, cornflower, nettle, St. John's wort. It is forbidden to self-medicate. Each drug is agreed with the attending physician.
Infectious and viral process in the body. Any sexually transmitted infection can provoke a miscarriage, which must be cured before pregnancy, otherwise there is a high risk of infection of the fetus in the womb. A great threat of miscarriage in the early stages exists due to viral infections and inflammation of the internal organs. A dangerous symptom is the high temperature of the mother, accompanied by intoxication of the body. At the stage of pregnancy planning, it is important to stop chronic diseases.
History of abortion , unsuccessful surgery, unprofessionalism of the doctor and unfortunate circumstances.
Immunological factors .

The list of causes of miscarriage in the early stages of pregnancy and in the later period may be more extensive, in each case, doctors identify the pathology individually.

Isthmic-cervical insufficiency (ICI)

One of the most common causes of spontaneous miscarriage during pregnancy is CCI - dilatation of the cervix and isthmus of the uterus as a result of increasing pressure from the growing fetus. Pre-pregnancy manipulations with the uterus (cervical dilation due to abortion, childbirth or curettage) affect the condition of the muscle ring. Damaged areas are tightened by scar tissue that does not have elasticity, is not amenable to stretching and contraction. ICI also has a functional nature when there is a hormonal imbalance.

ICI occurs in the period from the 11th to the 27th week after conception, when the embryo begins to produce androgens in the mother's body with the launch of the adrenal glands. Taking into account the mother's hormones, their indicator can be exceeded - this softens the cervix, opens and shortens it. Harmful bacteria and microorganisms penetrate into the formed channel, infecting the fetal egg. The initial stages of ICI do not have obvious symptoms, since they do not entail the tone of the uterine muscles. With the loss of strength of the membranes, amniotic fluid pours out. There are no pain sensations.

If a woman has had a miscarriage that started with amniotic fluid, she should report it to her doctor when monitoring a subsequent pregnancy.

Treatment of isthmic-cervical insufficiency

Endocrine disorders are corrected by prescribing hormonal drugs. An assessment of the condition of the uterus is carried out by a doctor a couple of weeks after the start of taking medications. They say about positive dynamics when the opening is suspended and no further expansion of the neck is observed. In the absence of the planned effect, surgical intervention is prescribed. Similar measures are used for the traumatic nature of the neck deformity. You should not be afraid of the operation, the doctor acts delicately, without causing additional injuries to the patient, without causing discomfort to the baby growing in the womb. The procedure is most effective in the early stages of pregnancy. Suturing can significantly reduce the risk of infection of the embryo through the lower edge of the cavity.

Surgical intervention takes place in a hospital. Before the operation, the pregnant woman is examined. After the procedure, the vagina is sanitized, for which the suturing site is treated with chlorhexidine and furatsilin for three days. The patient needs to undergo a weekly follow-up examination with the attending physician, where he assesses the situation, making adjustments to the therapeutic protocol if necessary. The sutures are removed at the 38th week of pregnancy. During this time, the neck matures, preparing the birth canal for the passage of the fetus. Many women in labor worry that they will need a caesarean section if they have stitches, but this is not true. In most cases, women give birth on their own.

Immediate action is recommended if the amniotic sac prolapses (falls out) into the cervix between 16 and 24 weeks. The suturing of the neck obliges the woman to observe bed rest, strictly follow the daily routine, avoid physical exertion, and do not skip taking medications. In rare cases, complications occur. Among them, the eruption of sutures through the tissues, provoked by the frequent tension of the muscles of the uterus. To prevent tone, tocolytics are prescribed - medicines to prevent premature birth. The expectant mother should be prepared for frequent examinations and smears, which may be caused by the likelihood of accumulation of pathological microflora on the suture threads.

It is also important to conduct psychological therapy, where a woman is taught relaxation techniques. The behavior of the future mother is a decisive factor in the successful bearing of the fetus in case of pregnancy complications. Panic and fuss create an unfavorable prognosis in stabilizing the situation. If a spontaneous abortion occurred for reasons of ICI, when you can get pregnant after a miscarriage, the doctor will say. Ideally, the period should be at least two years. The specialist must also take measures to prevent a repeated situation of losing a child.

In addition to the suture, ICI correction is also carried out using an obstetric pessary. An alternative method is the imposition of a special ring of hypoallergenic materials on the cervix. Silicone is the most commonly used. The ring creates additional support, preventing the opening of the neck.

Uterine hypertonicity - risk prevention

Uterine contractions before natural delivery is called hypertonicity. The condition is not an independent disease, it signals a malfunction in the body, often manifesting itself in the early stages of pregnancy. The causes of the pathological phenomenon are:

Hormonal disorders caused by insufficient function of the placenta, ovaries, problems with the adrenal glands, causing imbalance.
Genital infantilism , organ defects.
Neoplasms , tumors in the uterus that are not necessarily malignant (eg, fibroids).
During pregnancy infectious processes, viral diseases.
CCI - opening of the cervix under increasing pressure created by the growing embryo.
Immunological problems .
Chronic diseases of the body (cardiovascular disorders, renal insufficiency).
Past miscarriages early pregnancy, symptoms of which may recur, induced abortions.

In addition to physiological causes, psychological factors are of no small importance. A woman who is in a depressed state can provoke hypertonicity in herself.

You can feel the tension of the muscles of the uterus on your own, without the help of a specialist. This is evidenced by the heaviness that appears in the lower abdomen, pulling pains in the lumbar region. Symptoms are similar to painful menstruation. Arising in the first trimester, the condition provokes spontaneous abortion, missed pregnancy, death of the fetal egg. In the subsequent period, premature birth due to hypertonicity is likely.

Why does the tension of the walls of the uterus cause irreversible consequences? The reason is the disturbed blood supply to the placental tissues, the occurrence of hypoxia of the embryo and the slowdown in the development of the emerging child. Following the contraction of the muscles of the uterus, the placenta does not contract, which causes its detachment and provoking the release of the fetal bladder.

Hypertonicity is diagnosed during a scheduled visit to a specialist. Stabilization of the situation requires the appointment of sedative drugs and antispasmodics. A strengthening effect is provided by therapy with the inclusion of vitamin B6, magnesium. In most cases, the measures taken are sufficient to neutralize the risks. Self-treatment, which can cause irreversible consequences, is strictly prohibited. With hypertonicity, the main rule for a pregnant woman is calmness and lack of physical activity. Some women who have had a successful delivery say they "didn't get up" during their entire pregnancy. With hypertonicity, sexual intercourse is also excluded.

If the threat cannot be neutralized, hospitalization is recommended. It is especially dangerous when severe cramping pain is complemented by spotting. To lie down "for preservation" is an adequate measure in the struggle for the birth of a healthy and strong baby. In the hospital walls, a pregnant woman is prescribed a vaginal examination, ultrasound. If necessary, a woman takes urine and blood tests, checks the hormonal background, and is examined for the presence of STIs.

At the onset of labor activity before the 34th week, the condition is tried to be stabilized with tocolytics. The most dangerous period is from the 25th to the 28th week, when the woman is recommended the maximum possible bed rest. After that, the fetus has every chance of survival. In order to quickly form the pulmonary system of the embryo, allowing it to survive with an early birth, hormones are prescribed.

Having an unfavorable prognosis for miscarriage and the threat of miscarriage, it is necessary to take up prevention at the stage of conception planning.

Stages of spontaneous abortion

There are certain signs that attract attention and divide the course of a miscarriage into specific stages:

Threat - having noticed factors threatening pregnancy, you can take measures to restore the situation, normalize the mother's well-being.
Start of abortion - at this stage, the doctor can apply life-saving manipulations and give recommendations to the pregnant woman.
Miscarriage in progress – the condition is irreversible, it is impossible to stop the pathology. The death of the fetal egg begins, which leaves the uterine cavity.
Completed abortion - the uterus gets rid of the residual tissues of the embryo, cleanses, restores its original parameters. It is important to prevent the remnants of foreign fibers inside, otherwise the organ becomes infected with decaying residues and toxins go into the bloodstream.

Symptoms of a miscarriage - how not to miss the threat

If there is a threat of miscarriage in the early stages, the following symptoms may occur: The pain may be monotonous or come in waves.

Slow bleeding opens, the signs of which are reduced to brownish spotting. Bright scarlet blood can stand out, it is often confused with menstruation.

Uterine tone .

A woman who does not know how an early miscarriage occurs should listen to her inner state.

Should alert:

spasmodic pain impulses;
Drawing pain in the lumbar region.

In the later stages, the above symptoms are added:

liquid discharge from the vagina, which may indicate damage to the amniotic sac;
pain when urinating;
internal bleeding, which warns of a deterioration in the general condition, fainting, dizziness, pallor of the skin. All this is an indication for emergency hospitalization of a pregnant woman.

The beginning of an abortion is characterized by more pronounced symptoms of miscarriage - contraction-like pain, severe dizziness, loss of strength. Instead of smearing discharges, clot-like ones appear, abundantly manifested during movement. Pregnancy can be saved if the area of detachment of the fetal egg is small and the fetal heartbeat is determined.

The third stage is useless for saving the fetus. There is girdle pain in the lower back and abdomen. Together with abundant blood loss, a fetal egg comes out of the uterus. Incomplete miscarriage requires curettage of the uterine cavity if parts of the embryo or membranes of the fetal egg remain in it, otherwise there is a high risk of complications that will endanger the life of the mother.

In rare cases, complications and serious health consequences can occur after a spontaneous abortion. But in the majority of situations, the body independently copes with what happened, expelling the parts remaining in the uterine cavity with a natural contraction of the muscles. An early spontaneous miscarriage does not always occur, a dangerous condition can also occur in the later stages. Some women try to provoke the release of the fetus with decoctions of herbs and medications. This is fraught with complications, including sepsis, dysfunction of the reproductive organs, after which pregnancy becomes impossible.

Methods of diagnosis

The symptoms of a threatened miscarriage at an early stage will be determined by a doctor during a visit to the antenatal clinic. The specialist will check the size of the uterus, determine the tone of its muscles, the condition of the cervix, and examine the discharge from the genital organs. A reliable method to identify the existing threat is transvaginal ultrasound diagnostics. The doctor draws attention to segmental muscle contractions of the uterus, detachment of the fetal egg. Genetic testing will help analyze the likely causes of a miscarriage. The patient's history is carefully collected.

Medical therapy

Any method is useful to maintain pregnancy. A qualified doctor develops an individual treatment protocol based on the available diagnostic data. Drugs used may include:

sedatives;
restorative therapy;
hormone stabilizing drugs;
uterine antispasmodics;
vitamin and mineral supplements.

The specialist eliminates the threat of miscarriage in the early stages, tells how to prevent a relapse. In the later stages, the cervix is fixed with a special suturing (usually for a period of 16-25 weeks, if there is an ICI).

In case of an unsuccessful attempt to stop a spontaneous abortion, the following treatment tactics are used:

Waiting - an organism that has freed itself from an embryo does not require specialized treatment.
Drug therapy - the patient is prescribed drugs that complete the removal of foreign tissues from the body. By causing severe spasms of the muscular walls of the uterus, the tablets provoke the expulsion of residues from the cavity.
Surgery - is used in case of complications or inconvenient for the independent exit of the fetus, the bending of the uterus.

Curettage

Having symptoms of a miscarriage in early pregnancy and faced with the need for a curettage (gynecological cleansing), a woman worries about the state of her reproductive system. It is not worth doing this, the operation takes place in a gentle mode, with maximum delicacy in relation to the patient's childbearing ability. Curettage is performed when there is a risk of incomplete exit of the embryo from the uterine cavity and the development of infection in the pelvic organs due to the elements remaining in it. Ignoring the procedure can lead to blood poisoning and the formation of a pathology that prevents re-conception.

Vacuum aspiration, however, is performed more frequently, which is more gentle. The complex application of the method with hysteroscopy allows you to carefully examine the internal contents of the uterus in order to prevent poorly cleaned areas on the mucous membrane.

Preparation for gynecological cleaning (curettage)

Gynecological cleaning is carried out for diagnostic and therapeutic purposes for various indications :

after childbirth;
in missed pregnancy, miscarriages;
for menstrual irregularities;
for accurate diagnosis of gynecological disorders.

Curettage is recommended a few days before the onset of menstruation. In this case, blood loss decreases and a favorable prognosis is given for rapid tissue recovery. The operation requires a preliminary examination, testing. This is :

complete blood count;
blood coagulation test;
smear for examination of the bacteriological environment;
analysis for STIs.

Before curettage, you stop taking any medications, dietary supplements that have not been discussed with a specialist. Even plant components that can affect blood clotting and provoke blood loss during surgery can be dangerous. Your healthcare provider should be made aware of the medications you are taking so that they know what risks may arise.

Rules for preparing for the procedure:

refrain from sexual intercourse three days before the operation;
avoid the use of intimate hygiene products (gels, creams, ointments, liquids), suppositories, tablets and vaginal sprays;
Do not douche;
Do not eat or drink 10 hours before surgery. This is necessary for high-quality anesthesia.

Cleaning

Curettage is carried out in a hospital, the woman is placed on the gynecological chair of the operating room. The doctor removes the upper layer of the mucous lining the uterine cavity from the inside. The exclusion of pain involves anesthesia. If there were signs of miscarriage in the early stages of pregnancy or at a later period, after which it spontaneously terminated, the dilated cervix allows for curettage without anesthesia. For anesthesia, intravenous administration of the drug is used, selected individually, taking into account the characteristics of the patient's body. A few seconds after the injection, the woman falls into a shallow sleep, the discomfort disappears, which makes the doctor's actions painless.

A dilator inserted into the cervix straightens the walls of the organ, facilitating access to the internal cavity. Holding the neck, the specialist inserts a rounded probe with a small diameter, after which he replaces it with a more voluminous analogue. A special video camera attached to the end of the probe allows for hysteroscopy - examination of the cavity before curettage. Cleaning is done with a curette, shaped like a small spoon on a long handle. Carefully collected tissues are stored in a specialized sterile tube, which is later sent to the laboratory for histological examination.

The procedure rarely takes more than one hour, usually 20 minutes is enough for the doctor. Together with the cavity, the cervical canal is cleaned. Manipulations are called RDV - separate diagnostic curettage. Collected samples are placed separately. Histology is used to identify the structure of tissues in order to exclude the presence of atypical cells in them, indicating cancerous lesions, precancerous conditions. The study is carried out within two weeks, after receiving the results, the woman revisits the gynecologist for a follow-up examination.

Curettage is often carried out for diagnostic purposes to determine the symptoms of pathological conditions in the functioning of the organs of the reproductive system. These can be:

irregular cycle;
voluminous discharge and painful menstruation;
bleeding during menopause;
difficulties in conceiving in the absence of visible causes of pathology;
suggestion of developing uterine cancer.

Possible complications

Complications can occur, as after any surgical intervention. A serious consequence is the discovery of uterine bleeding. In order to prevent it, oxytocin is used - injections stimulate the cessation of abnormal blood flow. Oxytocin will help if the bleeding is due to insufficient contraction of the uterus. In violation of blood clotting, it is ineffective.

Another complication of is hematometra, when blood clots accumulate in the uterine cavity, which can cause an inflammatory process in the tissues. It is caused by a spasm of the cervix that occurred immediately after cleaning, which interferes with the evacuation of blood. Experts recommend the use of antispasmodics that relax the muscles of the organ and contribute to the normal outflow of blood. A woman should be alerted by pulling pains in the lower abdomen and a sharp cessation of discharge.

After cleansing, endometritis may occur when inflammation affects the lining of the uterus. A measure of therapy for a dangerous diagnosis is a course of antibiotics. Pain in the abdomen and a sharp increase in body temperature testify to the pathology. Any dangerous change in condition should be reported to the doctor immediately. In this case, countermeasures will be taken in a timely manner, which will eliminate the risks of developing more formidable complications.

How to behave after a miscarriage

A miscarriage that has occurred requires a certain tactic of behavior. Among the measures recommended by doctors:

It is advisable to postpone a new pregnancy attempt for 3-6 months . Otherwise, the risk of repeating the undesirable development of events is high. If pregnancy occurs before the expiration date, there is no need to panic. The main thing is the supervision of a specialist.
If you are waiting for , ask for advice on effective contraception.
Follow your doctor's advice .
Complete the required examinations , get tested.

Consult what effect the medicines you take will have on the fetus if you become pregnant during therapy. Find out after what period of time you can fearlessly try to conceive a child.

How to detect genetic pathologies during repeated pregnancy

If a miscarriage of the first pregnancy occurs due to a genetic factor, it is especially scary to decide on a second one. But you should not be afraid of this, with a well-designed therapy, the chances of success are more than great. Diagnostic procedures today are highly accurate and allow you to identify pathology in the early stages. Examination in this case is mandatory, as well as the following:

who are over 35;
has screening changes;
who had markers of chromosomal pathologies and malformations of the embryo;
who already have children with chromosomal abnormalities.

Ultrasound diagnostics can detect malformations in 80-85% of cases. However, the technology is not impeccably reliable, as it misses pathologies in 20% of situations. Biochemical screening, invasive examinations have valid data. The latest version of the study allows you to identify up to 99% anomalies. No less popular is the high-precision PANORAMA test for determining DNA pathologies.

When planning a new pregnancy, it is imperative to visit a geneticist. Screening diagnostics for the detection of abnormal genes will help eliminate the risks of possible pathologies, the factor of heredity and genetic failure during conception. Sometimes the threat of miscarriage in the early stages exists in almost healthy carriers. The examination will allow you to find out about the anomaly in advance and undergo treatment.

Planning a new pregnancy

The medical community is unanimous in the issue of planning a new pregnancy after a spontaneous abortion. Conception is not recommended for at least 3-6 months. During this period, the woman's body will recover and gain strength to bear the fetus. Observation by a doctor, harmonization of hormonal levels, examination of parents to identify possible pathologies are important. In order not to become pregnant in the first months, it is recommended to use contraceptive methods prescribed by your doctor.

Examination after a miscarriage includes blood and urine tests, examination of the microflora of the vagina with a smear, detection of overt and latent genital infections, glucose and hormone testing, examination of partners for biological compatibility. Planning is an important step towards having a healthy baby. After the studies, the woman is prescribed strengthening therapy. It is important to completely reconsider eating habits, to exclude factors that are harmful to well-being. Vitamins, folic acid are used. Fast food, food containing carcinogens and preservatives are excluded from the diet. Subject to the rules recommended by the doctor, a successful pregnancy with a favorable outcome is likely.

It is not uncommon for a pregnancy test to show two lines after a miscarriage. This is due to the restructuring of the body, the organs of the reproductive system. It is important to report the incident to your doctor. The presence of remnants of embryonic tissue in the uterus can provoke a positive test result. In this case, immediate curettage is necessary, which neutralizes the risk of inflammation and infection. To accurately determine her condition, a woman needs to undergo an ultrasound diagnosis, take tests to determine hCG in the blood.

The question of whether it is possible to get pregnant after a miscarriage worries many parents. The answer is unequivocal - yes, if you follow the recommendations of experts, carefully plan a new conception, monitor your well-being and state of your health.

Components of success after a miscarriage

Spontaneous abortion can provoke not only the health of the patient, but non-compliance with simple rules can become a threat. To reduce the risk of losing a child during pregnancy, required:

1. Keep calm - it is important for a mother to exclude from her life all the factors that make her nervous. Irritation is not the best way to normalize the condition. In order to stabilize the emotional background, rest is recommended, the use of soothing teas with the permission of the doctor. Good results are given by decoctions of chamomile, lemon balm, mint.

2. Avoid taking unnecessary medicines and preparations. But it is unacceptable to stop the therapy prescribed by the doctor on your own. Each step must be discussed with the gynecologist.

3. Eliminate harmful occupational factors. Work in the chemical industry and other hazardous facilities can create an undesirable background in the body, which prevents normal gestation. It is important to understand what is of great value to the mother - the birth of a healthy baby or a career factor. Many refuse to work to increase the chance of having a baby.

4. Eliminate bad habits. It is unacceptable for a woman who has experienced miscarriage to drink alcohol and smoke. It is forbidden to do this and the future father. This negatively affects the quality of spermatozoa, provokes difficulties with conception and risks of deviations in the development of the embryo.

5. Take vitamin complexes, specially designed to prepare the body for pregnancy, the formation of basic conditions for its favorable course.

6. Eat right. A complete, balanced diet works wonders. With a lack of weight, a nutritionist will develop an adequate diet for a woman with the inclusion of a large amount of protein foods rich in vitamins and trace elements of vegetables, fruits, and cereals. Recommended fats contained in fish, seeds, nuts, avocados, olives.

7. Get rid of extra pounds. Obesity adversely affects the development of pregnancy. Science has proven that enhanced nutrition during this period is not required. The main thing is its balance.

Infections during pregnancy

Infectious processes transferred before pregnancy develop immunity in the mother to similar agents of influence. Primary infection poses a great threat, so vaccination will be useful before planning conception. Perinatal diagnosis allows you to detect the infectious process at the initial stage and prevent its harmful effects. This is possible if the pregnant woman is registered from an early date.

Infection may develop due to an infection transmitted by airborne droplets. It is the most dangerous, since it is almost impossible to prevent it. This applies to mumps, measles, rubella. HIV and hepatitis infect the body through sexual contact, similar to chlamydia. Listeriosis is transmitted with poor-quality products. A pregnant woman can pass infections to a developing baby. Pathology is determined by profile tests of latent infection.

Routine pregnancy monitoring involves regular testing. Sexual infections are determined using a smear, ultrasound shows deviations in the development of the baby, and KGT is aimed at listening to the work of the fetal heart muscle. If there is a suspicion of a serious infection of the embryo, blood sampling from the umbilical cord and amniotic fluid analysis are practiced.

Infection of a child also depends on concomitant factors. The speed of diagnosis, the literacy of the treatment, the type of pathogen, the duration of the pregnancy are taken into account. The following infectious processes deserve special attention:

1. Viral etiology - a huge number of viruses poses a danger to a pregnant woman. The threat is genital herpes, rubella, infectious type erythema, cytomegalovirus, hepatitis B, measles, mumps, chickenpox.

2. Bacterial infections, detected during the analysis of biological materials (feces, urine, blood), examination of certain organs of the body. Active reproduction provokes a rapid growth in the number of bacteria in the vagina. Not all microorganisms pose a threat to the child. Dangerous candidiasis, streptococcus, chlamydia, bacterial vaginosis, cystitis.

The successful course of pregnancy is threatened by intestinal infections, often activated in the summer. Their carriers can be animals and poorly processed food before consumption. Of particular danger are listeriosis, salmonellosis, toxoplasmosis.

Prevention of infections during pregnancy

Infection of the mother threatens the life of the fetus. From the 3rd to the 12th week, the infected organism responds with a miscarriage or the formation of malformations of the child. From the 11th to the 25th - developmental delay. At a later date, organs are deformed and prerequisites for premature birth are created. In order to prevent intrauterine infection, it is recommended to apply a number of rules:

be examined for the detection of STIs;
examine blood, determine the presence of antibodies to infection carriers, pathogens;
avoid contact with sick people, visits to crowded places where there is a possibility of infection by airborne droplets;
Examine pets for dangerous infections and, if necessary, treat them or remove them from the home until the threat is eliminated;
to exclude fast food, store-bought semi-finished products from the diet, subject meat and fish to thorough heat treatment;
remove from the diet sushi and other culinary delights purchased in restaurants, cafes;
thoroughly wash hands, fruits, vegetables with special disinfectants that are not capable of harming a pregnant woman and a child;
it is planned to visit a gynecologist, undergo examinations recommended by a doctor, take tests, take vitamins;
register at the first sign of pregnancy;
prepare for conception, cure infections, vaccinate.

It is also important for the child's father to follow most of the recommended rules. If only the mother undergoes treatment, a relapse is likely during sexual intercourse, neutralizing the beneficial effect of therapy.

A woman who has had a miscarriage in the past should be alert to any deviations from the norm in her state of health. It is important to pay attention to ailments, pain, weakness, dizziness. Accounting for an early consultation will create conditions for the bearing of the fetus and the birth of a child. There is no need to be afraid that a miscarriage will forever deprive the joy of motherhood.

Having completed a course of examinations, passing tests and following the measures prescribed by the doctor to treat imbalances in the body, you will create all the conditions for a favorable pregnancy outcome. Tune in to the positive, protect yourself from worries, worries, stress. Feel the support of loved ones, hope for the best! Get advice from good specialists to rule out any unfavorable prognosis before conception or take steps to neutralize them. Health and prosperity to you, your families and loved ones!

When to call an ambulance for a pregnant woman

Pregnancy warning signs for immediate medical attention or an ambulance.

During pregnancy, there are often conditions in which a woman needs medical attention. Sometimes, when you feel unwell, it is difficult to know what to do: call an ambulance immediately or wait and make an appointment with your doctor. Sometimes such indecision can turn into serious problems. In practice, there are a number of symptoms that should not be neglected. Each of them can be a manifestation of a pathology in which it is necessary to immediately hospitalize a pregnant woman in a hospital. Consider these symptoms and related pathologies.

Warning symptoms during pregnancy

Bleeding - one of the most common reasons for pregnant women to go to the ambulance is various bleeding associated with pregnancy or diseases of the reproductive organs.

Obstetric bleeding is discharge mixed with blood or blood released from the genital tract of a woman during pregnancy, childbirth or in the postpartum period. The intensity and duration of such bleeding can vary greatly depending on the cause that caused them - from scanty blood smears on underwear, to heavy and prolonged bleeding.

They can occur at any stage of pregnancy and when they appear, the patient most often feels general malaise, dizziness, fainting or severe pain in the lower abdomen and lower back may occur.

Causes of bleeding during pregnancy:

1. Spontaneous miscarriage or abortion - such a pathology can occur at any stage of pregnancy, but the highest risk is during the first three months of pregnancy, at which time, for a variety of reasons, pregnancy is threatened with termination, fetal rejection, placental discharge begins which can cause miscarriage. This is accompanied by the following symptoms: discharge with blood or bright scarlet blood from the genital tract appears, the woman feels acute pain, there is hypertonicity of the anterior wall of the uterus - the stomach “hardens”.

Any manifestations of the first signs of a miscarriage are a reason to urgently seek medical help, and before the arrival of the ambulance, it is completely at rest, do not get up and take 1-2 tablets of antispasmodics (no-shpa, metacin or a suppository with papaverine). With timely medical care, the chance of maintaining a pregnancy increases.

2. Placenta previa - a gynecological pathology in which the placenta is attached to the place where the fetus exits the uterus. This arrangement does not interfere with the normal growth and development of the child, but greatly increases the risk of bleeding.

The symptoms of placenta previa are unexpected bleeding or spotting that occurs in the background of complete well-being after the twentieth week of pregnancy. If such symptoms appear, you should immediately call an ambulance, while waiting for the doctors, lie on your left side and try to give the lower half of the body an elevated position - put a pillow or something soft under your hips.

3. Placental abruption - "children's place" - this is the connection of the unborn baby with the mother, if this connection is not violated in time, there is a serious threat to the bearing of the child. The risk of such a pathology increases in the last months of pregnancy, the first signs of a threatening placental abruption are a pain symptom, bleeding from the genitals, weakness, uterine hypertonicity, contractions may occur.

If such symptoms appear, you should immediately call an ambulance until she arrives, try not to make unnecessary movements, lie down, put an ice pack on your lower abdomen, and do not eat or drink.

Any, as well as discharge from the genital organs with an admixture of blood in a pregnant woman, is a sign of a serious obstetric pathology that possibly threatens not only the life of the unborn child, but also the life of the pregnant woman. Such symptoms are a clear indicator for emergency hospitalization in the gynecological department. While waiting for the ambulance for pregnant women, you need to stop any kind of activity and be completely at rest.

Pain syndrome

Very often, bearing a child is accompanied by various pain sensations, this is due to physiological changes caused by hormonal changes for bearing a child. These symptoms are not always pathological. But it is necessary to clearly distinguish between situations in which pain is just an unpleasant symptom of a normal pregnancy or a sign of serious health problems in a pregnant woman and her child.

At the beginning of pregnancy, the occurrence of mild pain in the lower abdomen, in the lower back - lower back, in the abdomen or in the enlarging mammary glands is considered normal.

Such unpleasant sensations are associated with the pressure of the growing uterus on the organs and blood vessels, with sprains, with the restructuring of the mammary glands. They are short-term, not too intense and pass quickly.

If the pain is severe, cramping, does not go away for a long time, has arisen in the genital area, uterus or in the lumbar region, this condition requires qualified medical care and you need to take care of your health without delay.

If very strong pain occurs, it is recommended to call emergency care, and before the doctors arrive, go to bed and take antispasmodics - no-shpu, metacin, suppositories with papaverine.

Headache during childbearing may be one of the first signs of preeclampsia . An ambulance should be called if there are signs of pathology such as severe pressing pain in the temples or the back of the head, darkness in the eyes, flickering of "flies" or multi-colored spots before the eyes, nausea and vomiting, increased blood pressure, unmotivated excitement or depression. All these are signs of developing preeclampsia - a special pathological condition of pregnant women requiring immediate medical intervention. In addition to headache, with preeclampsia, there is a strong increase in pressure, edema appears, and protein is detected in urine tests. In more complex cases, a strong aggravation of the general condition of the patient, short-term stunning or loss of consciousness, and the occurrence of convulsive movements are possible. With the onset of such symptoms, it is urgent to call an ambulance for pregnant women. Before the arrival of doctors, the patient should be laid in a dark room, in complete silence, to alleviate the condition, give an elevated position in bed and monitor the patient's condition. If the doctor prescribed drugs that lower blood pressure, you can take them before the arrival of the ambulance.

Surgical pathologies

Situations in which a person may need urgent medical attention can occur at any time and in any place. During pregnancy, the risk of such problems is somewhat higher than in any other.

In order not to harm the child and his mother, you need to seek medical help as soon as possible and try to remain calm.

"Acute abdomen" is a collective term that unites a whole group of various diseases and pathologies of internal organs that occur in the abdominal cavity. Such conditions develop very quickly and for the patient to recover, it is necessary to immediately deliver her to a surgical hospital for surgical intervention.

Symptoms of such surgical pathologies are severe cutting or dull pains in the abdominal cavity, their intensity increases over time, in addition, there are signs of disruption of the digestive tract - nausea, vomiting, there may be a restriction of muscle mobility of the anterior abdominal wall, stool retention. In addition to the above signs, the general state of health is greatly deteriorating - the patient feels severe weakness, dizziness, her skin turns pale, sweat is strong and blood pressure drops.

Often there may be signs of inflammatory changes in the abdominal cavity - an increase in body temperature, increased breathing and heart rate.

A variety of diseases, both related to the female reproductive system and related to the pathology of internal organs, can cause the development of such a surgical pathology:

1. Ectopic pregnancy - occurs when a fertilized ovum does not attach properly - not in the uterine cavity, but in the abdominal cavity or fallopian tube. Such an egg can develop for some time, but then its development stops and spontaneous miscarriage occurs. Such a pathology becomes the most common cause of the development of "acute abdomen" in pregnant women. With the development of pregnancy outside the uterine cavity, a pregnant woman feels severe pain in the lower abdomen, there are no regular menstrual flows, vaginal discharge with blood impurities appears. With a developing ectopic pregnancy, complaints can be minimal - mild pain and spotting. An interrupted ectopic pregnancy becomes the reason for placing the patient in a hospital. In this case, a rupture of the fallopian tube or other tissues may occur. This provokes severe pain - there is a "dagger" pain in the lower abdomen, the appearance of blood from the genitals. A woman feels a sharp deterioration in well-being that occurs due to symptoms of internal bleeding - severe weakness, possible fainting, pressure drop, pain shock.

2. Uterine rupture - this pathology occurs after surgery on the uterus - caesarean section, removal of tumors, excision of the uterine angle after removal of an ectopic pregnancy. Symptoms of such a pathology are a change in the shape and contours of the abdomen, severe pain in a certain place, with palpation, you can feel the edges of the gap and cicatricial changes.

3. Ovarian cyst torsion - the occurrence of such a complication is possible in the presence of formations in the ovaries. A cyst is a benign formation in the ovary, which is a cavity with liquid, if the cyst is attached to the ovary with the help of a "leg", then there is a risk of torsion of the cyst, while blood supply is disturbed, blood vessels are compressed and tissue death begins. This causes severe pain, which can be provoked by any physical activity, sexual intercourse or nervous strain. Scanty vaginal discharge also appears, and other symptoms of intoxication may be present.

4. Violation of the blood supply to the myoma node - if a pregnant woman is diagnosed with uterine fibroids, as the fetus grows, compression of the vessels that feed this formation is possible, this leads to disruption of the blood supply to the fibroids and the occurrence of constant dull pain in the area of uterine fibroids.

5. Acute appendicitis - can occur at any time, up to 75% of cases of acute appendicitis in pregnant women occur in the first months. Clinically, the disease is manifested by a standard set of symptoms - pain in the epigastrium or in the lower third of the right side of the abdomen. On examination, you can notice a strong tension in the abdominal muscles. If help was not provided on time, nausea, vomiting, and a rise in body temperature join.

6. Acute cholecystitis - an inflammatory disease of the gallbladder, it often develops in pregnant women, about 10% of all pregnant women suffer from disorders in the gallbladder, but most often the disease does not require medical attention. In case of exacerbation, the patient is tormented by severe pain on the right side, irridating to the scapula and right shoulder, indomitable vomiting, which does not bring relief and deterioration in the general condition of the patient. In such cases, it is also necessary to contact the ambulance specialists.

7. Acute pancreatitis - occurs when the pancreas becomes inflamed. The main symptom of the disease is an acute, sudden onset girdle pain or pain in the upper abdomen, severe nausea and vomiting, and a sharp rise in body temperature.

8. Perforation of a gastric or duodenal ulcer - if a woman was diagnosed with inflammation or ulceration of the walls of the stomach or intestines before pregnancy, there is a risk of bleeding from damaged vessels or formation of a hole in the wall of the organ - perforation. With such a pathology, there is a very strong dagger pain, fainting, weakness, vomiting with blood is possible.

Before the arrival of the ambulance, in all the cases described above, it is required to ensure the complete rest of the pregnant woman, put her on the bed and not give any painkillers and in no case eat or drink until the doctors arrive. It is allowed to take antispasmodics - no-shpy, metacin - 1-2 tablets. Do not try to make an enema or wash the patient's stomach on their own. It is also not recommended to take painkillers or laxatives - this can greatly distort the clinical picture of the disease and complicate its further diagnosis.

Somatic diseases

Almost every person has certain pathologies in the work of internal organs, and for women, during pregnancy, the risk of developing an exacerbation of these diseases increases, which can lead to complications during pregnancy.

1. Renal colic - occurs when there is a violation of the outflow of urine from the urinary organs. The reason for this delay in urination may be the formation of a kidney stone, chronic diseases of the urinary system. During renal colic, the patient is tormented by very severe pains in the lower back, the pain is very strong, occurs suddenly and becomes more intense over time, in addition, the general condition of the patient is disturbed - swelling, headache, nausea and vomiting may occur. Before the ambulance arrives, you can’t take liquids, you need to try to calm down and, if necessary, take antispasmodics - no-shpu, papaverine.

2. Asthma attack - Asthma attack may be triggered by physical exertion, nervous shock, eating an allergen, or other causes. There is shortness of breath, the patient's breathing is noisy and wheezing, she is tormented by a feeling of fear and anxiety, a panic attack may occur.

Before the arrival of doctors, you need to seat the patient, unfasten tight clothing, open the window, lower your hands and feet into hot water. Perhaps the use of inhaled forms of the drug to relieve swelling and spasm.

Childbirth

Even if the expectant mother has been preparing for the onset of labor pains and has been looking forward to this moment, unexpected signs of impending labor can be taken by surprise and cause panic.

You need to contact an ambulance when regular labor occurs or after amniotic fluid breaks.

Regular labor pains are repeated every 10-15 minutes, last at least 10-15 seconds and their intensity and frequency increase all the time. If regular contractions appear at least once every 15-10 minutes, with a frequency of 20-10 seconds, or if the water breaks, you need to call an ambulance, and before they arrive, try to calm down and collect the necessary things.

Check the availability of all documents - an exchange card, passport, birth certificate, insurance policy or contract for childbirth.

While there is time, you need to collect or check the availability of things necessary in the maternity hospital - socks, diapers, pads after childbirth, panties after childbirth, towels, toilet paper. hygiene products, a bathrobe, slippers, a nightgown are usually given out there, but if they allow it, you can also have your own, a notebook and a pen, bepanten cream, drinking water, a pack of cookies and, of course, all documents). To prepare for childbirth, a woman in labor needs to cut her nails, remove jewelry, remove hair and remove hair from intimate places.

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