Procedure done after miscarriage

Dilation and curettage (D&C) - Mayo Clinic

Overview

Female reproductive system

The ovaries, fallopian tubes, uterus, cervix and vagina (vaginal canal) make up the female reproductive system.

Dilation and curettage (D&C) is a procedure to remove tissue from inside your uterus. Health care providers perform dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion.

In a dilation and curettage, your provider uses small instruments or a medication to open (dilate) the lower, narrow part of your uterus (cervix). Your provider then uses a surgical instrument called a curette, which can be a sharp instrument or suction device, to remove uterine tissue.

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Why it's done

Dilation and curettage is used to diagnose or treat a uterine condition.

To diagnose a condition

Before doing a D&C, your provider might recommend a procedure called endometrial biopsy or endometrial sampling to diagnose a condition. Endometrial sampling might be done if:

You have unusual uterine bleeding
You have bleeding after menopause
You have unusual endometrial cells, which are discovered during a routine test for cervical cancer

To perform the test, your provider collects a tissue sample from the lining of your uterus (endometrium) and sends the sample to a lab for testing. The test can check for:

Endometrial intraepithelial hyperplasia — a precancerous condition in which the uterine lining becomes too thick
Uterine polyps
Uterine cancer

If more information is needed, your provider then might recommend a D&C, which is usually done in an operating room.

To treat a condition

Hysteroscopy

During a hysteroscopy, your provider uses a thin, lighted instrument (hysteroscope) to view the inside of your uterus.

When performing a D&C to treat a condition, your provider removes the contents from inside your uterus, not just a small tissue sample. This might be done to:

Prevent infection or heavy bleeding by clearing tissues that remain in the uterus after a miscarriage or abortion
Remove a tumor that forms instead of a typical pregnancy (molar pregnancy)
Treat excessive bleeding after delivery by clearing out any placenta that remains in the uterus
Remove cervical or uterine polyps, which are usually noncancerous (benign)

A D&C might be combined with another procedure called hysteroscopy. During hysteroscopy, your provider inserts a slim instrument with a light and camera on the end into your vagina, through your cervix and into your uterus.

Your provider then views the lining of your uterus on a screen, checking for areas that look unusual. Your provider also checks for polyps and takes tissue samples as needed. During a hysteroscopy, uterine polyps and fibroid tumors can be removed.

At times, a hysteroscopy might be done combined with an endometrial biopsy before a full D&C procedure.

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Risks

Complications from dilation and curettage are rare. However, there are risks, including:

Perforation of the uterus. This occurs when a surgical instrument pokes a hole in the uterus. This happens more often in women who were recently pregnant and in women who have gone through menopause.

Most perforations heal on their own. However, if a blood vessel or other organ is damaged, a second procedure might be needed to repair it.
Damage to the cervix. If the cervix is torn during the D&C, your provider can apply pressure or medicine to stop the bleeding or can close the wound with stitches (sutures). This might be prevented if the cervix is softened with medication before the D&C.
Scar tissue on the uterine wall. Rarely, a D&C results in development of scar tissue in the uterus, a condition known as Asherman's syndrome. Asherman's syndrome happens most often when the D&C is done after a miscarriage or delivery.

This can lead to unusual, absent or painful menstrual cycles, future miscarriages and infertility. It can often be treated with surgery.
Infection. Infection after a D&C is rare.

Contact your health care provider if after a D&C you have:

Bleeding that's heavy enough that you need to change pads every hour
Lasting dizziness or lightheadedness
Fever
Cramps lasting more than 48 hours
Pain that gets worse instead of better
Foul-smelling discharge from the vagina

How you prepare

Dilation and curettage can be done in a hospital, clinic or your provider's office, usually as an outpatient procedure.

Before the procedure:

Follow your provider's instructions on limiting food and drink.
Arrange for someone to take you home because you may be drowsy after the anesthesia wears off.
Allow time for the procedure and a few hours of recovery afterward.

In some cases, your provider might start dilating your cervix a few hours or even a day before the procedure. This helps your cervix open gradually and is usually done when your cervix needs to be dilated more than in a standard D&C, such as during pregnancy terminations or with certain types of hysteroscopy.

To promote dilation, your provider may use a medication called misoprostol (Cytotec) — given orally or vaginally — to soften the cervix. Another dilation method is to insert a slender rod made of laminaria into your cervix. The laminaria gradually expands by absorbing fluid in your cervix, causing your cervix to open.

What you can expect

During the procedure

Dilation and curettage (D&C)

During a dilation and curettage procedure (D&C), your provider uses a vaginal speculum to hold the walls of the vagina apart. Then your provider inserts a series of rods (dilators) of increasing thickness to open (dilate) your cervix and allow access to your uterus. Next, your provider inserts a long, thin instrument (curette) through your cervix into your uterus and carefully removes the tissue lining the inside of the uterus.

For dilation and curettage, you'll receive anesthesia. The choice of anesthesia depends on the reason for the D&C and your medical history.

During the procedure:

You lie on your back on an exam table while your heels rest in supports called stirrups.
Your provider inserts an instrument called a speculum into your vagina, as during a Pap test, to see your cervix.
Your provider inserts a series of increasingly thick rods into your cervix to slowly dilate it until it's open enough.
Your provider removes the dilation rods and inserts a spoon-shaped instrument with a sharp edge or a suction device and removes uterine tissue.

Because you're either unconscious or sedated during a D&C, you shouldn't feel any discomfort.

After the procedure

You'll likely spend a few hours in a recovery room after the D&C so that you can be monitored for heavy bleeding or other complications. This also gives you time to recover from the effects of anesthesia.

Typical side effects of a D&C can last a few days and include:

Mild cramping
Spotting or light bleeding

For discomfort from cramping, your provider might suggest taking ibuprofen (Advil, Motrin IB, others) or another medication.

You should be able to resume your activities within a day or two.

To prevent infection, don't put anything in your vagina until your provider says it's OK. Ask when you can use tampons and resume sexual activity.

Your uterus must build a new lining after a D&C, so your next period might be early or late. If you had a D&C because of a miscarriage, and you want to become pregnant, talk with your provider about when it's safe to start trying again.

Results

Your health care provider will discuss the results of the procedure with you after the D&C or at a follow-up appointment.

By Mayo Clinic Staff

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D&C Procedure After a Miscarriage: Risks & Complications

A D&C, also known as dilation and curettage, is a surgical procedure often performed after a first-trimester miscarriage. In a D&C, dilation refers to opening the cervix; curettage refers to removing the contents of the uterus. Curettage may be performed by scraping the uterine wall with a curette instrument or by a suction curettage (also called vacuum aspiration).

Do You Need a D&C After a Miscarriage?

The procedure is done to:

Remove tissue in the uterus during or after a miscarriage or abortion or to remove small pieces of placenta after childbirth. This helps prevent infection or heavy bleeding.
Diagnose or treat abnormal uterine bleeding. A D&C may help diagnose or treat growths such as fibroids, polyps, hormonal imbalances, or uterine cancer. A sample of uterine tissue is viewed under a microscope to check for abnormal cells.

About 50% of women who miscarry do not undergo a D&C procedure. Women can safely miscarry on their own with few problems in pregnancies that end before 10 weeks. After 10 weeks, the miscarriage is more likely to be incomplete, requiring a D&C procedure. Choosing whether to miscarry naturally (called expectant management) or to have a D&C procedure is often a personal choice that is best decided after talking with your healthcare provider.
For some women, the emotional toll of waiting to miscarry naturally is too unpredictable and too much to handle in an already challenging situation. Healing for them may start upon having a D&C procedure. A D&C may be recommended for women who miscarry later than 10-12 weeks, have had any complications, or have medical conditions in which emergency care could be needed.

How is a D&C Performed?

You can have a D&C in your doctor’s office, an outpatient clinic, or the hospital. It usually takes only 10 to 15 minutes, but you may stay in the office, clinic, or hospital for up to five hours.
Your doctor will need your complete medical history and a signed consent form. Be sure to tell the doctor if:

You suspect you are pregnant
You are sensitive or allergic to any medications, iodine, or latex
You have a history of bleeding disorders or are taking any blood-thinning drugs

A sedative is usually given first to help you relax. Most often, general anesthesia is used, but IV anesthesia or paracervical anesthesia may also be used. You should be prepared to have someone drive you home after the procedure if general or IV anesthesia is used.

You may be given antibiotics intravenously or orally to help prevent infection.
The cervix will be examined to determine if it is open. If the cervix is closed, dilators (narrow instruments in varying sizes) will be inserted to open the cervix to allow the surgical instruments to pass through. A speculum will be placed to keep the cervix open.
The vacuum aspiration (also called suction curettage) procedure uses a plastic cannula (a flexible tube) attached to a suction device to remove the contents of the uterus. The cannula is approximately the diameter in millimeters as the number of weeks gestation the pregnancy is. For example, a 7mm cannula would be used for a pregnancy that is 7 weeks gestation. The use of a curette (sharp-edged loop) to scrape the lining of the uterus may also be used, but this is often not necessary.
The tissue removed during the procedure may be sent off to a pathology lab for testing.
Once the health care provider has seen that the uterus has become firm and the bleeding has stopped or is minimal, the speculum will be removed and you will be sent to recovery.

Are There Risks and Complications?

Risks associated with anesthesia such as an adverse reaction to medication and breathing problems
Hemorrhage or heavy bleeding
Infection in the uterus or other pelvic organs
Perforation or puncture to the uterus
Laceration or weakening of the cervix
Scarring of the uterus or cervix, which may require further treatment
Incomplete procedure that requires another procedure to be performed

What to Expect After a D&C

Most women are discharged from the surgical center or hospital within a few hours of the procedure. If there are complications or you have other medical conditions, you may need to stay longer. You will more than likely be given an antibiotic to help prevent infection and possibly some pain medication to help with the initial cramping after the procedure.
Things to know about taking care of yourself at home:

Most women can return to normal activities within a few days, and some feel good enough to return to normal non-strenuous activity within 24 hours.
You may experience some painful cramping initially, but this should not last longer than 24 hours.
Light cramping and bleeding can be expected from a few days to up to 2 weeks. Ibuprofen is usually suggested for treating cramps.
You should not insert anything into the vaginal area (including using a douche or having sexual intercourse) for at least 2 weeks or until the bleeding stops. Your health care provider should give you specific instruction for when intercourse can resume.
Tampons should not be used until you start your next regular period, which could be anywhere from 2-6 weeks after the D&C procedure.
It is unknown when ovulation will return, so once sexual intercourse is allowed, you should use a method of contraception until your health care provider says it is okay to try to get pregnant again.
Make sure to attend your follow-up appointment.

When to Contact the Doctor

Most women experience few complications after a D&C procedure after miscarriage, but you should be aware of symptoms that could signal a possible problem.
Your health care provider should give you specific instructions on what to expect, but contact them as soon as possible if you experience any of the following:

Dizziness or fainting
Prolonged bleeding (over 2 weeks)
Prolonged cramping (over 2 weeks)
Bleeding heavier than a menstrual period, or filling more than one pad per hour
Severe or increased pain
Fever over 100. 4 °F
Chills
Foul smelling discharge

Want to Know More?

Miscarriage
After a Miscarriage: Surviving Emotionally
After a Miscarriage: Support Friends and Family Through Loss

Compiled using information from the following sources:

1. Managing Complications in Pregnancy and Childbirth, World Health Organization

https://www.who.int/

https://www.nlm.nih.gov/medlineplus/ency/article/002914.htm

3. Women’s Health Care: 20 Common Problems. Smith, Mindy, et al, Ch. 15, 2000.

4. William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 9.

5. Danforth Obstetrics and Gynecology Ninth Ed. Scott, James. Gibbs, et al, Ch. 9

Cleansing after a miscarriage

When the body experiences the loss of a fetus in the early stages, it is subjected to powerful stress. Tune in to bear a child, he issues a failure of internal programs, due to which the embryo dies. Before we figure out how is cleaning a missed pregnancy , provoking a spontaneous miscarriage with medications and how the recovery period goes after these procedures, let's dwell a little on the pregnancy itself, which is called undeveloped.

Every woman has heard stories of missed pregnancy, but few go into details. The less you know, the stronger and more confident you sleep. Following this principle, future women in labor consciously protect themselves from unnecessary knowledge that can negatively affect their mood and inspire unnecessary fears before conception. However, many women experience fetal freezing firsthand, purging, preparing to become mothers again. To ensure that materials for studying the anomalous state are always at hand, we tried to collect all the necessary information in one article.

Define the terminology

Before moving on to cleansing a missed pregnancy, let's define the term itself. Why does a fetus that develops normally in the womb freeze? How does a child that is being formed yesterday stop living under the influence of external factors? Does the mother make mistakes in the process of bearing? And can the father cause miscarriage? About everything in order.

Missed pregnancy is usually called the state of death of the embryo due to the impossibility of its further development. Many women mistakenly confuse this concept with lagging fetal development. However, these are completely different phenomena. With a developmental delay, the doctor can prescribe competent timely treatment that will allow the baby to be born healthy and strong. With an undeveloped pregnancy, the child dies in the mother's womb, there is no chance of saving him. At the same time, a woman does not always understand that the pregnancy is terminated. This can only be diagnosed by a doctor and a prescribed health examination.

Spontaneous fading of pregnancy is most common in the early stages of a baby's development. It includes up to 80% of the total number of calls. Despite the fact that the mother is not able to understand that the pregnancy has stopped, she can feel something is wrong, carefully listening to her own body. What criteria should be given special attention?

Toxicosis - normally, toxicosis gradually stops by the second trimester of pregnancy or becomes much weaker than the initial one. But if the feeling of nausea disappears suddenly and for good, there is reason to be wary - is everything okay with the child. Contact your obstetrician-gynecologist who is observing you, describing to him the symptoms that bother you in as much detail as possible.
Breast - during pregnancy, it fills with heaviness, swells, increases in volume, becomes like a bulk apple, more precisely, a larger fetus. All this is about them, about the mammary glands. This is how the hormonal background of a woman's body affects the chest. As soon as these symptoms have disappeared, visit a specialist. Talk about what happened and share your own concerns.
Pain and discharge from the vagina - if the pulling pain in the sacrum and lower abdomen does not give you rest, rolls in waves and is accompanied by bloody discharge - it's bad. This is not an accurate indication of the need for subsequent cleaning of a missed pregnancy, but it signals an impending disaster. Start bed rest immediately and call an ambulance. Do without the hassle, stress and any activity. It is possible that you will be allowed to go home after the examination. If it is possible to save the child, you can be placed in the outpatient department at the antenatal clinic for preservation.

Diagnosis of a missed pregnancy before cleaning

Only a specialist is able to determine the need for cleaning a missed pregnancy, as well as the pregnancy itself. To do this, the obstetrician-gynecologist carefully examines the pregnant woman, using diagnostic tools:

Manual examination is the most common reason for determining a miscarriage when the mother is not yet aware of the misfortune that has occurred. Examining the woman who turned to him manually, the doctor notes the discrepancy between the size of the uterus and the expected life span of the embryo.
Blood test - the amount of pregnancy hormones with an increase in its duration should increase and show a positive trend. If this does not happen, and hormones reduce the level, a serious problem can be stated in the form of an undeveloped pregnancy.
Ultrasound diagnosis of the uterus is a mandatory procedure in a comprehensive examination of a woman. The uterus itself, the fetal egg, and the embryo are examined. The doctor carefully examines the fetus, notes its activity or passivity, listens to the heartbeat. If no movements are noted, no heartbeat is heard, we can talk about a missed pregnancy.

When the diagnosis is made, it remains to decide what is best to do to remove the embryo - cleaning the miscarriage or waiting for spontaneous expulsion of the fetus, which may not occur.

Cleansing a missed pregnancy or how to expel a fetus from the body

When confirming the diagnosis, it is very important for a woman to get immediate medical attention. If this is not done in a timely manner, there is a high risk of developing complications associated with a fetal egg left in the uterus. There are many options for the development of events - from the inflammatory process to the strongest blood poisoning. Task number 1 for the near future is the cleaning of a missed pregnancy in order to eliminate the fetal egg from the body.

Abroad, there is a common practice, according to which a failed childbirth is given a period of time to expel the egg from the cavity on her own. To prevent negative events, a woman is recommended to do an ultrasound weekly and visit a gynecologist's office. If a miscarriage does not occur, and an inflammatory process begins to appear in the tissues, the cleaning of a missed pregnancy is used to eliminate the remnants of the embryo in the uterus and stop the infection developing in the body. There are three main methods of treatment used in Russia:

A drug effect that terminates a miscarriage. The patient takes pills and after 1-3 days she has a miscarriage. The method resembles medical abortion, but is not 100% reliable. The doctor will not give any guarantee that there will be no excess tissue left in the uterine cavity, which can later cause inflammation. It is not uncommon for technology to be supplemented by cleaning a missed pregnancy in order to completely scrape out all foreign bodies from the uterine cavity.
Vacuum aspiration - when, under great directed pressure, a tube inserted into the uterine cavity sucks out the remains of the dead body of the embryo. The method is used only in the early stages of pregnancy.
Curettage - reliable cleaning of missed pregnancy by surgical intervention. The uterus is cleaned by the surgeon and carefully released by hand from the placenta and fetus.

Determines which method to use, specialist. Self-treatment is unacceptable here.

How is a missed pregnancy cleaned by scraping

For some reason, the female half of society is terrified of cleaning a missed pregnancy by scraping, although the procedure has been used in gynecological practice for a long time. It is so developed that it is almost impossible for a professional doctor to disrupt the operation. Specially conducted studies have shown that the main factor of fear in anticipation of curettage is the expectation of pain. However, modern medicine has reached such heights that discomfort and pain at the time of cleaning a missed pregnancy are completely absent.

For this purpose, general anesthesia is used, which blocks pain and neutralizes the body's sensitivity for the duration of the operation. Before being admitted to a hospital, an anesthesiologist conducts a conversation with a woman, who determines which drug to use during the procedure and what dose to calculate so that anesthesia does not harm the health and well-being of the patient. In addition, her gynecologist communicates with the woman, whose task is to exclude possible contraindications to the procedure. Among them:

infections;
inflammation of the uterus;
inflammation of the appendages;
suspicion of violation of the integrity of the mucous membranes of the uterus.

The operation to clean a miscarriage is performed in a gynecological chair after a dose of general anesthesia is administered. The patient comes to her senses upon completion of all procedures performed in the ward. Therefore, he cannot remember the smallest details of what happened. And the woman does not feel severe pain. The situation is slightly different when the patient cannot be anesthetized. In this case, the cleaning of a frozen pregnancy takes place under local anesthesia.

The doctor carefully injects the uterus with specialized drugs that block sensitivity, treats the genital area with iodine solution, covers the vagina with medical alcohol to exclude the possibility of infection. It is important to observe the measure in processing, otherwise aggressive disinfecting solutions can burn the mucous membrane. This will affect the patient's discomfort in the vagina over the next few days.

The procedure for cleaning a miscarriage normally takes no more than 20 minutes, if complications can be avoided. The doctor expands the cervix with a special tool and removes the fetal egg from the cavity with a curette.

What complications can occur

The operation does not always go smoothly. In a minimal percentage of cases, complications after surgery are possible. Among them:

Damage to the integrity of the walls of the uterus - a kind of perforation, recognized as a very serious complication with severe consequences. According to statistics, such a pathology occurs in 1% of cases after an unsuccessful operation.
Opening bleeding after cleaning a dead pregnancy - this phenomenon must be reported to the doctor immediately, even if the discharge is of a slight smearing nature. There is a danger of blood clots accumulating in the uterine cavity, which will require a second curettage operation.
Inflammation - occurs when an infection enters the wound. After cleaning a frozen pregnancy, high fever, chills, pain symptoms of a pulsating nature should alert.
Adhesions - this abnormality may appear several years after surgery. The adhesive process negatively affects the stability of menstruation, fertilization and many other functions of the female body.

After the cleaning of a miscarriage is completed, you must carefully follow the doctor's recommendations. Body temperature should be closely monitored. From the second day, she should return to normal. It is necessary to control the separation from the vagina - there should be no heavy bleeding and discharge with an unpleasant odor. If a woman feels well after cleaning a missed pregnancy, after a couple of days the doctor draws up an extract and allows her to leave the hospital to continue treatment at home.

At home, monitoring of well-being should be continued for at least another 2-3 weeks. According to the recommended schedule of visits to the gynecologist, pay a visit to the consultation to see the attending physician and make sure that the normal course of affairs. After the end of the rehabilitation period, it is necessary to find out the causes of a missed pregnancy in order to eliminate them in the future. It is necessary to plan conception no earlier than in a year. There is no need to fear that after a failed pregnancy and cleansing, you will not be able to become a mother. By excluding dangerous factors from the anamnesis of both parents, and following all the instructions of specialists, you will become a mother to the delight of yourself and the people around you.

What to do after a miscarriage

If a woman has a miscarriage, it is important to take competent measures to restore her 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.

Experts 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

A miscarriage that has occurred is complete when all parts of the embryo come out of the uterine cavity together with membranes and amniotic fluid. 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 that provoke 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 abnormalities 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 the appointment of 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 setting. 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 neck 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 tension in 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 beginning of labor activity before the 34th week, the state 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 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.

Indolent 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 symptoms described above are added:

liquid vaginal discharge, 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 a 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 to save 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;
hormonal 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 and 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 performed for diagnostic and therapeutic purposes for various indications :

after childbirth;
for missed pregnancy, miscarriage;
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;
STI testing.

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;
bulky 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 with any surgical procedure. 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 .
Pass the necessary examinations , take tests.

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, testing 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 pose 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 in the mother poses a threat to 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 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, treat them if necessary, or remove them from the home until the threat is eliminated;
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 the pregnant woman and the 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.

After completing 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 outcome of pregnancy. 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.

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