Should you go to the doctor after a miscarriage

Miscarriage: Signs, Symptoms, Diagnosis, Treatment

Series Miscarriage

Written by WebMD Editorial Contributors

What Are the Treatments for Miscarriage?

The first thing your doctor will try to do is prevent you from having a miscarriage. If the doctor thinks you’re at risk for having one, they may tell you to cut back on activity, including sex, until the signs are gone. Some recommend bed rest, although there’s no scientific evidence it’ll prevent a miscarriage. It can also raise your risk for other health issues. More often than not, there isn’t a lot your doctor can do to stop a miscarriage.

Treatment of a miscarriage, once it starts, depends on your symptoms. The main goal of treatment during and after a miscarriage is to prevent heavy bleeding (they’ll call it hemorrhaging) and infection.

If vaginal bleeding fills more than one super sanitary pad an hour for 2 hours, call your doctor. Heavier bleeding and cramping often indicate that a miscarriage is happening. Most of the time, your body will pass all of the pregnancy-related tissue. The earlier you are in the pregnancy, the more likely your body will complete the miscarriage on its own.

If all of the tissue didn’t come out, a condition known as an incomplete miscarriage, you may need treatment to stop the bleeding and prevent infection. The most common procedure is a dilation and curettage (D&C), which involves widening your cervix and scraping the uterine lining, or endometrium. Sometimes the doctor uses suction along with scraping. This procedure can be uncomfortable, so you’ll probably get general anesthesia to put you to sleep if you need it. Another option is to take medication (misoprostol), which will help your body pass the tissue. Talk to your doctor to figure out what’s right for you.

You may get antibiotics or other medications afterward to slow the bleeding. Let your doctor know if you have any additional vaginal bleeding. You should also find out whether you have Rh-negative blood. If you do, you’ll probably need a shot of Rh immune globulin to prevent problems in future pregnancies.

Call your doctor after a miscarriage if:

You have a fever or chills. Septic (infected) abortions are rare in cases of miscarriage, but a fever or chills could mean you have an infection. The doctor will make sure they remove any remaining pregnancy-related tissue, and you should take antibiotics to prevent serious illness.

Tests After a Miscarriage

Most of the time, chances are good that the next pregancy after a miscarriage will be healthy. But if you have two or more miscarriages in a row, the doctor may suggest tests to find out if there’s a problem that you should treat before you try again. These could include:

Imaging tests. There may be something wrong with the structure of your uterus that’s keeping you from carrying a baby to term. The doctor can check for this with an ultrasound, an X-ray or a hysteroscopy.
Endometrial biopsy. During a hysteroscopy, your doctor may take a small piece of the lining of your uterus to look for abnormal cells.
Genetic tests.Chromosome problems are a common cause of miscarriages. You and your partner may get a karyotype test, which checks your chromosomes for anything unusual.

Blood tests. The doctor may check levels of certain hormones. Blood tests can also reveal risk factors for miscarriage, like diabetes, autoimmune disorders, and blood clotting problems.

Physical Recovery After Miscarriage

It usually doesn’t take long for your body to recover from a miscarriage. You may feel better within a few hours, or it could take a few weeks. Doctors recommend you don’t have sex or put anything in your vagina, like a tampon, for 2 weeks. That’s to lower the chances of an infection. You‘ll probably have your period again in 4-6 weeks.

Emotional Recovery After Miscarriage

It's common to feel sad after losing a pregnancy. Many couples feel the grief of losing a child. This is normal, so allow yourself time to grieve. Consider joining a support group where you can talk about your experience and feelings with others who’ve had a miscarriage. Family and friends may want to comfort you, but may feel like they don't know how. If you can, let them know that you need their support, tell them what they can do, and rely on their help.

Miscarriage can be a physical and emotional challenge for you and your partner. It can put a high amount of stress on your relationship. You may be tempted to blame yourself or your partner for the miscarriage. Don’t. It's highly unlikely either of you did anything to cause the miscarriage or could have done anything to prevent it.

Keep in mind that there is a good chance that you will give birth to a healthy baby in the future. Only about 20% of women who have had a miscarriage have another miscarriage the next time they become pregnant.

Although it's possible to become pregnant right after a miscarriage, most experts recommend waiting until after you have had one or two normal menstrual cycles before trying to get pregnant again.

Next In Miscarriage Series:

Prevention

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. What to do after a miscarriage?

When a woman finds out about her pregnancy, she changes her rhythm of life, especially if the pregnancy is desired. However, depending on many circumstances, miscarriage , that is, a natural termination of pregnancy, may occur. Statistics say that up to 20 percent of pregnancies end in pathological abortions. Often a woman may not know that she was pregnant, as a miscarriage sometimes occurs at a very early stage and seems to be just a normal delay in menstruation followed by heavy discharge.

If a woman finds out that she is pregnant and wants to become a mother, she should be very attentive to her condition. The threat of miscarriage often occurs in the early stages of pregnancy and therefore it is necessary to know what symptoms and signs precede a sudden miscarriage.

Signs

The main sign of a suspected miscarriage is bleeding from the uterus. They happen not abundant, pale scarlet or gray-brown. The discharge most often gradually increases and is characterized by sudden spasms or pulling pains in the lower abdomen. These symptoms may last for some time.

The pains are often so mild that the woman simply does not pay attention to them. They are able to be interrupted, and the woman simply forgets about them, especially if the discharge also stopped, and before that they were insignificant. Meanwhile, the very first symptoms should alert you and you should urgently go to the gynecologist for examination and consultation. Even if the process has stopped, after a few days you can feel a sharp deterioration in health, and then you can no longer save the life of the unborn child. Be sure to pay attention to what exactly comes out with the discharge, if there are tissue fragments, it means that miscarriage has already occurred. Therefore, one should not hesitate to go to the doctor, the fetus may come out, in whole or in parts, there may be white particles or a round gray bubble. When the body is completely cleansed, the pain will subside, but before that it may continue for some time.

Terms of miscarriages

A miscarriage is classified as early if it occurred before twelve weeks from the onset of pregnancy. Starting from the 22nd week, if a spontaneous miscarriage has occurred, it is considered late. If the termination of pregnancy occurred before thirty-seven weeks, then this is already called premature birth. All subsequent fetal rejections are called term births and are generally considered normal, since during this period, mostly able-to-survive children are born. In modern medicine, children born after 22 weeks are nursed and subsequently do not differ from those born at term with normal weight.

Types of miscarriages

Specialists have identified several types of miscarriages.

Complete or inevitable - characterized by pain in the lower back and dilatation of the cervix, hemorrhages from it. The fetal membrane necessarily bursts, and the pregnancy is terminated. The fetus comes out of the uterus, and all discomfort in the form of pain and bleeding stops.
Miscarriage is different in that the fetus died, but remained in the mother's body. This can be detected by a doctor when examining a woman and when listening to the fetal heartbeat.
Repeated miscarriage is rare, it occurs only some time after the first and can occur up to three times in a row in the early stages.

Causes of spontaneous abortion

The vast majority of women, having learned about their pregnancy, want to give birth to a healthy baby. And if there is a spontaneous miscarriage , then for a failed mother this is a real tragedy. Many, having experienced an abortion, try to conceive a child faster again, but first you need to know the reasons for what happened in order to save the fetus in the future. According to statistics, the largest number of miscarriages occurs precisely in the early stages.

There are several reasons for this:

Violations in genetics.

This is the most common cause of miscarriage. This is not due to heredity, it is a consequence of the mutation of parent germ cells, which accidentally ended up in unfavorable conditions. This is also the influence of radiation, poisoning, viruses, that is, temporary situations that affected the quality of germ cells. The body thus gets rid of a weak non-viable fetus. It is impossible and unnecessary to prevent such spontaneous abortion. It is only necessary, having decided to become pregnant, to try to cleanse your body of possible harmful influences.

Hormonal disorders

The cause of miscarriage at a very early stage also lies in the lack of the hormone progesterone, or in the fact that a woman has an excess of male sex hormones that suppress the production of estrogen and progesterone in her body. In this case, the fetus can be saved medically by administering the necessary medicines to the woman. The work of the adrenal glands, as well as the thyroid gland, affects the production of hormones, so a lot depends on the work of these glands throughout the pregnancy process.

Immunological causes .

In this case, the vitality of the fetus is directly affected by the Rh conflict. The embryo will inherit the positive Rh of the man, and if the partner has a negative Rh, then her body simply rejects cells that are foreign to him. A similar situation can be prevented by injecting the expectant mother with a variety of progesterone, a process called immunomodulation.

Sexually transmitted infections such as toxoplasmosis, syphilis, trichomoniasis, chlamydia and others are of great danger. External infection: bacteria and viruses infect the fetal membranes, and the body will inevitably reject the embryo. Therefore, before becoming pregnant, you should be examined to know for sure that there are no infections, and if the result is positive, undergo treatment.

In addition, all inflammatory processes, various diseases of the internal organs, which are accompanied by a persistent high temperature, can also lead to unexpected rejection of the fetus. Rubella is especially dangerous, and viral hepatitis is common. But even a sore throat, mild pneumonia, appendicitis sometimes play a key role and lead to a miscarriage, so the expectant mother must undergo a thorough examination even before the child is conceived, and then beware of all kinds of infections and weakening of the body.

Medical abortion.

If a woman had an abortion in a hospital and then became pregnant and decided to give birth, there is a danger that she will have a miscarriage. Abortion is a stress factor for the body, ovarian dysfunction is often observed, inflammatory processes in the female genital organs can begin, and all this will lead, at best, to miscarriage and subsequent repeated miscarriages, and at worst, to infertility. Therefore, you need to think very seriously before going for an abortion.

Medicines and certain herbs.

It is advisable for a pregnant woman not to take any medication at all, especially during the first three calendar months. Medicines and herbs can cause various defects in the fetus, which in turn will lead to its rejection. Analgesics and uncontrolled hormonal contraceptives are especially dangerous. Parsley and nettle should be eaten with caution - they cause a high tone of the uterus, which in turn can reject the fetus.

Stress.

It is no coincidence that in ancient times, pregnant women were protected from unrest, they were created comfortable conditions, and they tried to give as many positive emotions as possible. Now the direct dependence of the health of the unborn baby on the mental state during pregnancy has already been proven. Any stress, fear and overstrain can cause an unexpected termination of pregnancy. If you have a problem (death of a loved one, divorce, etc.), you need to find sedatives with the help of a doctor, they will help you cope with this period.

Unhealthy lifestyle.

Of course, the intake of alcoholic beverages, an unhealthy lifestyle, smoking, even coffee consumption in large quantities, improper diet - all this can lead to a transient miscarriage. Therefore, the expectant mother should prioritize and change her rhythm of life in advance in order to give birth to a healthy child.

Sexual intercourse, falling, heavy lifting.

All of these factors can affect the fetus, so you should protect yourself and your baby by avoiding these activities.

What to do after a miscarriage?

Having experienced the tragedy of losing a child, parents often intend to immediately conceive a new baby, but they are afraid that everything will happen again. In this case, you do not need to make independent decisions, but consult a doctor. And first of all, it is necessary to identify the cause that led to the miscarriage. For this, the expectant mother needs to undergo as thorough an examination as possible.

If no obvious cause is found, the fetus most likely has a chromosomal abnormality. In this case, you should not worry, since the next conception will occur with a different set of chromosomes, which means that there will be no repeated miscarriage. If the miscarriage was repeated, it is necessary to contact a geneticist and conduct a study of the set of chromosomes of both parents. If it turns out that the cause was an infection, then it is necessary to fully recover. If we are talking about sexual infections, then both parents need to undergo therapy. It is necessary to take tests for hormonal studies, hemostasis systems and determine the immune status.

After a miscarriage, should be treated, if necessary, and pause between conceptions. During pregnancy, you should not take medications to prevent re-spontaneous pathological termination of pregnancy. Therefore, you can become pregnant only after the end of the course of treatment. If the cause was hormonal abnormalities, then the expectant mother should take special drugs to stabilize the background, and at this time she should never become pregnant. During the pause, you need to choose contraceptives with the help of a doctor. You can go to a specialized clinic where you will be prescribed a full course of rehabilitation.

The first week after a miscarriage women often experience pain in the lower abdomen, heavy bleeding, so you should refrain from sexual intercourse with a man. If there is severe bleeding, acute pain in the lower abdomen, convulsions, high fever, palpitations, nausea, vomiting, then you should immediately consult a doctor to identify the cause of this condition. It is necessary to plan a subsequent pregnancy not earlier than three months after this situation, but preferably six months later. Until that time, it is worth reconsidering your outlook on life, giving up hard work, eating right and wisely, taking vitamins, exercising, losing weight if you are overweight, stop smoking, drinking alcohol, think over your daily routine.

It is very important during this recovery period to have a positive attitude and confidence that the next attempt will be successful. This is harder to do than to say, because after a miscarriage the woman is in a depressed state and is afraid of a repetition of the situation. You can’t get hung up on your problem, during this period it’s better to do some favorite thing, relax, change the situation, travel, visit the city more often. The modern ecological situation in cities has a bad effect on women's health, so private trips to nature, a trip to the sea, to friends in another city can distract from painful thoughts. An important role in this case is played by the woman's relatives and, above all, the husband, who can surround her with care and attention, creating peace of mind.

You may need to contact a counseling psychologist or psychotherapist. Yoga classes, self-education, visiting theaters, exhibitions and temples have a very beneficial effect on the psyche of a woman and help to distract from her problems. Helping others who have a difficult life situation, caring for the sick can also have a beneficial psychological effect and help you look at your problems from the outside.

Remember, the human body is a self-healing system, it just needs a little help.

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 week 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 CSI - 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 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, is cleansed, and 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 above symptoms are added:

liquid discharge from the vagina, which may indicate damage to the amniotic sac;
pain when urinating;
internal bleeding, which warns the deterioration of 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 can 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 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;
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 using 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 .
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 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, 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, thoroughly heat treat meat, fish;
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.

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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